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