1 / 33

INCOMPLETE CROSSMATCH

INCOMPLETE CROSSMATCH. I ntended L earning O utcomes (ILOs). Compatibility Testing Approaches Requiring Less Than a Complete Crossmatch Is the Crossmatch Really Needed? What can be given in an emergency transfusion?. Why do we care?. Compatibility testing is done to avoid

noura
Download Presentation

INCOMPLETE CROSSMATCH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. INCOMPLETE CROSSMATCH

  2. Intended Learning Outcomes (ILOs) • Compatibility Testing • Approaches Requiring Less Than a Complete Crossmatch • Is the Crossmatch Really Needed? • What can be given in an emergency transfusion?

  3. Why do we care? Compatibility testing is done to avoid a hemolytic transfusion reaction If the Host or Recipient recognizes the donor RBC surface antigens as foreign, the host will mount an immune response to the donor RBC’s

  4. Major Blood Groups ABO

  5. ABO blood group antigens present on red blood cells and IgM antibodies present in the serum

  6. Major Blood Groups Rhesus 47 Antigens make up the Rhesus Blood Group The most significant is the D antigen

  7. What is compatibility testing? • Also called pretransfusion testing • Purpose: • To select blood components that will not cause harm to the recipient and will have acceptable survival when transfused • If properly performed, compatibility tests will confirm ABO compatibility between the component and the recipient and will detect the most clinically significant unexpected antibodies

  8. Compatibility testing • Can be divided into 3 categories: • Preanalytical procedures • Serological testing • Postanalytical procedures

  9. Patient Identification • Must confirm recipient’s ID from bracelet ON the patient • Full patient name and hospital number • Name of physician http://www.usatoday.com/tech/news/techinnovations/2006-07-17-chips-everywhere_x.htm

  10. Sample Identification • The sample should also have the full patient name, hospital number, and physician • Date and time of collection, phlebotomist’s initials • All of this should be on the request form and the sample

  11. Specimen Tubes Pink Top - EDTA Red Top – no additives

  12. Serological Testing • 3 tests: • ABO/Rh • Antibody detection/identification • Crossmatch

  13. ABO/Rh Typing • In the ABO typing, the forward and reverse MUST match • In the Rh typing, the control must be negative • Both of these will indicate what type of blood should be given

  14. Anti A Anti B Anti A Anti B A B Anti A Anti B Anti A Anti B AB O

  15. Antibody screen • Also called the indirect Coombs test or the indirect antiglobulin test • The antibody screen will detect the presence of any unexpected antibodies in patient serum • If antibodies are detected, identification should be performed using panel cells (with an autocontrol) • IS • 37° (LISS) • AHG

  16. Crossmatching • Purpose: • Prevent transfusion reactions • Increase in vivo survival of red cells • Double checks for ABO errors • Another method of detecting antibodies

  17. Crossmatches • According to the AABB Standards: The crossmatch “shall use methods that demonstrate ABO incompatibility and clinically significant antibodies to red cell antigens and shall include an antiglobulin phase”

  18. Crossmatch No agglutination ~ compatible Agglutination ~ incompatible Donor RBCs (washed) Patient serum

  19. The procedure • Donor cells are taken from segments that are attached to the unit itself • Segments are a sampling of the blood and eliminate having to open the actual unit

  20. Crossmatch Procedure • if antibodies are NOT detected: • Only immediate spin (IS) is performed using patient serum and donor blood suspension • This fulfills the AABB standard for ABO incompatibility • This is an INCOMPLETE CROSSMATCH • If antibodies ARE detected: • Antigen negative units found and X-matched • All phases are tested: IS, 37°, AHG • This is a COMPLETE CROSSMATCH

  21. Crossmatches… Will Verify donor cell ABO compatibility Detect most antibodies against donor cells Will Not Guarantee normal survival of RBCs Prevent patient from developing an antibody Detect all antibodies Prevent delayed transfusion reactions

  22. Approaches Requiring Less Than a Complete Crossmatch

  23. Type and Screen • Determines the ABO-Rh of the patient and the presence of the most commonly found unexpected antibodies(elimination of the crossmatch ).

  24. Type and Screen • If an emergency transfusion is required after type and screen alone, an immediate-phase crossmatch is performed. • Blood given in this manner is more than 99% effective in preventing incompatible transfusion reactions due to unexpected antibodies.

  25. Is the Crossmatch Really Needed? • If the correct ABO and Rh blood type is given, the possibility of transfusing incompatible blood is less than 1 chance in 1000. • ABO-Rh typing alone results in a 99.8% chance of a compatible transfusion, • The addition of an antibody screen increases the safety to 99.94%, and • A crossmatch increases this to 99.95%.

  26. Physician responsibility in ordering uncrossmatched blood • In an emergency (ER or OR), there may not be enough time to test the recipient’s sample • It is your judgment that the risk of the patient dying from from anemia is greater than the risk of transfusing the patient without pre-transfusion testing

  27. What can be given in an emergency? • Type-Specific, Partially Crossmatched Blood • An ABO-Rh typing and an immediate-phase crossmatch • An abbreviated format • Macroscopic agglutination. • This takes 1 to 5 minutes

  28. What can be given in an emergency? • Type-Specific, Uncrossmatched Blood • The ABO-Rh type • Most ABO type-specific transfusions are successful. • Caution should be used for patients who have previously received transfusions or have had pregnancies.

  29. What can be given in an emergency? • Type O Rh-Negative (Universal Donor), Uncrossmatched Blood • Type O blood lacks the A and B antigens • Type O Rh-negative, uncrossmatched packed RBCs should be used in preference to type O Rh-negative whole blood. • More than two units of type O Rh-negative, uncrossmatched whole blood, the patient probably cannot be switched to his or her blood type .

  30. Specific Recommended Protocol • Infuse crystalloids or colloids. • Draw a blood sample for typing and crossmatching. • If crossmatched blood is not ready to give, use type-specific or type O Rh-negative cells or type O Rh-positive cells for males or postmenopausal females without a history of transfusions.

  31. Summary • The crossmatch “shall use methods that demonstrate ABO incompatibility and clinically significant antibodies to red cell antigens • If an emergency transfusion is required after type and screen alone, an immediate-phase crossmatch is performed before transfusion (an abbreviated format ) • If crossmatched blood is not ready to give, use type-specific or type O Rh-negative cells

More Related