Transfusion - Pre-compatibility Testing —
Training activity: 3

Details

Perform appropriate further testing or referral and reporting for anomalous ABO and Rh grouping results

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Manual techniques
• Clinical information necessary to guide decisions

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to investigating and reporting anomalous ABO/Rh results.
• Consider how the learning outcomes apply, specifically those which relate to selecting techniques, identifying algorithms, describing limitations, practicing according to guidelines/procedures, performing acceptance testing, and proposing resolutions for anomalous results.
• What constitutes an appropriate investigation strategy for different types of ABO/Rh anomalies?
• What are the key steps in troubleshooting a blood group discrepancy? When is referral to a reference laboratory necessary?
• Discuss with your training officer to clarify the scope of expected investigations for different types of anomalies and reporting procedures.

What is your prior experience of this activity?

• Think about what you already know about the causes of ABO and Rh discrepancies e.g., technical errors, patient conditions like leukaemia, or unexpected antibodies.
• What tests might be useful for investigating discrepancies e.g., repeat testing, adsorption/elution, patient history review?
• Consider possible challenges you might face e.g., multiple discrepancies, rare phenotypes, urgent need for blood. And think about how you might handle these.
• Recognise the scope of your own practice for this activity. When would you definitely need to seek advice from senior staff or a clinical scientist regarding a complex or unresolved discrepancy?
• Acknowledge how you feel about tackling blood group discrepancies, knowing they require careful investigation to ensure patient safety.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in systematic problem-solving and selecting appropriate investigative tests in transfusion science.
• Identify specific insights you hope to gain into the serological basis of blood group discrepancies and their clinical implications.

What additional considerations do you need to make?

• Have you consulted any actions identified from previous experiences with blood typing or unexpected results that could inform your approach?
• Identify important information you need to consider before embarking on the activity, such as laboratory algorithms for discrepancy resolution, the availability of specialised reagents, or accessing relevant patient clinical history.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate during the investigation of an anomalous result?
• Are you encountering situations such as:
  • Complex serological pictures e.g., suspected autoagglutination persisting despite initial corrective steps
  • Limited sample volume hindering the selection of multiple confirmatory tests
  • The patient’s clinical urgency requiring a rapid interpretation, but the anomaly remains unresolved

How are you reacting to the unexpected development?

• How is this impacting your actions? Did you adapt or change your investigative strategy in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately applying sequential testing algorithms to narrow down the potential cause of the anomaly
  • Seeking immediate expert advice from a clinical scientist or senior colleague if the serological picture is too complex or ambiguous
  • Adapting your reporting to reflect the unresolved status and any interim recommendations for compatible blood
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your knowledge to resolve a discrepancy under clinical pressure? Is it affecting your confidence in selecting the next appropriate investigative test?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully applying the required further testing and proposing resolutions for anomalous typing, or needing to escalate the case for reference laboratory referral?
• What are you learning as a result of the unexpected development? For example, are you gaining critical insight into the application of sequential testing algorithms or the need to consider alternative explanations for discrepancies?

On action

What happened?

• Begin by summarising the process you followed to investigate and resolve anomalous ABO and Rh grouping results. What further testing did you perform or initiate? Did you consider referral?
• Consider specific anomalies that were particularly difficult to resolve or interpret. How did you feel managing the investigation process?
• Include any ‘reflect-in-action’ moments where an unexpected result from the further testing prompted you to immediately adjust your investigative strategy.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the causes and resolution of anomalous grouping results. What strengths did you demonstrate, such as skills in devising and performing investigative strategies and proposing resolutions? Were there knowledge gaps regarding rare anomalies or specific techniques for resolution?
• Compare this experience against previous cases. Has your ability to troubleshoot and resolve grouping discrepancies improved?
• Identify any challenges you experienced e.g., obtaining additional samples, interpreting complex antibody issues and how you handled them.
• Did you need to seek advice or discuss the case with a senior colleague or a referral laboratory? Did you ensure you were working within your scope of practice when deciding on the course of action and reporting the final result?
• Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in investigating anomalous grouping results.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take, such as specific types of anomalies or investigative techniques you need to study further. Do you need to review case studies or standard operating procedures for troubleshooting ABO/Rh anomalies?
• How will your approach to investigating grouping anomalies change based on this experience?
• Do you need more practice in performing specific techniques e.g., adsorptions, elutions or interpreting complex patterns of reactions?

Beyond action

Have you revisited the experiences?

• Reflecting on your prior experiences investigating anomalous ABO and Rh grouping results, what specific areas did you aim to improve, based on past reflections e.g., selecting appropriate further tests, understanding underlying causes, documentation?
• Have you successfully integrated these improvements into your practice when faced with anomalies? Are you now more confident and proficient in managing and resolving these situations?
• Have you engaged in professional storytelling or shared experiences of investigating anomalous grouping results with peers or discussed specific challenging cases or referral criteria with senior staff?
• Did these discussions offer new perspectives on effective investigation strategies or the interpretation of resolution testing?

How have these experiences impacted upon current practice?

• How does the knowledge and skill gained from repeatedly investigating anomalous grouping results, supported by reflection, help you prepare for assessments like a DOPS performing testing to resolve blood grouping for samples with anomalous initial results or an OCE reporting results?
• How has your ability to manage and resolve anomalous ABO and Rh grouping results evolved over time?
• Are you more adept at selecting the right follow-up tests and interpreting the results accurately?
• How clear are you now on the boundaries of your scope of practice when resolving complex anomalies and knowing when formal referral is necessary?

Relevant learning outcomes

#	Outcome
# 1	Outcome Select suitable and valid techniques for transfusion pre-compatibility testing.
# 2	Outcome Identify sequential testing algorithms appropriate to the samples under investigation for pre-compatibility testing.
# 3	Outcome Describe the limitations of methods used in pre-compatibility testing including sources of error and sample issues.
# 4	Outcome Practice in accordance with guidelines and procedures relevant to pre-transfusion testing.
# 5	Outcome Perform acceptance testing of samples requiring pre-transfusion testing and ensure samples follow appropriate testing streams relating to clinical condition.
# 7	Outcome Propose resolutions for anomalous blood group antigen typing.