Summary
The CAP transfusion medicine accreditation checklist has been revised to enhance patient, donor, and blood bank safety. New requirements include verifying ABO and Rh types through repeat testing or historical records, conserving group O Rh(D)-negative RBCs, and implementing systems to reduce mistransfusion risk. The revisions also address specimen labeling, transfusionist training, and donor information verification, incorporating technology for improved efficiency and accuracy.
Transfusion medicine
Valerie Neff Newitt
April 2026—Revisions and additions to the CAP transfusion medicine accreditation checklist released last year were made to safeguard patients, donors, and the blood bank inventory.
The changes, which encompass specimen labeling, type verification, stewardship of group O Rh(D)-negative RBCs, and transfusionist training, among others, are “fantastic for blood banks across the country,” says CAP Checklists Committee member Karen Roush, MD, MBA. The reason: “We can use efficiencies and preserve the integrity of what we are doing for patients, donors, and the blood supply—and then use technology appropriately to do that.”
One of the new requirements is TRM.40575 ABO Group and Rh(D) Type Verification (for Serologic or Computer Crossmatch). It says the recipient’s ABO group and Rh(D) type has been verified by repeat testing of the same sample, a different sample, or agreement with a historical type in the laboratory’s records. It also says repeat testing of the same sample is inadequate for computer crossmatching for issuing non-type O red cells, unless the sample has been drawn using technology or methods for ensuring positive identification—for example, a digital bedside identification system.
In the previous checklist edition, this was required of laboratories using a computer crossmatch, under TRM.40670; it now applies also to a serological crossmatch. (TRM.40670 was deleted and merged with TRM.40575 to expand its applicability to all compatibility testing methods.)
“It allows the possibility,” Dr. Roush explains, “that a medical director could derive some other process to ensure that a single sample has been drawn to a level of credibility that would allow the testing to be performed on that sample twice.”
Acceptable ABO and Rh historical records for transfusion purposes are only those that are generated or entered by laboratory personnel into the health system’s laboratory information system and performed by an accredited laboratory or one certified by the relevant government agency in its jurisdiction.
“If you are going to be able to use another lab’s ABO Rh type, it should have been put into the system by the laboratory, and you should be able to reference it all the way back to the accredited laboratory it came from,” says Dr. Roush, who is vice chair of the Department of Pathology, Methodist Health, Dallas.
When there is an unexplained ABO typing discrepancy on the current sample, the requirement says, a serologic crossmatch technique must be employed.
Also new is TRM.40707 Stewardship of Group O Rh(D)-Negative Red Blood Cells, which requires the laboratory to have processes to conserve these RBCs. Studies show, the requirement notes, that at least 40 percent of group O Rh(D)-negative RBCs are transfused to non-group O Rh(D)-negative patients.
“This requirement is important because it helps preserve Rh-negative red blood cells for patients who really need those Rh-negative red blood cells,” Dr. Roush says. “And that would be women of childbearing years who are Rh-negative or Rh-unknown whom we don’t want to immunize for Rh so they are not at risk for hemolytic disease of the newborn.”
It also means, she adds, that it may be appropriate to transfuse an Rh-negative patient with Rh-positive red cells if they are women outside of childbearing years or men who do not have D antibodies.
Many hospitals already likely have a process in place for conserving Rh(D)-negative RBCs for the right patients, Dr. Roush notes, “because they felt their Rh-negative situations were riding on a very thin line. This requirement formalizes it, and I think blood bankers will welcome having a cohesive plan.”
One of the revised requirements is TRM.30575 Mistransfusion Risk Reduction, which requires having a system to reduce the risk of mistransfusion for nonemergent red cell transfusions and provides options the laboratory can consider.
Among those options is a new one: comparison with previous records per TRM.40300 Historical Record Check, which says ABO, Rh, and antibody screen test results are compared with results of the same tests recorded previously to detect discrepancies and identify patients who require specially selected units.
“You can use either historical checks in your own system or potentially a historical check that came from another system that is properly validated,” Dr. Roush says. “That means a report came directly from a lab that’s accredited so that you can look at a type that was generated elsewhere but has the credentials.”