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Blood Bank

Information Technology

In the contemporary Blood Bank, the Laboratory Information System (LIS) is as vital as the microscope. Information Technology (IT) in this sector has evolved from simple record-keeping to complex “middleware” that actively prevents fatal errors. The LIS acts as the central brain of operations, enforcing logic checks, managing inventory, and ensuring traceability from vein-to-vein. Operations management relies heavily on IT to ensure that the “Electronic Crossmatch” is safe and that regulatory data requirements are met automatically

The Laboratory Information System (LIS) Architecture

The LIS is a software database designed specifically for laboratory workflow. In Blood Bank, it is often a distinct module or a completely separate software package (e.g., WellSky, SoftBank, Meditech) compared to the General Lab LIS, due to the unique regulatory requirements of transfusion medicine

The Interface (Connectivity)

  • Uni-directional Interface: The LIS sends orders to the automated analyzer (Download), but the analyzer cannot send results back. The laboratory scientist must manually type results into the computer. (Obsolete and risky)
  • Bi-directional Interface: The standard today
    • Host Query: The analyzer scans the sample barcode, “asks” the LIS what tests to run, runs them, and then automatically “uploads” the results back to the LIS
    • Impact: Eliminates transcription errors (typos) which are a leading cause of ABO mistyping

Truth Tables & Logic Checks

The LIS is programmed with “Truth Tables” (serological rules) that prevent the entry of impossible or contradictory results

  • Example: If a laboratory scientist enters “Anti-A: 4+” and “A1-Cells: 4+” (an ABO discrepancy), the LIS will trigger an error message and refuse to file the result until the discrepancy is resolved
  • Historical Check: When a patient sample is accessioned, the LIS automatically checks the database for previous records
    • Alert: “Warning: Patient historically Group A, Current Result Group O.” This stops the process immediately, flagging a potential wrong-blood-in-tube error

The Electronic Crossmatch (Computer Crossmatch)

This is the pinnacle of IT application in Blood Bank. It replaces the physical serological crossmatch (mixing donor cells and patient serum) with a logic check performed by the computer

  • Eligibility Criteria: The LIS is programmed to only allow an Electronic Crossmatch if strict FDA criteria are met:
    1. Patient has NO current antibodies
    2. Patient has NO history of antibodies
    3. Patient has two separate ABO/Rh determinations: on file (one current, one historical or a second draw)
  • The Process
    1. Laboratory scientist scans the Donor Unit Barcode (Unit #12345, Group A Pos)
    2. Laboratory scientist scans the Patient ID (Patient Doe, Group A Pos)
    3. The LIS compares the two data points
    4. Logic: Does Donor ABO = Patient ABO (or is compatible)?
    5. Result: If Compatible, the LIS “Electronic Crossmatch” result is filed as Compatible and a tag is printed
  • Safety: The system hard-stops incompatible assignments. It is physically impossible to issue a Group A unit to a Group O patient via the computer unless the emergency override is activated

Barcode Technology & ISBT 128

Standardization of data formats allows blood products to move globally between collection centers and hospitals without relabeling or manual entry

  • ISBT 128 (International Society of Blood Transfusion): The global standard for blood labeling
    • Data Structure: Every barcode contains specific identifiers: The Donation Identification Number (DIN), Product Code (e.g., E0376V00), Blood Group, and Expiration Date
    • Check Digits: The barcodes contain hidden mathematical algorithms. If a barcode is scratched and the scanner misreads a “7” as a “1,” the check digit calculation will fail, and the scanner will beep/reject the scan
  • Patient Bedside Identification (e.g., BloodLoc, lattice): Handheld scanners used by nurses at the bedside
    • Process: Nurse scans patient wristband \(\rightarrow\) Scans Blood Bag tag
    • Logic: The handheld device confirms the match. If the wrong unit is hung, the device alarms and locks out the transfusion

Disaster Recovery & Downtime Procedures

Because the LIS is critical for safety (historical checks), IT failure is a major operational risk. “Downtime” refers to periods when the computer system is offline (planned maintenance or unplanned crash)

The Downtime Strategy

  • No History = No Electronic Crossmatch: During downtime, the computer cannot verify the patient’s history. Therefore, the lab must revert to physical serological crossmatching (Immediate Spin) for all patients to confirm ABO compatibility
  • Manual Logs: All issue/transfusion records must be kept on paper logs
  • Reconciliation: Once the system comes back up, all manual data must be back-entered into the LIS to maintain the permanent record

Server Redundancy

  • Mirroring: Critical Blood Bank data is often stored on redundant servers. If the primary server crashes, the system automatically fails over to the backup server with minimal interruption
  • Remote Hosting (Cloud): Many modern LIS systems are cloud-based, meaning the data isn’t even in the hospital basement; it’s in a secure data center elsewhere, protecting it from local disasters (floods/fires)

Data Security & HIPAA

  • Audit Trails: Every keystroke in Blood Bank LIS is tracked
    • Traceability: If a result is changed from “Positive” to “Negative,” the system records Who: changed it, When, and requires a Comment/Reason. This is essential for legal defense and regulatory inspections
  • Access Levels: Not all users see everything. A phlebotomist may only have access to “View Orders,” while a Blood Bank Supervisor has access to “Modify Results” or “Un-verify Data.”