Reporting and Communication

Every result the transfusion service releases needs a record that outlives the shift, and so does every conversation about it. When you telephone a crossmatch outcome or an antibody identification, write down who you spoke to, what you said, the read-back they gave you, the time and your own identifier. Amended reports need the same care: the original stays visible, the correction is flagged as an amendment, and the record shows who was told and when. Months later an investigator should be able to reconstruct the exchange from your entry alone.

Observations are not only results. Sample condition on arrival, haemolysis, clots, a label that does not quite match the requisition, a delayed courier, a reagent that behaved oddly - all of it belongs in the permanent record, timed and attributed. Note what you saw, what you did about it, who you contacted and when a replacement arrived. Verbal handover to the next shift does not count as documentation. These entries are what allow a later transfusion reaction investigation, or an audit of turnaround time, to be answered with evidence rather than recollection.

Reporting is the point at which laboratory work becomes clinical action, so the wording has to carry the meaning. A positive antibody screen resolved to a clinically significant specificity should tell the ward what units the patient now needs, not merely that something was detected. Where an investigation is unfinished, issue an interim report that says so and gives a realistic time, rather than holding everything silently or releasing a compatibility statement you cannot defend. Report in the format and terminology your centre has agreed, and confirm the report reaches the ordering practitioner.

Requests can go missing quietly. A group and screen is ordered, no sample ever arrives, and nobody notices until the patient is on the table. Reconciling the pending list against samples received and results released is a routine duty, usually performed at shift change. Anything ordered but not resulted needs a reason attached: sample never collected, request cancelled by the ward, testing still in progress. Chase the gaps by telephone, document the call, and hand over whatever remains open. Closing a request without a documented reason is as much a defect as losing the sample.

Some cases cannot be finished where they start. A pan-reactive panel with a positive autocontrol, a suspected antibody to a high-incidence antigen, a warm autoantibody masking an alloantibody, or a request for a rare phenotype will often need a reference laboratory. Recognising the limit of your own site's testing is a competency in itself. When you refer, send the transfusion and pregnancy history, current medications, the panels already run and a named contact, and tell the ordering physician what has been sent and when an answer can reasonably be expected.

Quality and safety breaches are escalated immediately, not filed for a monthly review. A unit issued against the wrong identification, a refrigerator that has sat above 6 degrees Celsius, a reagent used past expiry, a near-miss caught at the bedside - each triggers containment first, then notification. Quarantine the product, tell the transfusion service supervisor or medical director, and complete the incident record while your memory of it is fresh. Reporting is not blame-seeking: haemovigilance only works when near-misses reach it, and a hidden breach removes the evidence a centre needs to prevent the next one.

Sometimes the transfusion service holds the sample that will yield a diagnosis someone else must make. A neonate with a positive direct antiglobulin test and a rising bilirubin needs an eluate and a physician's attention, because haemolytic disease of the foetus and newborn is a clinical diagnosis rather than a bench one. The same applies to a suspected haemolytic transfusion reaction, an unexplained fall in haemoglobin after transfusion, or serology pointing to an autoimmune process. Route the specimen promptly to the individual or laboratory who can take it further, and record where it went.