Pretransfusion testing for red blood cell transfusion
- Lynne Uhl, MD
Lynne Uhl, MD
- Associate Professor of Pathology
- Harvard Medical School
Safe transfusion of red blood cells (RBC) is possible because donor RBC units can be selected for their compatibility with the recipient's blood type. Transfused RBC units do not need to be antigenically identical to the recipient's RBCs, but they do need to lack antigens that could provoke clinically significant hemolysis in the recipient (eg, a blood group A donor unit transfused to a blood group O recipient).
This topic discusses the practical aspects of compatibility testing and interpretation of potential results from this testing.
Separate topic reviews provide an overview of RBC antigens and their clinical significance, management of the patient for whom compatible cells cannot be found, practical aspects of blood transfusion, and management of hemolytic transfusion reactions. (See "A primer of red blood cell antigens and antibodies" and "The incompatible crossmatch" and "Red blood cell transfusion in adults: Storage, specialized modifications, and infusion parameters", section on 'Specialized modifications' and "Transfusion-associated immune and non immune-mediated hemolysis".)
Terms that may be helpful in accurate communication regarding desired testing and interpretation of results from compatibility testing include the following:
●AABB – An international organization that provides technical input and guidance on standards and accreditation for transfusion practice and cellular therapies. AABB publishes a technical manual approximately every three years and standards for blood banks and transfusion services as well as cellular therapy every two years. The organization was formerly known as the American Association of Blood Banks; the name was changed to AABB in 2005 to reflect its expanded (international) scope.
- Technical Manual, 18th ed, Fung M, Grossman BJ, Hillyer CD, Westhoff CM. (Eds), AABB Press, Bethesda, MD 2014.
- Goodnough LT, Viele M, Fontaine MJ, et al. Implementation of a two-specimen requirement for verification of ABO/Rh for blood transfusion. Transfusion 2009; 49:1321.
- Meyer E, Uhl L. A case for stocking O D+ red blood cells in emergency room trauma bays. Transfusion 2014.
- Butch SH, Judd WJ, Steiner EA, et al. Electronic verification of donor-recipient compatibility: the computer crossmatch. Transfusion 1994; 34:105.
- http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm252829.htm (Accessed on November 17, 2014).
- Shulman IA. The risk of an overt hemolytic transfusion reaction following the use of an immediate spin crossmatch. Arch Pathol Lab Med 1990; 114:412.
- Shulman IA, Petz LD. Red cell compatibility testing: Clinical significance and laboratory methods. In: Clinical practice of transfusion medicine, Petz LD, Swisher SN, Kleinman S, et al (Eds), Churchill and Livingstone, San Francisco 1996.
- Josephson CD, Castillejo MI, Grima K, Hillyer CD. ABO-mismatched platelet transfusions: strategies to mitigate patient exposure to naturally occurring hemolytic antibodies. Transfus Apher Sci 2010; 42:83.
- Arndt PA. Drug-induced immune hemolytic anemia: the last 30 years of changes. Immunohematology 2014; 30:44.
- Padmore R. Possible mechanisms for intravenous immunoglobulin-associated hemolysis: clues obtained from review of clinical case reports. Transfusion 2015; 55 Suppl 2:S59.
- Chapuy CI, Nicholson RT, Aguad MD, et al. Resolving the daratumumab interference with blood compatibility testing. Transfusion 2015; 55:1545.
- Goodell PP, Uhl L, Mohammed M, Powers AA. Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol 2010; 134:202.
- Denomme GA, Johnson ST, Pietz BC. Mass-scale red cell genotyping of blood donors. Transfus Apher Sci 2011; 44:93.
- Ramsey G, Mintz PD. Transfusion practice in solid organ transplantation. In: Transfusion Therapy: Clinical Principles and Practice, 3rd edition, Mintz PD. (Ed), AABB Press, Bethesda, MD 2011.
- SPECIMEN REQUIREMENTS
- Specimen age/collection date
- Specimen collection tube
- Other information
- PRETRANSFUSION TESTING
- ABO and Rh(D) type
- Antibody screen
- - Overview of antibody screening
- - Screening methods
- Tube-method (liquid phase testing)
- Solid-phase adherence method
- Column agglutination
- Compatibility testing (crossmatch)
- - Overview of compatibility testing
- - Electronic crossmatch
- - Immediate spin crossmatch
- IgG crossmatch (full crossmatch)
- INTERPRETATION OF PRETRANSFUSION TESTING RESULTS
- ABO-type discrepancies
- Antibody screen
- Incompatible crossmatch
- Potential confounders
- - Autoimmune hemolytic anemia
- - Massive transfusion
- - Out-of-group platelet transfusion
- - Drugs and therapeutic antibodies
- Drug-induced antibodies
- Rh(D) immune globulin
- NON-ROUTINE TRANSFUSION SITUATIONS
- Emergency release/insufficient time for testing
- Patient with multiple alloantibodies
- Patient with complex serologic testing precluding antibody identification
- SPECIAL POPULATIONS
- Infant <4 months
- Sickle cell disease
- Hematopoietic cell transplantation
- Solid organ transplantation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS