输血实验室室间与室内质控（规范).pptVIP

结果 患者存活 ， 但延长肾脏透析时间 分析1 人为错误 在报告中出现错误的ABO血型 交叉实验结果判读错误 对仪器设备功能的假想 对实验结果的判定出现错误 对出现结果差异的实验未进行复检 发血前未进行间接抗人球交叉配血 临床医生未认识到这是急性HTR 分析2 系统错误 员工 – 有这么多员工都不在场 – 没有最少工作人员配置的政策 初级员工工作时缺乏高级技术人员的监督 科室主管待命系统 – 缺乏训练和经验，缺乏动力, 过度操劳 设备 – 使用不可靠的设备，设备缺乏保养维护 试验 – 在交叉配血实验中出现高比例的假阳性，导致忽视阳性结果 体系 – 系统允许24小时内，对输血反应进行调查。这对ABO/D分型错误结果的发现担搁 系统无检查记录本上结果的要求 文件 – 无成文规定要求重复XM试验 分析3 引入系统的防止错误再发生的措施 实验室工作最少人员配置条例 回顾随叫随到待命系统 训练待命系统的员工 监督初级员工 建立定期设备维护体系 训练临床医生识别输血反应 建立记录与结果的检查复合系统 规定如何处理存在差异的结果 患者存活 – 不采取惩戒措施 Thank you 谢 谢！ 放映结束 感谢各位批评指导！ 让我们共同进步 * The aim of EQA is to raise standards. Changes are difficult to measure objectively, however the parameters listed above will give some indication. UK performance has improved significantly in many areas over the last decade. We have seen positive changes in practice in terms of selection and use of reagents and techniques / technology. * ABO 6/782 0.75% reported were incorrect D 12/782 1.5% Antibody screens 26/193 6.2% false negative. i.e. 26 of the 193 results returned that should have been positive were negative. There were very few false positive results and these are not included Antibody ID - 11/139 results returned on samples containing an antibody… give unrealistic picture since only the better resourced labs attempt ID. Crossmatching - 70/309 22.7% results returned (where there should have been an incompatibility) were negative. False positives not included. Crossmatching worse than screening, possible reasons: screening cells homozygous expression of antigens cells provided for crossmatching (although in Alsevers) may deteriorate in transit - loss of more labile antigens. Suspect problems in performing IAT * Calculated in the same way as overall error rates, i.e. as number of errors dived by the number of opportunities for error. Screening and XM - false negatives only. Better than overall results… same ratio of errors Follow-up (of Harare) revealed problems in IAT and with for