CMC EQAS – Transfusion Medicine Module

Methodology Survey Form –Blood Banks

If you are a BLOOD BANK and wish to participate in the CMCEQAS Transfusion Module please fill up the form below and send it along with your registration form.

PIN(Existing participants)

Immunohaematology Techniques Performed
Circle all that apply
Blood group - Forward typing / Blood group - Reverse typing@ / Direct Antiglobulin Test (DAT)* / Indirect Antiglobulin test (IAT)#
Compatibility / Testing Antibody Screen / Antibody Identification / Antibody Titration
1 / Parameter / Manual / Automated / Slide/Tile / Tube / Column agglutination technique (Card) / Microplate / Other
Specify
2 / Blood group and
Rh Type /
3 / Direct Antiglobulin test (DAT)*
4 / Indirect Antiglobulin test (IAT)# /
5 / Compatibility testing
6 / Phase of compatibility testing / Saline / Albumin / LISS+ / Coombs / Temp: 37 deg C
7 / Company providing blood grouping Antisera / Company providing blood grouping Cards
8 / Source of Antisera (DAT/IAT) / Source of Cards (DAT/IAT)
9 / Source of Cells for IAT / In-house / Commercial (Specify) / Phenotyped / NOT Phenotyped
10 / Source of cells for reverse typing / In-house / Commercial (Specify)
11 / Immunohaematology Automation Company
12 / Immunohaematology Automation Platform
13 / Antibody screen cell panel
(Circle/enter appropriate data) / In-house / Commercial / Commercial / Specify Vendor
14 / Number of donors in cell panel / Specify / 2 cells / 3 cells
15 / Antibody identification cell panel(Circle/enter appropriate data) / In-house / Commercial / Commercial / Specify Vendor
16 / Number of donors in cell panel / Specify / 8 cell / 11 cells
@ Indirect typing ; *Also referred to a Direct Coombs test (DCT);# Also referred to as Indirect Coombs Test (ICT); + Low Ionic Strength Solution
17 / Donors & Donations
18 / Number of Donors per year / Repeat Voluntary Donors(%) / Number of donations per year / Voluntary donations (%)
19 / If your Blood Bank prepares components, circle all relevant products made
20 / Whole blood only / Packed Red cells (no additive) / Red cells concentrate with additive / Plate rich plasma / Platelet rich concentrate / Fresh frozen plasma
Banked plasma (never frozen) / Cryo precipitate / Cryo (plasma)supernate
21 / Is apheresis performed? / Yes / No / If yes please circle components produced / Platelets / Red cells / Plasma / Leucocytes
22 / Infectious Disease screening
23 / Source of kits / NACO ONLY / Self-purchased / Both NACO + Self purchased / Other (Specify)
24 / Malaria / Rapid Cards (Antigen/Antibody) / Fluorescence / Thin/Thick Smear / Syphilis / RPR / VDRL / ELISA
25 / Viral Screen / Rapid kits / ELISA / ECI / NAT / Other (Specify)
26 / Specify kit name for ID test / Malaria / Syphilis / HIV / HBV / HCV / Other
27 / Manufacturer for ID test
28 / Do you use independent controls for ID Screens / NO / YES
(Specify)
29 / Any additional tests performed for Infectious disease screening specify
30 / Automation for ID screen / Company / Platform
31 / Quality Assurance (Circle all that apply)
32 / Internal QC performancefrequency / At reagent selection / Daily / QC performed on / Antisera (Reagents) / Reagent red cells
33 / Instrument calibration / No / Yes / Participation in EQAS / CMCEQAS / Any other(specify)
34 / Comments

Signature: ______Seal: ______Date: ______

CMCEQAS_Methodology_survey_BB_20161/2