COMPATIBILITY

TESTING
Week 5

Compatibility Testing
All steps in the identification and testing of a potential

transfusion recipient and donor blood before transfusion

Done in an attempt to provide a blood product that
survives in-vivo and provides its therapeutic effect in the
recipient
Ensures the greatest compatibility technically possible
between the donor unit and the patient, with no adverse
reactions from the transfused blood
Includes:
Recipient identification
Sample collection and handling
Pre-transfusion testing

Principles of the Crossmatch

What is a crossmatch?

Performed for all red cell transfusions (except emergency

situations)
Involves mixing the plasma from the recipient with red
cells from the donor
Haemolysis or agglutination at any step in the process
indicates the presence of recipient antibodies interacting
with donor red cell antigens
No agglutination/haemolysis = compatible, ok to transfuse
Agglutination/haemolysis present = incompatible,
unacceptable for transfusion to that patient

Purposes of crossmatch testing

Prevent life-threatening transfusion reactions

Maximise in-vivo survival of transfused red cells

The crossmatch procedure attempts to fulfill these goals

by:
Serves as a double check of ABO errors caused by
patient misidentification or donor unit mislabelling
Provides a second means of antibody detection in a
patient who has a clinically significant antibody, or a
history of one

Crossmatch Procedure
Must be rapid and simple enough to be practical

Successful transfusion: in a stable, non-bleeding patient

one unit of red cells should increase the patients

Haematocrit by 3% and the Haemoglobin by 10g/L

Crossmatch Procedures
Two classifications: serologic and computer

Serologic:
Tests the patients plasma with the red blood cells from the donor
unit in an indirect antiglobulin test
Always done when:
Patient has clinically significant antibodies donor units must be
antigen negative for that antibody
Patient is transfusion dependent

Crossmatch Procedures
Computer crossmatch:

Uses the laboratory information system (LIS) to make the

final check of ABO compatibility in the selection of

appropriate units for transfusion
Group and Hold performed first = group + antibody screen
Patient does not possess any clinically significant
antibodies in the current or any previous sample
LIS must indicate the patients eligibility or ineligibility for
computer crossmatch

Computer Crossmatch Requirements

Onsite validated LIS and assurance that ABO

incompatibilities are detected; incompatible blood

products not released
Blood group performed on current sample
2nd group confirmation; either on current sample or
previous confirmed group
Donor unit details have been barcoded into the LIS, group
has been confirmed
LIS confirms patients blood group, antibody screen and
interpretation of crossmatch compatibility
Verification of all results entered to ensure that are correct
before products are released

Group & Hold vs Crossmatch

Group and hold (group + antibody screen) performed on

patients who may or may not need red cells

If no group discrepancy, current antibody screen is
negative and the patient does not have a history of
clinically significant antibodies, red cells can be ready for
the patient within 5 minutes of a phone call from the Dr
Advantages:
Better management of blood bank inventory
Increased time efficiency

Flexibility in laboratory staffing

Potential for a centralised transfusion service

Limitations of Crossmatch Testing

A compatible crossmatch does not guarantee a

successful transfusion outcome

Adverse transfusion reactions may still occur
Viral transmission, allergic reactions, febrile nonhaemolytic transfusion reactions
A negative antibody screen result does not guarantee that
the patients does not have clinically significant red cell
antibodies
All it means that the patient does not have any detectable
antibodies against the screening cells by the method used

Crossmatch Limitations
A compatible crossmatch does not guarantee the optimal

survival of red cells

Patients clinical condition (eg. Bleeding, red cell
sequestration) may limit the benefit of the transfusion
A delayed transfusion reaction could occur if a preexisting
undetectable clinically significant antibody is boosted in
strength by the transfusion of the corresponding antigen
in the donor unit and rapidly destroys the donor red cells
Even if red cell destruction does not occur, a patient may
become alloimmunised to the donor antigens, making
subsequent compatibility testing more time-consuming
and complicated

Crossmatch Limitations
Non-life threatening transfusion reactions may also occur,

making the transfusion uncomfortable for the patient

Hives
Low-grade fever
Chills
Itching
Transfusion associated circulatory overload (TACO)

Principles of Compatibility Testing

Step 1 Recipient Blood Sample

Properly collected

Labeled with accurate patient identification procedures

Fundamental practice for patient safety
Positive patient ID What is your name? What is your

date of birth?
Sample must be labeled at the patients bedside:
Surname, first name, hospital number, date of birth, date
and time of collection, collectors initials
Specimen must be hand-labeled, no computer generated
hospital stickers
Specimen details must match the request form

Patient Specimen
Usually plasma

EDTA tubes most commonly used

Provide anticoagulated blood with plasma and red cells

for testing
If patient has been pregnant or transfused within the last 3
months the sample can only be held for crossmatching for
72 hours (3 days)
If there is a reliable history of no recent transfusion or
pregnancy and the antibody screen is negative, the
sample may be held for crossmatching for 10 days
This will vary between laboratories

Patient Specimen
Specimen must not be haemolysed

Collected properly with no contamination from other fluids

Pre-Transfusion Testing on Patient

Sample
Check patient history: group and antibody status, history

of clinically significant antibodies, special requirements,

previous transfusion reactions
Perform group and antibody screen on current specimen
Perform antibody identification if required

Donor unit
Entered into LIS

Group confirmed (ARCBS does not guarantee anything!)

When crossmatching:
Compatible with patients group
Expiry date checked
Unit has been stored correctly
Good condition
Colour change may indicate haemolysis or
bacterial growth
Must be antigen negative if the patient has

a clinically significant antibody

Completed Crossmatch
Label tag attached to donor unit

Patients name, hospital number and blood group

Donor identification number and blood group of donor
Identity of the scientist performing the crossmatch
Label verification is performed at the end to ensure all

details are correct before the unit is issued

Transfusion on the Ward

Patient identification is crucial for safe transfusion

Ultimate responsibility of the nursing/medical staff

Positive patient identification procedures must be followed
The patients hospital identification wrist band must

exactly match the information on the unit tag

All details must be checked at the patients bedside by 2
qualified staff members
Transfusion must commence within 30 minutes from time
unit is taken from the blood fridge

Emergency Transfusion
In the event of life-threatening haemorrhage when there is

insufficient time to perform compatibility testing

Pre-transfusion specimen and recent transfusion history is
still required, if possible
Group O Negative red cells and group AB plasma
products are issued until the patients group is tested on a
current sample
Males and women >50 years old may have O Positive red
cells

Massive Transfusion
Defined as a total volume exchange of blood through

transfusion within a 24 hour period, approx 10 units red

cells
Other definition is >150mL/minute blood loss
Original sample no longer represents the circulating blood
of the patient as the patients circulation contains almost
entirely transfused donor blood
Any further units requested are given group specific

Neonatal Crossmatch
Neonatal period = <4 months old
Unable to produce their own antibodies
All antibodies detected will be from maternal origin
At 4 6 months old babies will start producing their own

ABO antibodies and become capable of producing

antibodies, if immunologically challenged through
transfusion
Initial neonatal testing:
Blood group (forward group only)
Antibody screen (either on neonate or mother)
Direct antiglobulin test (DAT)
If antibody screen is negative no further specimens are needed

from the baby until they are 4 months old

Neonatal Crossmatch
If mother has clinically significant antibodies, all red cell

units for the neonate must be antigen negative

A new specimen from the neonate is required until both
the antibody screen and DAT are negative

Non-Red Cell Fresh Products

Platelets, Fresh Frozen Plasma, Cryoprecipitate

Contain almost no red cells and do not need to be

crossmatched
Given on ABO group
ABO antibodies are important
Rhesus group of the product isnt important
Rh antigens are only found on red cells and are absent
from blood products
eg. Rh negative patient can receive Rh positive plasma
products

Critical Thinking Exercise

A 60 year old woman with anaemia is admitted to ED
Hb 60g/L (125-180g/L)
Subtle gastrointestinal bleeding over many weeks
Lethargic, dizzy, short of breath
Medical officer orders 2 units of red cells before theatre

Current group AB Positive, antibody screen negative

Historical group agrees AB Positive, previous anti-E

detected
What ABO group/s are compatible?
What type of crossmatch should be performed? Why?
Is any additional screening required on the donor unit
before crossmatching?