Specimen Considerations - Recipient
Compatibility Testing Specimen must be clearly and accurately
identified
Labeled with patient’s first and last name,
hospital ID, date specimen drawn, who drew
the specimen
The Crossmatch Information on request for crossmatch must
exactly match information on patient ID.
Never rely on door tag, bed tag, patient chart
for ID
Specimen Considerations - Donor
Fresh serum – specimen of choice Must contain same anticoagulant found in
Plasma may contain sm. fibrin strands donor unit
Calcium ions needed for complement activation Segment from donor bag is ideal specimen
Avoid hemolysis Retain blood sample (pilot tube) for 7 days
Specimen within 3 days of transfusion (2 after transfusion
days if pregnant/transfused within past 3
months)
Retain for 7 days after transfusion
1
Recipient ABO Group Donor ABO Group
ABO Compatibility
Best to give ABO group specific blood
A A or O
Should not give ABO non-specific whole
blood
In Packed Red Cells small amount of B B or O
antibodies remaining in plasma are diluted by
patient’s system are inconsequential
AB AB, A, B, or O
Recipient blood is forward and reverse typed.
Donor ABO group must be confirmed after
O O
ABO label is attached.
Patient Type Other Choices
Rh Compatibility
O pos O neg
Match donor and recipient for D antigen – O negative None
highly immunogenic A pos A neg, O pos, O neg
Rh positive recipient may receive Rh
A neg O neg
negative blood – but, best to reserve Rh
negative units for Rh negative recipients B pos B neg, O pos, O neg
Do not need to do Du testing B neg O neg
Comfirm Rh type of all units that are labels AB pos AB neg, O pos, O neg, A
Rh negative – including Du pos, A neg, B pos, B neg
AB neg O neg, A neg, B neg
2
Antibody Screen Crossmatch
Major crossmatch – recipient serum + donor red
cells –
Recipient serum tested for unexpected Detects recipient antibodies against donor antigens
antibodies Final check on ABO compatibility
Screening cells must possess all relevant Minor crossmatch – recipient red cells + donor
serum – not required by AABB and not
blood group antigens to detect all clinically recommended
significant antibodies Done in 3 phases – with some variations
Room temperature
37 °C incubation
Antihumanglobulin (Coomb’s) phase
An autocontrol is also usually run with the
crossmatch
Room temperature Crossmatch 37 °C incubation
Incubating cell-serum mixture at 37 °C
Identify major ABO incompatibilities
Enhancer often added
May also detect insignificant cold antibodies
Increased detection after prolonged incubation
An immediate spin reading is recommended
(rather than an incubation period)
Recipient serum + 2-5% suspension of donor
cells, centrifuge and observe for agglutination
3
Antihumanglobulin Phase
Cell-serum mixture is washed following the
All negative AHG tubes tested with control
37 °C incubation to remove antibodies
cells
remaining in the serum
Commercially prepared red blood cells sensitized
Add AHG, centrifuge and observe with IgG antibodies
AHG phase is optional if: Control cells must be positive
No clinically significant antibodies in antibody
screening tests
No record of clinically significant antibodies
Variations-Enhancement Techniques
Proteolytic Enzymes
Decrease in zeta potential by removing surface
Albumin- enhances agglutination of some IgG
glycoproteins
antibodies
Can destroy certain antigens
LISS Used in conjunction with other antibody detection
Increases attractive forces between red cells methods – never as sole means of detection
(lower zeta potential)
Reduced incubation times
Occasionally get unwanted positive reactions
4
Urgent Release of Blood Electronic (Computer) Crossmatch
Donor blood is selected based on ABO compatibility
verified by comparison of the donor unit information and
Requesting physician must document that the the Rh type
clinical situation was urgent to require release following conditions must be met
of uncrossmatched blood computer must be validated on site - this is the reason most
blood banks do not do electronic crossmatches - rigorous
Usually give O neg unless ABO type/Rh of validation process by FDA
recipient has been determined (can't use computer must be programmed to prevent release of ABO
previous records) incompatibile blood and to alert if Rh positive blood assigned to
Rh negative donor
Units must be labeled to make it clear that patient does not have any detectable antibodies or has not had
any detectable antibodies in the past
testing was incomplete
ABO type on patient must be done at least twice - one may be
a record, but one must be done currently
computer must contain donor information - donor
number, name of component, ABO/Rh, etc.
method to verify correct entry of data
