Appendix 1 - Borang Keputusan Ujian Saringan (BKUS)

Unit Perubatan Transfusi, Hospital Universiti Sains Malaysia

Keputusan Ujian Saringan Penderma Darah

Tarikh Cetak:
HUSM/MHT/L19
Bil Anti
No. Bag HIV Anti MP Komen
Hbs Ag ½ HCV VDRL

Masa

Dijalankan oleh JTMP:

Keputusan disahkan oleh:

Keputusan Ujian Saringan Penderma/TMSIS-

Version 3.0 UPT/L19/01/2004
Appendix 3

AxSYM control values are within acceptable ranges:

- AxSYM HBsAg Negative Control : 0.35 – 0.65

- AxSYM HBsAg Positive Control : 3.50 – 31.50
- AxSYM HIV Negative Control: 0.22 – 0.70
- AxSYM HIV-1 Positive Control: 1.00 – 7.00
- AxSYM HIV-2 Positive Control: 1.00 – 7.00
- AxSYM HCV Negative Control: 0.01 – 0.60
- AxSYM HCV Positive Control: 2.10 – 7.10
Appendix 5 - Borang Keputusan Ujian Kepastian Serologi Penderma Darah
(BKUS2)

UNIT PERUBATAN TRANSFUSI

HOSPITAL USM

KEPUTUSAN UJIAN KEPASTIAN SEROLOGI PENDERMA DARAH

Tarikh : ___________________ Masa : _________________

Ujian SARINGAN KEDUA Spesimen Dari Segmen Bag Darah

( Ujian HBsAg, HCV dan HIV 1 & 2 )

Ujian : ______________
No. Bag Komen
No. Makmal 1st OD 2nd OD

Segmen di ambil oleh JTMP :

Saksi JTMP : Masa :

Ujian dijalankan oleh JTMP :

Keputusan disahkan oleh : Masa :

Appendix 7 – Releasing of Screened Blood/Blood Components

Donor Registration
CHECKING FOR DONOR STATUS OF ‘DISEKAT’
Responsibility : PAP/PTR

1. Enter all donor information from BPPD into the TMSISS system
2. Print ‘Cetakan Laporan Harian’ at the end of the day
3. Ensure all BPPD forms are given to MLT Transfusion Microbiology/
Component Section together with printed copy of ‘Cetakan Laporan Harian’
4. Inform MLT Transfusion Microbiology/ Component Section if there are any
donors with DISEKAT status

Transfusion Microbiology/ Component Section

CHECKING OF SCREENED BLOOD AND DONOR’S PREVIOUS DONATION
STATUS
Responsibility: MLT

1. Receive BPPD and ‘Cetakan Laporan Harian’.

2. Check the status of the donor from printed copy of ‘Cetakan Laporan Harian’
either 1 (DISEKAT) or 2 (TIDAK DISEKAT).
3. Check the current screening result for all markers. If reactive, discard the blood
and blood products
4. If the current screening result is negative and previous donation was blocked
(DISEKAT), verify with Medical Officer whether the blood can be used:
i- For the donor who is under monitoring by MO : the recent donated blood
and blood products should be discarded
ii- If the donor status is normal: MO will remove the status from DISEKAT
and the recent donated blood can be used
5. Verify the status with ‘Cetakan Laporan Harian’ form by write initial and date on
the form.
6. Recheck the donor status in Rekod Keputusan Ujian Saringan Penderma Darah
7. Transfer the quarantined blood which is negative for screening test into
CHECKED blood fridge.
8. Record in File ‘Laporan Permasalahan Bahagian Makmal: Serologi/Komponen’
for any actions taken.
9. Return the printed ‘Cetakan Laporan Harian’ to Donor Registration Counter for
filing.

Routine Immunohematology Section

RELEASING OF SCREENED BLOOD TO THE PATIENT
Responsibility: MLT

1. Check the blood/component to be released to the patient either using TMSISS or

manually using the File Rekod Keputusan Ujian Saringan
2. Release requested CHECKED blood to respective ward

Appendix 8: Flow Chart Releasing of Screened Blood/Blood Components

A) DONOR SECTION

Enter donor information into TMSISS system

Print Cetakan Laporan Harian

Submit BPPD and Cetakan Laporan Harian

Inform MLT for any ‘DISEKAT’ status

 B) TRANSFUSION MICROBIOLOGU/COMPONENT SECTION

Receive BPPD and Cetakan Laporan Harian

Check previous
donor status

‘DISEKAT’ ‘TIDAK DISEKAT’

Reactive
Negative Negative
Check current Check current
screening result screening result

Reactive
Yes Under MO
Discard blood Monitoring Discard blood

No

Can use blood

Transfer blood into CHECKED fridge

Record
C) ROUTINE IMMUNOHAEMATOLOGY SECTION

Check Negative status blood in TMSISS/ file

Release blood to respective ward

Appendix 2 - Inventory and Machine Maintenance

MONTH _______________________________ YEAR ________________________ SERIAL NUMBER ____________________

DAILY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
(INITIALS)
Clean Probes
(TEAH)
SHIFT 1

Empty Waste
Containers
Update inventory

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Clean Probes
(TEAH)
SHIFT 2

Empty Waste
Containers
Update inventory

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Clean Probes
(TEAH)
SHIFT 3

Empty Waste
Containers
Update inventory

WEEKLY (DATE AND INITIALS) WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5

MEIA Verification
Clean Sample Segments and Sample Cup Adaptors
FPIA Verification
Clean Matrix Cell Carousel and surrounding area
Clean Processing Carousel and surrounding area
Clean Air Filters
Clean Outside of Probes (WATER, ETOH or MEOH)
Clean Wash Cups/Waste Stations (WATER, ETOH or MEOH)
Clean Dispenser Nozzles and Baseplate
Flush Pumps and Syringes

MONTHLY (DATE AND INITIALS) DATE COMPLETED

Tubing Decontamination

P/N 38806-104
Appendix 4

CARTA ALIR KEPUTUSAN UJIAN SARINGAN HBsAg, ANTI-HIV DAN ANTI-HCV MENGGUNAKAN TEKNIK
MICROPARTICLE ENZYME IMMUNOASSAY (MEIA) UNTUK PENDERMA DARAH

MEIA
DARAH PENDERMA
(Tiub Pilot)

NON-REAKTIF REAKTIF REAKTIF

(equivocal d/t fibrin clots, etc)

Lapor keputusan sebagai NEGATIF Jalankan semula Jalankan semula

MEIA ke atas: MEIA ke atas:
i) sample tiub pilot yang telah dicentrifuge i) sample tiub pilot
ii) sample dari segmen. ii) sample segmen

Beg Darah & Komponennya dilekatkan

Dengan label untuk dimasukkan Diskrepensi
ke dalam peti “Checked Blood” Jika kedua-dua Jika kedua-dua Jika kedua-dua Jika segmen
NON-REAKTIF REAKTIF REAKTIF NEGATIF

Lapor ujian sebagai Hantar sampel dari beg darah Kuarantin dan Ulangi
Negatif, untuk ujian pengesahan ujian semula semua
darah diasingkan untuk Beg Darah & Komponennya penderma
perlupusan diasingkan untuk dilupuskan

Rekod Penderma Disekat

Darah boleh diguna Penderma dipanggil untuk
Ujian Confirmation dari REAKTIF NON-REAKTIF
Rekod Penderma sample badan
Tidak disekat
Appendix 6

SCREENING PROBLEMS; FOR MLT REFERENCE

SEND GIVE
BLOOD BARRED
P1 P2 S3 INTERP. FOR FORM NOTE/ACTION
DISCARD DONATION
CONFIRM TO S/N
N - - N X X X X NEGATIVE
WR/GZ WR/GZ N N √ X X X INITIALLY REACTIVE (IR)
WR/GZ N N N √ X X X INITIALLY REACTIVE (IR)
R R R R √ √ √ √ REPEATEDLY REACTIVE (RR)
HR HR WR/GZ/N ? REPEAT BATCH (SEGMENT)
WR/GZ WR/GZ GZ R √ √ X √ FILE ‘PEMANTAUAN MO’
REPEAT THE SAMPLE/
GZ GZ/N R ? REPEAT BATCH IF
NECESSARY

NOTE:
P1 : Pilot Tube (1st Screening)
P2 : Pilot Tube (2nd Screening)
S3 : Blood bag segment (3rd Screening)
INTERP : Result Interpretation (Status Screening)
N : Negative
R : Reactive
WR : Weakly Reactive
HR : Highly reactive
GZ : Grey Zone
√ : Yes
X : No

* PROBLEM WITH RESULT’S DISCREPANCY – CONSULT OFFICER ONCALL OR LECTURER IN-CHARGE