07 Pretransfusion Testing, AKA Compatibility Testing
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PURPOSE FOR PRETRANSFUSION /COMPATIBILITY TESTING
To select the safest blood / blood components for a blood transfusion
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Meets the recipient's (patient) needs
To select the safest blood / blood components for a blood
transfusion that
transfusion that
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:Purpose : To select the safest blood / blood components for a blood
transfusion that:
transfusion that:
Provides acceptable donor RBC survival rates
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PURPOSE FOR PRETRANSFUSION / COMPATIBILITY TESTING, To select the safest blood / blood components for a blood
transfusion that:
transfusion that:
Eliminates the destruction of recipient's cells
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PURPOSE FOR PRETRANSFUSION / COMPATIBILITY TESTING
Weighs the potential risks against the benefits
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crossmatch
The ______ is the fourth of the primary foundations in pretransfusion testing & a safe transfusion.
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H&H testing
PROCESS LEADING TO COMPATIBILITY TESTING:
The assumption here is that the patient has had an ______ performed and the results showed an anemic patient.
The assumption here is that the patient has had an ______ performed and the results showed an anemic patient.
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clinical staff
The ________ must initiate the transfusion on behalf of thepatient.
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1
MD / NURSING ORDER: MD = initiates the transfusion order
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2
MD / NURSING ORDER: Nurse = creates the BB requisition for the transfusion
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3
MD / NURSING ORDER: The Compatibility Testing is usually ordered as a "Type & Cross" ...which refers to the blood typing of the patient and the crossmatch
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MD / NURSING ORDER: The Type & Cross phrase in the nurse's mind means compatibility testing for ALL blood / blood components...even though the phrase really applies only to red cell containing blood products, i.e., WB and RBCs. You may hear the nurse order a Type & Cross for 2 units of FFP or for
platelets...FFP or platelets are not crossmatched & those products do
not contain RBCs.
platelets...FFP or platelets are not crossmatched & those products do
not contain RBCs.
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Specimen collection & Patient ID (Phlebotomy Dept)
Specimen ID verification (Phleb & Lab)
Specimen Meets Requirements / Specimen Age
Review of patient's records (BB)
Specimen ID verification (Phleb & Lab)
Specimen Meets Requirements / Specimen Age
Review of patient's records (BB)
3 PROCESSING PHASES OF COMPATIBILITY
TESTING: Pre-Serologic Procedures
TESTING: Pre-Serologic Procedures
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Serologic Testing
3 PROCESSING PHASES OF COMPATIBILITY
TESTING: ABO / Rh typing & ABS of patient specimen Ab ID performed, when ABS is positive ABO confirmation testing of RBC unit & Rh0(D) confirmation on all Rh neg labelled units Crossmatching of blood (random or screened) for transfusion
TESTING: ABO / Rh typing & ABS of patient specimen Ab ID performed, when ABS is positive ABO confirmation testing of RBC unit & Rh0(D) confirmation on all Rh neg labelled units Crossmatching of blood (random or screened) for transfusion
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Post-Serologic Procedures
3 PROCESSING PHASES OF COMPATIBILITY
TESTING: Proper release of test results (manual or electronic)
Proper labeling of RBC / blood component
Proper release / distribution of RBC / blood component
Proper transportation / storage, when applicable
Proper re-release / re-distribution of RBC / blood component
TESTING: Proper release of test results (manual or electronic)
Proper labeling of RBC / blood component
Proper release / distribution of RBC / blood component
Proper transportation / storage, when applicable
Proper re-release / re-distribution of RBC / blood component
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PRE-SEROLOGIC PROCEDURES: Step 1
Patient ID verification - critically important to draw the correct patient
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COLLECTION OF SPECIMENS / TYPES: STEP 1
Use both patient RBCs and Serum / Plasma for testing
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STEP 1: COLLECTION OF SPECIMENS / TYPES
Usually use a BB pink top tube (K2 EDTA - dried form)
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Red top tube (clot) for antibody tests
Alternate Specimens
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Hematology plastic Lavender top tube (ensure K2 EDTA is the
anticoagulant inside the tube - not the liquid form of K3 EDTA in
the glass tube)
anticoagulant inside the tube - not the liquid form of K3 EDTA in
the glass tube)
Alternate Specimens
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STEP 1: COLLECTION OF SPECIMENS / TYPES
Make 3-5% patient cell suspension for testing
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SPECIMEN CRITERIA: Patient
Non-hemolyzed
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SPECIMEN CRITERIA: Patient
Free from IV contaminants
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SPECIMEN CRITERIA: Patient
≤ 3 days old
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SPECIMEN CRITERIA: Patient
Retain this sample for 7 days following the transfusion date
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Donor
Non-hemolyzed
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pigtail, hermetically sealed AND attached
Must take ______ / segment _______ to unit
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2 pigtails, 7 days
Always retain ______ / segments for ____\ following transfusion date
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BB patient history file
SEROLOGIC TESTING: COMPATIBILITY TESTING Recipient - For EVERY patient that is tested Always:
Check the __________ - to check previously testing or not
Check the __________ - to check previously testing or not
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prior history, antigen (K) negative
If patient has a ________ of having a clinically significant
antibody, e.g., anti-K, you must always give _______
blood - even if the current ABS result is negative
antibody, e.g., anti-K, you must always give _______
blood - even if the current ABS result is negative
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ABO & Rh
SEROLOGIC TESTING: COMPATIBILITY TESTING: Perform _______ typing (Du testing may be optional)
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Ab Screen (ABS)
SEROLOGIC TESTING: COMPATIBILITY TESTING: Perform ________
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Crossmatch (Xmat)
SEROLOGIC TESTING: COMPATIBILITY TESTING: Perform_________
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ABO confirmed
Donor RBC / WB Unit Confirmations: Every RBC / WB incoming unit from the blood supplier must be _________
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Rh0(D) confirmation
Donor RBC / WB Unit Confirmations: _________ is only required on all Rh neg RBC / WB units
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attached pigtail, 3-5% saline cell suspension
Donor RBC / WB Unit Confirmation Process: Using the ______ / segment of the RBC / WB unit, make a ________. Never use a loose pigtail.
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ABO confirmation, only
_______ - perform______ the Forward ABO typing for re-typing of all donor units
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Rh0(D) confirmation
only required on all Rh neg labelled units; usually Du test is NOT required to be performed, only IS test phase.
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100%
STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
ABO: ABO typing is critical & must be performed correctly / interpreted correctly ____ of the
time
ABO: ABO typing is critical & must be performed correctly / interpreted correctly ____ of the
time
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automation, manual
STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
ABO: Use ______ (Gel or Solid Phase) OR ________ (test tube)
ABO: Use ______ (Gel or Solid Phase) OR ________ (test tube)
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mismatch, HTR
STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
ABO: A ________ of ABO can result in an acute & severe ______ that could possibly result in immediate death of the patient dependent on the patient's condition
ABO: A ________ of ABO can result in an acute & severe ______ that could possibly result in immediate death of the patient dependent on the patient's condition
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100%
STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Rh: Rh typing is also critical & must be performed correctly / interpreted correctly _____ of
the time
Rh: Rh typing is also critical & must be performed correctly / interpreted correctly _____ of
the time
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child-bearing age (12 - 55 yrs), HDFN / fetal demise
STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Rh: Must match Rh...especially in ________ females to prevent severe ___________
Rh: Must match Rh...especially in ________ females to prevent severe ___________
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automation (Gel or Solid Phase), manual (test tube)
STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Rh: Use ________ OR _________
Rh: Use ________ OR _________
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optional
STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Rh: Du testing may be _____ on the transfusing recipient
Rh: Du testing may be _____ on the transfusing recipient
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critical & must be performed, 100%
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Ab Screen (ABS): ABS is ______ correctly / interpreted correctly ______ of the time
Ab Screen (ABS): ABS is ______ correctly / interpreted correctly ______ of the time
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prevent HTR, Delayed HTR
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Ab Screen (ABS): Must detect clinically significant antibodies to _______ or ________ , i.e., transfused RBCs can be destroyed (intra- or extra-vascular)p
Ab Screen (ABS): Must detect clinically significant antibodies to _______ or ________ , i.e., transfused RBCs can be destroyed (intra- or extra-vascular)p
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automation (Gel or Solid Phase), manual (test tube)
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Ab Screen (ABS): Use ________ OR _________
Ab Screen (ABS): Use ________ OR _________
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critical, 100%
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
Ab Screen (ABS): Xmat is ______ & must be performed correctly / interpreted correctly _______ of the time
Ab Screen (ABS): Xmat is ______ & must be performed correctly / interpreted correctly _______ of the time
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Physical / Manual,
Electronic
Electronic
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS
2 methods to perform a crossmatch (Xmat)
2 methods to perform a crossmatch (Xmat)
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:test tubes (TT)
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical
Manual: This is the serologic test using __________
Manual: This is the serologic test using __________
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IS, 37, & AHG
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical
Manual: Testing Phases are - ___________
Manual: Testing Phases are - ___________
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potentiating media
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical
Manual: Use the same ________ as used in the ABS (e.g., LISS, PEG)
Manual: Use the same ________ as used in the ABS (e.g., LISS, PEG)
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automated equipment (Gel or Solid Phase)
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical
Automation: Use of ____________
Automation: Use of ____________
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Test Phases
PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical
Automation: Automation may have different _________ dependent on the equipment, media, etc.
Automation: Automation may have different _________ dependent on the equipment, media, etc.
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MAJOR VS MINOR XMAT
Final Check of ABO Compatibility
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TT (TEST TUBE) XMAT TEST PHASE - IS
Detects only IgM Antibody at 22oC
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Immediate spin x-Match
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TT XMAT TEST PHASE - 37 & AHG
Detects clinically significant IgG antibody
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Detects IgM Abs
IS
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Detects IgG Abs
37C
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Detects IgG Abs
AHG
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IS
TT XMAT PHASES: 1) Most ABO incompat;
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IS
Potent other Bld Grp IgM Abs
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37C
Typically, Rh Abs react here
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AHG
Other Bld Grp Abs
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CCC / CC or √ cells
Purpose: Washing was adequate
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CCC / CC or √ cells
Purpose: AHG reagent added
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CCC / CC or √ cells
Purpose: Reagent is working
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CCC / CC or √ cells
Sensitized RBCs
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serologic
COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS
Xmat - electronic: Not a "________" test
TYPE AND CROSS
Xmat - electronic: Not a "________" test
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matches
COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS
Xmat - electronic: BB computer software ______ the recipient data (ABO / Rh, ABS, medical history) to each random donor unit(s) data (ABO / Rh type)
TYPE AND CROSS
Xmat - electronic: BB computer software ______ the recipient data (ABO / Rh, ABS, medical history) to each random donor unit(s) data (ABO / Rh type)
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negative
COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS
Xmat - electronic: Requirement: Performed only when the recipient's current ABS is _________
TYPE AND CROSS
Xmat - electronic: Requirement: Performed only when the recipient's current ABS is _________
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Requirement
COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS
Xmat - electronic: _________: There is no history of any Abs
TYPE AND CROSS
Xmat - electronic: _________: There is no history of any Abs
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Requirement
COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS
Xmat - electronic: _________: Must have current 2 ABOs, 2 Rhs, & 2 Ab Screens performed on 2 different specimens collected at 2 different times
TYPE AND CROSS
Xmat - electronic: _________: Must have current 2 ABOs, 2 Rhs, & 2 Ab Screens performed on 2 different specimens collected at 2 different times
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expedite
COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS
Xmat - electronic: To _________ the overall Xmat Turn-around Time (TAT)
TYPE AND CROSS
Xmat - electronic: To _________ the overall Xmat Turn-around Time (TAT)
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negative ABS
To expedit the overall Xmat Turn-around Time (TAT): Usually the ABS & Xmat are performed simultaneously, since a majority of the patients have _______ , the Xmat will also be "compatible" to the RBC units.
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unexpected Ab
To expedit the overall Xmat Turn-around Time (TAT): It's only if the patient has an _______ will the TAT is extended.
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AB Id panel, possibly ag screen RBC units
To expedit the overall Xmat Turn-around Time (TAT): Then you have to do an ____and ____ ...added more time.
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Patient's full name
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Medical Record Number (MRN)
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:DOB
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Hosp location
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Patient's ABO & Rh
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Unit #
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Unit ABO & Rh
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Unit expiration date
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Unit product code
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Other relevant attributes related to the unit, e.g., ag neg, CMV neg, low-titer, etc.
STEP 3 TEST RESULTS RELEASED
TRF contains
TRF contains
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:Ensure the unit is labeled for its relevant attribute related to the patient, when applicable
STEP 4 LABELING THE DONOR XMAT UNIT(S)
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Must match each TRF to its appropriate corresponding unit
STEP 4 LABELING THE DONOR XMAT UNIT(S)
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STEP 4 LABELING THE DONOR XMAT UNIT(S)
The (Transformation Record Form) TRF is attached to each corresponding appropriate unit via a rubber band or plastic tie tag
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STEP 5 RELEASE / DISTRIBUTION OF THE XMAT UNIT
Each Xmat unit(s) is / are checked AGAIN (by the CLS) just prior to
distribution
distribution
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GOOD THING
STEP 5 RELEASE / DISTRIBUTION OF THE XMAT UNIT
__________ - If any errors are detected prior to distribution, the
CLS can make corrections...only...& only at this time prior to
distribution
__________ - If any errors are detected prior to distribution, the
CLS can make corrections...only...& only at this time prior to
distribution
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BAD THING
STEP 5 RELEASE / DISTRIBUTION OF THE XMAT UNIT
__________- If any error is detected outside the Blood Bank, (e.g.,
on the hospital floor by the RN), this error is reportable / reviewed by
the hospital Transfusion Committee and, if a patient death results,
the error is reportable to the FDA.
__________- If any error is detected outside the Blood Bank, (e.g.,
on the hospital floor by the RN), this error is reportable / reviewed by
the hospital Transfusion Committee and, if a patient death results,
the error is reportable to the FDA.
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RELEASE / DISTRIBUTION OF THE XMAT UNIT
If units need to be available for a surgery patient, the surgery dept usually has a centrally-located, designated BB refrigerator to temporarily store units.
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Ensure the packing of the unit(s) are correct
RELEASE / DISTRIBUTION OF THE XMAT UNIT:
if the unit(s) need to be placed in a transport container for a surgery patient, the CLS must
if the unit(s) need to be placed in a transport container for a surgery patient, the CLS must
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:Place a temperature-control media inside the transporter to meet proper transportation / storage requirements*, as mandated by the regulations
RELEASE / DISTRIBUTION OF THE XMAT UNIT
if the unit(s) need to be placed in a transport container for a surgery
patient, the CLS must
if the unit(s) need to be placed in a transport container for a surgery
patient, the CLS must
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:The lid affixed to the container and is closed
if the unit(s) need to be placed in a transport container for a surgery
patient, the CLS must
patient, the CLS must
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:The transport container displays the patient's name and MRN
if the unit(s) need to be placed in a transport container for a surgery
patient, the CLS must
patient, the CLS must
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:RE-RELEASE / RE-DISTRIBUTION OF THE RBCs /
BLOOD COMPONENTS
BLOOD COMPONENTS
Upon return of the transport container, the temperature of each actual
RBC unit(s) / blood components must be measured.
RBC unit(s) / blood components must be measured.
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RE-RELEASE / RE-DISTRIBUTION OF THE RBCs /BLOOD COMPONENTS
If the temperature is maintained at acceptable limits*, then the RBC
unit(s) / blood components may be re-released / re-distributed at a
later time.
unit(s) / blood components may be re-released / re-distributed at a
later time.
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RE-RELEASE / RE-DISTRIBUTION OF THE RBCs / BLOOD COMPONENTS
If the temperature is out-of-range, the unit(s) can NOT be issued.
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