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Simulation training for antibody identification
Robert Lees and Carol Coyne Sheffield RCI
NHSBT
Introduction • RCI provide a specialist referral service
for surrounding hospital blood banks. • BMS staff require an extensive
specialist serology knowledge base. • No pool of pre-trained staff ready to
apply for jobs. • Recruitment is always difficult. • High standard of training required.
Training • On the bench training with real cases. • Usually starts with simple cases and
progresses to more complex cases. • The infrequency of specific types of
complex cases can hamper training. • Building serology confidence in trainees
is vital.
New training idea! • Neqas 2016 – Interactive training idea
brought back to Sheffield RCI by Lab manager based on the ‘Dungeons & Dragons’ game.
• Tasked with job of creating an RCI training package based on the same principle.
Basic principles • Role playing game. ( Need a Dungeon Master) • Key stages in the laboratory process were
identified and a series of cards produced for each. • Allows staff to experience theoretical scenarios
with the support of the senior staff before experiencing them in reality.
• Covers the whole process from sample arrival to serology resolution.
• CPD form used to document scenario and discussed outcomes
• Documented evidence of scenario training
• Allows multiple scenarios to be documented and kept for future reference
Primary card sets the scene
Potential scenario cards are presented face down and one is chosen
Potential scenario cards are presented face down and one is chosen
Other card options available
Sample is incorrectly
labelled (major error)
Sample is fully labelled, signed and
dated
Sample is unsuitable for
testing e.g. expired, leaking,
insufficient
Scenario Discussion • This prompts discussion surrounding
the options available for the selected scenario.
• Tests knowledge of guidelines and NHSBT policy regarding sample labelling requirements.
• Helps to identify the appropriate outcome from this scenario
Scenario Discussion • If at this point, (depending on the card chosen)
the investigation cannot progress, this is identified and the correct process discussed
- Hospital contact - Potential concession request • If the scenario can be resolved satisfactorily, the
game moves onto the second stage cards.
Stage 2 – Automated testing
• Header card revealed
Potential scenario cards are presented face down and one is chosen
Other card options available
Clot detected
in sample
Weak reactions
with antisera
Weak reactions
with reverse group cells
Results satisfactory,
ABO, RhD, Rh and K types
resolved.
Overview Tier 1 Question
Tier 1 Options
Tier 2 Question
Tier 2 Option
Action cards
Serology Result card
A
S
Now you get the idea.....time for the interactive bit!!
Patient history
• Female, aged 72 • Diagnosis – MDS • Referred for a routine antibody
investigation and crossmatch • No transfusion history • DAT 3+ IgG • O RhD+ E- K-
Question Card
Serology result cards • Multiple cards with possible outcomes face
down and one selected. • Random selection, mimics the unpredictable
nature of RCI investigations • Possible outcome cards include:-
• Pan-reactive • Weak non-specific reactions • Stronger reactions • Mixture of clear positives and negatives • Negative
Results from initial panels
Results show the presence of a pan reactive autoantibody
What next? • Additional panels • LISS tube IAT? • NISS tube IAT? • Neutralisation? • Pre-warmed techniques? • Genotype? • Rare cells? • Papanised alloadsorption • PeG alloadsorption? • Eluate
To name but a few of the possible options!
Select the next test you would perform from the
options available
Panel with LISS IAT results
LISS IAT showing weaker reactions but still pan-reactive, what next...?
What next? • Additional panels • LISS tube IAT • NISS tube IAT? • Neutralisation? • Pre-warmed techniques? • Genotype? • Rare cells? • Papanised alloadsorption • PeG alloadsorption? • Eluate
Technique chosen and serology result card
selected.....outcome....?
Panel with adsorption results
Adsorption cells profile
Resolution of the patient’s serology
• Has the serology has been resolved? • What antibodies would be reported for
this case? • What would you crossmatch?
Outcome Each stage should be documented on the CPD form and how each outcome was dealt
with, it can be referred back to when similar serological cases present
Patient scenarios can be as simple or as complicated as the game cards allow
Sheffield RCI have one final card....
Demonstrates a persons ability to recognise when the situation requires additional support
Nothing to stop Transfusion labs having a final card of their own…….
Thank you
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