BB

LECTURE (FINALS) | BETS

PRETRANSFUSION TESTING o Keep donor sample at 1-6C for at least 7 days
after transfusion.
Purpose: To select blood components which when transfused For both donor & Patient Sample:
will have an acceptable survival rate and will not cause o ABO grouping
destruction of recipients RBC. o Rh typing + weak D typing
o Ab screening
Steps:
1. Request for transfusion For patient sample:
2. Identification of transfusion recipient and blood o Check previous records of patient.
specimen collected. o Note unusual serological reactions, medications,
3. Testing of transfusion recipients blood specimen. recent blood transfusions, previous pregnancy
4. Donor RBC unit testing.
5. Donor red cell unit selection. For Donor sample:
6. Compatibility testing o Test for transfusion-transmitted infection (TTIS)

7. Labeling of blood or blood components.
Malaria, Hepa B & C, syphilis, HIV

Request for transfusion Selection of Donor Units
st
May be oral, electronic, or written format 1 Choice: the same with patients
Must accurately identify the recipient o Use at least ABO and Rh group
2 patient identifiers If unavailable: Units that lack any Ag against
Signed by attending physician recipients clinically significant Abs.
Units that do not contain all Ags on
Identifying, Collection & Preparation of Samples recipients RBCs are acceptable.
o Type AB recipient can be receive Type A
Pretransfusion testing begins and ends with proper or B or O
identification and collection of the patient sample. o Rh positive blood can receive Rh negative
blood.
Patient Identification Select Ag-negative RBCs for corresponding
o Identification wristband or verbally ask for unexpected Ab from the patient.
details o For clinically significant Abs only
o Compare patients full name, ID number & birth Select units based on expiration date
date with the test requisition. Check the units for discoloration, turbidity,
clots, wrong label or leakage.
Collection of patients sample
o Serum or EDTA plasma may be used. Avoid Crossmatching Test
hemolyzed samples except for patient with in Major Crossmatch
vivo hemolytic processes. (such as in with o PSDR Patient Serum + Donor RBCs
hemolytic anemia) Minor Crossmatch
o Samples from IV lines is allowed but proper o PRDS Patient RBCs + Donor Serum
protocol should be followed. o Ab Screening is done in lieu of minor
o Use samples within 3 days of scheduled crossmatch
transfusion if patient was transfused or Autocontrol
pregnant within the last 3 months. o PSDR Patient serum + Patients RBCs


To represent current immunological status Interpretation
o Label all samples properly o Compatible
o Keep patient samples at 1-6C for at least 7 days No agglutination & No hemolysis o
after transfusion. o Incompatible
With agglutination & hemolysis
Collection of donor sample
o Should be collected at the same time as the full Classification of Crossmatching
donor unit.


Serum A. Serologic Crossmatching

EDTA & Plasma Utilizes the major crossmatch

From segmented tubing of blood unit. Includes immediate spin and AHG
o Label all samples properly crossmatch
B. Computer Crossmatching

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 BB LECTURE (FINALS) | BETS
Compares recent ABO serologic results and Does not guarantee the absence of the antibody or
interpretation on file for both donor and normal survival of transfused cell.
patient.

Serologic Crossmatch Negative Ab Screening, Compatible crossmatching
1. Immediate spin Crossmatch A. (-) Ab screen , Incompatible Crossmatching
o PSDR Crossmatch 1. Donor RBC are ABO incompatible
o Can be solely done if patient has no o Retype Donor
clinically significant Abs on current 2. Donor RBC are polyagglutinable
testing and on previous records. 3. Anti A1 in the serum of A2 or A2B individual
Test only for ABO 4. Other alloantibodies reactive at room temp.
incompatibility perform a panel, include Room Temperature
o Type and Screen (T/S) procedure incubation
Test Patient sample for ABO, 5. Cold auto-antibodies
Rh, clinically significant 6. Rouleaux formation
7. Passively acquired Anti-A or Anti-B
unexpected Abs.

Store in Ref for future XM
B. (-) Ab screen , Incompatible AHG Crossmatch
o Abbreviated crossmatch
1. Donor RBC have DAT (+)
T/S + IS crossmatch
2. Antibody reactive only with cells having a strong
expression of a particular antigen.
2. Antiglobulin Crossmatch o Screen cells may not possess as strong as an
Used in the event of the recipient to expression of the antigen
demonstrate a clinically significant Ab in the o Perform panel
current Ab screening or has done so in the 3. Antibody reactive with low frequency antigen.
past. o Perform DAT first, if negative perform Panel
Add the same potentiator used in Ab 4. Passively acquired Anti-A or Anti-B
screening to parallel condition in
which the Ab was detected. Positive Ab Screening , Compatible crossmatching
Autocontrol (PSPR) is no longer
bH
required by AABB but still useful 1. Autoanti-H (autoanti H) or Anti- Anti- Le- and non
Collectively include group O units are selected.
IS Phase 2. Antibodies dependent on reagent red cell diluents.
37C incubation Phase 3. Antibodies demonstrating dosage and
AHG phase 4. Donor cells are from heterozygous.
o Patient has a weak antibody reacting with
Computer Crossmatch homozygous screen cells, donor cells are either
For AbO incompatibility detection only heterozygous or negative for the antigen.
o Use only samples submitted for 5. Donor unit is lacking corresponding antigen
pretransfusion testing o Patients has an antibody against screening cells
Unexpected antibodies which is not present or donor cells.
o Non-reactive in Ab screening Action: Perform antibody identification and test
donor for antigen.
No history of such Abs.

o At least 2 ABO/Rh types must be on a file.
Positive Ab Screening , Incompatible crossmatching

A. (-) autocontrol
Interpretation of crossmatching Testing
B. (+) autocontrol, (-) DAT
I. (-) Ab Screening, Compatible crossmatching
C. (+) autocontrol, (+) DAT
II. (-) Ab Screening, Incompatible crossmatching

III. (+) Ab Screening, Compatible crossmatching
A. (-) autosomal : presence of alloantibodies
IV. (+) Ab Screening, Incompatible crossmatching
Perform a panel and identification ab specificity
Negative Ab Screening, Compatible crossmatching Use appropriate reagent antiserum to confirm
that units are negative for that Ab is direct
Majority of tested sample.
o Negative Ab screen against
o Crossmatch with the donors RBC are
compatible
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If multiple Abs are present and unable to unable o Test patient serum for presence of
to identify all Ab specificities, send sample to a unexpected ABO Abs.
reference lab. 3. Compatibility testing for transfusion of plasma
products
B. (-) autosomal , (-) DAT o Only done if transfusing large volumes of
Rouleaux formation plasma products
o Confirm true agglutination by adding 1-3 o Test PRDS and detect ABO incompatibility
drops of saline 4. Intraunterine transfusion
Antibody to enhance media or enhancement o Compatibility testing performed using
dependent autoantibody mothers sample
o If all reagent RBCs are (+) but crossmatches o Donor unit must lack antigen against
appear compatible, consider an Antibody maternal antibody
reactive with a substance in the o Group Rh-negative donor selected when
preservative solution fetal type is unknown or when type is
Eliminated by washing reagent cells known but is not compatible with mothers
prior to use type.
o If there is uniform agglutination in all tubes, 5. Neonatal transfusion
consider an Antibody reactive with the a. Maternal sample can be used for
enhancement media compatibility testing
Resolve by using different b. Initial sample from infant typed for ABO
enhancement media or doing saline (forward typing) and Rh
testing c. Donor unit selected should be compatible
with both mother and baby
C. (-) autosomal , (+) DAT 6. Massive transfusion
Rouleaux formation a. Infusing 8 to 10 RBC units to a adult patient
Alloantibody causing a delayed serologic in <24 hours
reaction or hemolytic transfusion reaction b. Acute administration of 4 to 5 RBC units in 1
o Remove bound Ab from coated cells by hr.
elution and identify specificity. 7. Specimen with prolonged clotting time
Passively acquired autoantibody (such as IVIG). o Patients with coagulation abnormalities
Cold-reactive antibodies associated with disease or medications
o Cause problems with ABO 7 D typing, Ab (heparin, warfarin)
detection & crossmatching o Add thrombin to induce clotting
o Use pre-warmed technique: pre-warm cells, o Add protamine sulfate to counteract effects
serum and saline of heparin
No IS, wash with warm saline 8. Preoperative autologous blood
immediately after incubation and use o Autologous transfusion: refers to the
anti-IgG AHG serum removel and storage of blood or
Warm-reactive antibodies components from a donor for the donors
o Cause problems with D typing using a high possible use at a later time.
protein typing sera o According to AABB standards:
o Use low-protein anti-D reagent with pretransfusion testing is required
appropriate control
Blood Inventory Management
Pretransfusion Testing in special Circumstances Maximum Surgical Blood Order Schedule (MSBOS)
1. Emergencies
o Perform pretransfusion testing, if possible
Shorten incubation time by using LISS
o If not possible, give ABO-specific and Rh-
specific blood
o If also not possible, give type O-negative
pRBCs.
2. Transfusion of non-group-specific blood
o Example: Type A given large volumes of
types O RBCs