Red blood cell compatibility testing (crossmatching)
- Steven Kleinman, MD
Steven Kleinman, MD
- Section Editor — Transfusion Medicine
- Clinical Professor of Pathology
- University of British Columbia, Vancouver
Compatibility testing is performed by the transfusion service in an effort to detect any serologic incompatibilities that might result in decreased survival of donor red cells in the transfused patient. The following tests are required [1,2]:
●ABO confirmation and Rh determination of the recipient's red cells
●ABO confirmation and Rh confirmation of the donor red cells if labeled as Rh negative
●Antibody screen of the recipient's serum to detect clinically significant antibodies (ie, the indirect Coombs test)
●Crossmatch of the recipient's serum with the donor red cells by a method that will detect ABO incompatibility and clinically significant antibodies
- Standards for Blood Banks and Transfusion Services, 19th ed, American Association of Blood Banks, Bethesda 1999.
- Yazer MH. The blood bank "black box" debunked: pretransfusion testing explained. CMAJ 2006; 174:29.
- Butch SH, Judd WJ, Steiner EA, et al. Electronic verification of donor-recipient compatibility: the computer crossmatch. Transfusion 1994; 34:105.
- 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.
- Rumsey DH, Ciesielski DJ. New protocols in serologic testing: a review of techniques to meet today's challenges. Immunohematology 2000; 16:131.
- Novaretti MC, Silveira EJ, Filho EC, et al. Comparison of tube and gel techniques for antibody identification. Immunohematology 2000; 16:138.
- Technical Manual, 12th ed, American Association of Blood Banks, Bethesda 1996.
- Staves J, Davies A, Kay J, et al. Electronic remote blood issue: a combination of remote blood issue with a system for end-to-end electronic control of transfusion to provide a "total solution" for a safe and timely hospital blood transfusion service. Transfusion 2008; 48:415.
- Boral LI, Henry JB. The type and screen: a safe alternative and supplement in selected surgical procedures. Transfusion 1977; 17:163.
- 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.
- Walker RH, Lin DT, Hartrick MB. Alloimmunization following blood transfusion. Arch Pathol Lab Med 1989; 113:254.
- 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.
- Issitt, PD. The clinical significance of some anti-red cell antibodies. Adv Pathol 1982; 1:395.
- Ludvigsen CW Jr, Swanson JL, Thompson TR, McCullough J. The failure of neonates to form red blood cell alloantibodies in response to multiple transfusions. Am J Clin Pathol 1987; 87:250.
- Oberman HA, Barnes BA, Friedman BA. The risk of abbreviating the major crossmatch in urgent or massive transfusion. Transfusion 1978; 18:137.
- Shulman IA, Spence RK, Petz LD. Surgical blood ordering, blood shortage situations and emergency transfusions. In: Clinical Practice of Transfusion Medicine, Petz LD, Swisher SN, Kleinman S, et al (Eds), Churchill and Livingstone, San Francisco 1996.
- TYPE AND SCREEN PROTOCOL USING AN IMMEDIATE SPIN CROSSMATCH (NO PRIOR HISTORY OF RED CELL ANTIBODIES)
- The computer (electronic) crossmatch
- COMPATIBILITY TESTING USING A FULL CROSSMATCH (POSITIVE ANTIBODY SCREEN OR A PRIOR HISTORY OF RBC ANTIBODIES)
- SPECIMEN REQUIREMENTS
- ANTIBODY DETECTION
- Standard technique
- Gel column technique
- PREVIOUS RECORD COMPARISON
- TYPE AND SCREEN PROCEDURES
- Risks associated with the immediate spin crossmatch in the presence of a negative antibody screen
- Types of results that may be encountered in compatibility testing
- CROSSMATCHING IN THE PRESENCE OF ANTIBODIES
- Compatibility testing for neonates and infants under four months of age
- Release of blood in emergency situations when compatibility testing has not been completed
- Compatibility testing in the presence of massive transfusion
- Compatibility testing after infusion of out-of-group blood components
- NON-ROUTINE SEROLOGIC SITUATIONS