Immunohematology Reference Lab
The John J. Moulds Immunohematology Reference Laboratory (IRL) is one of only 61 AABB accredited IRLs in the country and a member of the American Rare Donor Program. Established as a reference lab in the 1970s, currently it is one of the leading suppliers of rare blood in the nation with an internationally known rare red cell collection and ability to match and supply compatible blood for patients with rare antibodies. The IRL is staffed with licensed medical technologists and Specialists in Blood Banking.
Reference Lab Locations
Shreveport Immunohematology Reference Laboratory Hours
7am – 8pm (Monday – Friday)
Routine hours, full staff coverage. Routine and complex compatibility and antibody identification services provided. In house staff available for consultation service regarding antibody interpretations, product selection, and availability of compatible blood products.
8pm – 11pm (Monday – Friday)
Non-Routine hours, reduced staff coverage. Priority requests of primary interest. Routine work integrated if workload permits. Priority based on patient need and available resources. Non-routine fee applies. Priority fee applies, if STAT work requested.
Saturday / Sunday & Holidays – may be staffed and/or on call
Saturday / Sunday & Holidays – may be staffed and/or on call Non-routine hours, reduced staff coverage. 9am – 9pm service without call out fees. Any other time is considered call-out hours. Routine compatibility and antibody services integrated if workload permits. Priority given to samples based on urgency, available resources and indicated transfusion plans. Non-routine fees will apply to samples requiring work during these hours. Priority fees apply to any requests designated as STAT, however, patient urgency is the primary dictator for order of work. Therefore, patient information and detailed completion of the request form is critical. Routine samples integrated into the workflow will not be charged extra fees.
11pm – 7am (Monday – Friday) / Hours outside of 9am – 9pm on weekends / holidays
Call-out hours, no staff on site. Call-out hours are provided on a limited basis and are primarily for consultation only. Any requests for on-site testing must be coordinated with a Shreveport Laboratory staff member to get approval. While every effort will be made to provide timely compatibility testing and antibody identification, requesting facilities may experience increased wait times. A Call-Out fee will be assessed for each sample tested during these hours regardless of completion, in addition to Priority and Non-Routine fees.
Lake Charles Reference Laboratory Hours
8am – 5pm (Monday – Friday)
Routine hours, full staff coverage. Routine and complex compatibility and antibody identification services provided. In-house staff available for consultation service regarding antibody interpretations and availability of compatible blood products.
Saturday / Sunday & Holidays – may be staffed and/or on call
9am – 9pm (Saturday & Sunday) may be staffed or on call – no call out fees between these hours
Non-routine hours, reduced staff coverage. 9am – 9pm service without call out fees. Priority fee applies, if STAT work requested.
Other hours
After hours services in Lake Charles are provided on a limited basis and all requests must be coordinated with either a Lake Charles or Shreveport Laboratory staff member for approval of testing. Based on the availability of staff, testing may be completed in either Lake Charles or Shreveport. While every effort will be made to provide timely compatibility testing and antibody identification, requesting facilities may experience increased wait times during off hours. A Call-out fee will be assessed along with Non-Routine and Priority fees.
Baton Rouge Reference Laboratory Hours
8am – 5pm (Monday – Friday)
Routine hours, 1 or 2 techs on site. Routine and complex compatibility and antibody identification services provided. In-house staff available for consultation service regarding antibody interpretations and availability of compatible blood products.
Other hours
Consultation is available through the Baton Rouge laboratory outside of regular hours. Testing is not currently available but additional staff and hours will be added as workload dictates. In case of emergency, please call the Lake Charles or Shreveport Reference Laboratory to request services during these off hours.
Requesting Services
LifeShare’s accredited Immunohematology Reference Laboratory is available to assist referring hospitals in resolving serological problems and locating compatible blood products when requested. Due to the complexity of this work, resolving problems or finding compatible blood may not be accomplished in the time frame requested by the submitting facility. When this occurs, the requesting facility will be notified of any delays. When delays are experienced, the hospital staff must make the decision regarding transfusion therapy in urgent or emergent situations. LifeShare’s Medical Director is available for consultation in these circumstances.
Sample Submission Categories & Fee Assessment
Submitted samples will be prioritized based on patient status in consultation with the facility. Initial evaluations may take 4 – 8 hours in normal situations, with final reports normally completed within 72 hours.
- Routine: Test results or crossmatch compatible products not need immediately. Generally completed within 24 hours. Routine requests will be triaged and completed based on the order received and specific needs of the patient. Routine items may often be completed same day, but there is no guarantee.
- Priority: Test results or crossmatch compatible products desired within the shift received. Priority (i.e. STAT) requests will be triaged and completed before routine work providing a complex antibody workup is not required. Priority requests will be triaged based on the specific needs of the patient and a Priority fee will be assessed.
- Routine and Priority are internal classifications used by LifeShare Reference Laboratory staff to triage request. Facilities submitting a request should provide a specific date/time when results or products are desired.
- Fees are assessed when samples are requested to move up in the processing order or when processed during Non-routine hours. Non-Routine and Call-out fees may be assessed even if the sample was received during covered hours but the majority of the work fell into a different classification. For example, if a sample arrives late in a shift and requires extensive work after the shift, these fees may apply.
Request Forms
Immunohematology Reference Laboratory Consultation.Compatibility Request Form
The L-35 is used to request reference and compatibility services from the reference lab. This may involve the identification of antibodies, a request for antigen negative units, or routine crossmatching of blood products for transfusions.
Submitting the Request Form
Call the Laboratory technologist to notify of intent to submit sample. Specify any known problems with transfusion or reactivity currently encountered.
Complete Side 1 of Consultation Request (Form L-35).
- When possible, the patient Social Security Number (SSN) should be provided. This provides a unique identifier that allows the laboratory to maintain continuity of care for the patient if treated at multiple facilities. If unable to supply SSN, a Patient ID number should be provided that will forever identify the patient at the requesting facility. Additionally, a unique ID number must be provided. This number will be used on all tags and paperwork when crossmatching is performed. It is acceptable to use the SSN or Patient ID for the unique ID number provided the number is written on the ID number line.
- In order to resolve the problem as quickly as possible, please provide all information requested. Incomplete or incorrect submissions may cause delays.
- “Date/Time Needed” must be indicated to help the technologists prioritize and schedule all requests submitted to the laboratory. This should reflect the actual time the blood is desired for transfusion.
- Fax a copy of the completed request form to the laboratory.
- Send the completed request form to the laboratory with the patient’s sample.
Laboratory Submitting Samples
Sample Requirements
- For antibody identification
Collect two 7-mL EDTA (purple or pink top) samples and a 10-mL clotted (plain red top) sample from the patient. Additional blood may be requested for complex problems. Do not send samples in gel separator tubes. Do not separate samples.
- For crossmatch only
Collect one 7-mL EDTA (purple or pink top) sample and a 10-mL clotted (plain red top) sample from the patient. Additional blood may be requested if unexpected antibodies are observed. Do not send samples in gel separator tubes. Do not separate samples.
Sample Labeling
Label each tube with
- Complete patient name (Last, First, Middle Initial) as it appears on hospital records. (Note: On computer generated labels, ensure entire patient name prints on label.) Name on tube must match name on written request form.
- ID number. (Note: ID number must match the ID number on the written request form.)
- Date and time sample drawn
- Phlebotomist’s initials
Sample Shipping
- Prepare samples and request form for shipment to Laboratory using standard protocol for shipment of biological specimens.
- Ship samples and request form to the appropriate Laboratory. Shipping may be arranged by contacting the local LifeShare Blood Center to coordinate transport on a scheduled courier run. Alternately, samples and request form may be shipped via mail or facility arranged courier. Samples shipped directly from a facility must be on wet ice in an insulated container. Insulated containers are available from the local LifeShare Blood Center.
- Notify Laboratory of estimated arrival time for specimen.
Laboratory – Results/Findings
A written preliminary report communicating the results of the investigation will accompany blood products to the requesting facility. For workups where no blood products are requested, the preliminary report will be faxed to the facility upon completion of the serological investigation. Following supervisory review, a final report will be sent to the requesting facility by mail.
When requested, the blood center technologist will verbally communicate results of investigations as soon as they are available to the blood bank of the facility indicated on the Consultation Request.
Records of all patient testing will be filed at LifeShare Blood Centers.
Laboratory – Special Services
Washed Blood
There are very few clinical indications for washing red cell units. Multiple progressive allergic reactions and patient antibodies against immunoglobulin A (IgA) are the two most common. Washing is performed in an open system and requires 2 to 3 hours for completion. The washed product has a 24 hour expiration. Due to the clinical considerations for washing blood products, Medical Director approval is required for all requests. Please contact the reference lab for additional information.
Laboratory – Transfusion Reactions
Signs and Symptoms
Signs and symptoms may present during transfusion or in the hours/days post transfusion that may indicate a possible transfusion reaction. The following is a list of possible indicators:
- Fever greater than 1°C (2°F) above pre-transfusion baseline
- Chills
- Backache
- Shortness of breath
- Respiratory distress
- Rash, hives, or itching
- Nausea or vomiting
- Chest pain
- Abnormal pain of indeterminate origin
- Hemoglobinuria (pink, red or dark colored urine)
Immediate Actions
When a transfusion reaction is suspected (These actions are tailored to LifeShare Compatibility customers. Always follow local procedures for evaluation of suspected transfusion reactions):
- Stop the transfusion
- Notify the attending physician
- Collect and label post-transfusion samples from patient: [One 7-mL EDTA (purple or pink top) sample and a 10-mL clotted (plain red top) sample]
- Report of Transfusion Complications
- Notify LifeShare of suspected transfusion reaction
- Send the following to LifeShare:
- Report of Transfusion Complication
- EDTA and Red top samples
- Blood component bag with all attached tubing and fluids
Laboratory Investigation
Laboratory investigation will include:
- Clerical check of component bag, label, paperwork, and patient sample
- Repeat of ABO testing on the post-transfusion sample
- Visual check of pre- and post-transfusion sample to evaluate for evidence of hemolysis
- Direct antiglobulin test (DAT) on post-transfusion sample
- Additional testing based on initial findings
In the event Transfusion Related Acute Lung Injury (TRALI) or Transfusion Associated Circulatory Overload (TACO) is suspected, additional information may be requested.
Trali
Transfusion-Related Acute Lung Injury (TRALI) is a respiratory complication often associated with infusion of antibodies to leukocyte antigens during transfusion of blood products. Clinical signs and symptoms typically include fever, chills, dyspnea, cyanosis, hypotension, and new onset of bilateral pulmonary edema. If TRALI is suspected following transfusion of blood products:
- Notify one of LifeShare Blood Centers’ Laboratories at either 318.673.1466 (Shreveport) or 337.439.5851 (Lake Charles).
- Complete Section 1 of LifeShare Evaluation of Suspected TRALI L-41.
- Additionally, list the unit numbers (BUN) and component type in Section 2 of all blood products transfused within past 24 hours.
- Once complete, Fax the form to either Shreveport 318.227.8317 or Lake Charles 337.494.3853.
- TRALI evaluation may take up to 30 days to complete.
Licenses & Certifications
LifeShare Blood Centers is licensed by the U.S. Food & Drug Administration and accredited by AABB. LifeShare also holds additional credentials appropriate to responsibly and legally conduct business.