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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 PerformedCircle all that applyBlood group - Forward typingBlood group - Reverse typing@Direct Antiglobulin Test (DAT)*Indirect Antiglobulin test (IAT)#Compatibility Testing Antibody ScreenAntibody IdentificationAntibody TitrationTick to indicate your current practice1ParameterManualAutomatedSlide/TileTubeColumn agglutination technique (Card)MicroplateOtherSpecify2Blood group andRh Type3Direct Antiglobulin test (DAT)*4Indirect Antiglobulin test (IAT)#5Compatibility testing6Phase of compatibility testingSalineAlbuminLISS+CoombsTemp: 37 deg C7Company providing blood grouping AntiseraCompany providing blood grouping Cards8Source of Antisera (DAT/IAT)Source of Cards (DAT/IAT)9Source of Cells for IATIn-houseCommercial (Specify)PhenotypedNOT Phenotyped10Source of cells for reverse typingIn-houseCommercial (Specify)11Immunohaematology Automation Company12Immunohaematology Automation Platform13Antibody screen cell panel(Circle/enter appropriate data)In-houseCommercialCommercialSpecify Vendor14Number of donors in cell panelSpecify2 cells3 cells15Antibody identification cell panel(Circle/enter appropriate data)In-houseCommercialCommercialSpecify Vendor16Number of donors in cell panelSpecify8 cell11 cells@ Indirect typing ; *Also referred to a Direct Coombs test (DCT);# Also referred to as Indirect Coombs Test (ICT); + Low Ionic Strength Solution17Donors & Donations18Number of Donors per yearRepeat Voluntary Donors(%)Number of donations per yearVoluntary donations (%)19If your Blood Bank prepares components, circle all relevant products made20Whole blood onlyPacked Red cells (no additive)Red cells concentrate with additivePlate rich plasmaPlatelet rich concentrateFresh frozen plasmaBanked plasma (never frozen)Cryo precipitateCryo (plasma)supernate21Is apheresis performed?YesNoIf yes please circle components producedPlateletsRed cellsPlasmaLeucocytes22Infectious Disease screening23Source of kitsNACO ONLYSelf-purchasedBoth NACO + Self purchasedOther (Specify)24MalariaRapid Cards (Antigen/Antibody)FluorescenceThin/Thick SmearSyphilisRPRVDRLELISA25Viral ScreenRapid kitsELISAECINATOther (Specify)26Specify kit name for ID testMalariaSyphilisHIVHBVHCVOther 27Manufacturer for ID test28Do you use independent controls for ID ScreensNOYES(Specify)29Any additional tests performed for Infectious disease screening specify30Automation for ID screenCompanyPlatform31Quality Assurance (Circle all that apply)32Internal QC performancefrequency At reagent selectionDailyQC performed on (Circle)Antisera (Reagents)Reagent red cells33Instrument calibrationNoYesParticipation in EQASCMCEQASAny other(specify)34CommentsSignature: ___________________________Seal: __________________________Date: _______________ ................
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