07 Pretransfusion Testing, AKA Compatibility Testing

To select the safest blood / blood components for a blood transfusion

To select the safest blood / blood components for a blood
transfusion that

Provides acceptable donor RBC survival rates

Eliminates the destruction of recipient's cells

Weighs the potential risks against the benefits

The ______ is the fourth of the primary foundations in pretransfusion testing & a safe transfusion.

PROCESS LEADING TO COMPATIBILITY TESTING:
The assumption here is that the patient has had an ______ performed and the results showed an anemic patient.

The ________ must initiate the transfusion on behalf of thepatient.

MD / NURSING ORDER: MD = initiates the transfusion order

MD / NURSING ORDER: Nurse = creates the BB requisition for the transfusion

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

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.

3 PROCESSING PHASES OF COMPATIBILITY
TESTING: Pre-Serologic Procedures

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

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

Patient ID verification - critically important to draw the correct patient

Use both patient RBCs and Serum / Plasma for testing

Usually use a BB pink top tube (K2 EDTA - dried form)

Alternate Specimens

Alternate Specimens

Make 3-5% patient cell suspension for testing

Non-hemolyzed

Free from IV contaminants

≤ 3 days old

Retain this sample for 7 days following the transfusion date

Non-hemolyzed

Must take ______ / segment _______ to unit

Always retain ______ / segments for ____\ following transfusion date

SEROLOGIC TESTING: COMPATIBILITY TESTING Recipient - For EVERY patient that is tested Always:

Check the __________ - to check previously testing or not

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

SEROLOGIC TESTING: COMPATIBILITY TESTING: Perform _______ typing (Du testing may be optional)

SEROLOGIC TESTING: COMPATIBILITY TESTING: Perform ________

SEROLOGIC TESTING: COMPATIBILITY TESTING: Perform_________

Donor RBC / WB Unit Confirmations: Every RBC / WB incoming unit from the blood supplier must be _________

Donor RBC / WB Unit Confirmations: _________ is only required on all Rh neg RBC / WB units

Donor RBC / WB Unit Confirmation Process: Using the ______ / segment of the RBC / WB unit, make a ________. Never use a loose pigtail.

_______ - perform______ the Forward ABO typing for re-typing of all donor units

only required on all Rh neg labelled units; usually Du test is NOT required to be performed, only IS test phase.

STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

ABO: ABO typing is critical & must be performed correctly / interpreted correctly ____ of the
time

STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

ABO: Use ______ (Gel or Solid Phase) OR ________ (test tube)

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

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

STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

Rh: Must match Rh...especially in ________ females to prevent severe ___________

STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

Rh: Use ________ OR _________

STEP 2: PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

Rh: Du testing may be _____ on the transfusing recipient

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

Ab Screen (ABS): ABS is ______ correctly / interpreted correctly ______ of the time

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

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

Ab Screen (ABS): Use ________ OR _________

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

Ab Screen (ABS): Xmat is ______ & must be performed correctly / interpreted correctly _______ of the time

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS

2 methods to perform a crossmatch (Xmat)

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical

Manual: This is the serologic test using __________

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical

Manual: Testing Phases are - ___________

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical

Manual: Use the same ________ as used in the ABS (e.g., LISS, PEG)

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical

Automation: Use of ____________

PATIENT COMPATIBILITY TESTING PROCEDURE, AKA, TYPE AND CROSS: Crossmatch (Xmat) - physical

Automation: Automation may have different _________ dependent on the equipment, media, etc.

Final Check of ABO Compatibility

Detects only IgM Antibody at 22oC

Detects clinically significant IgG antibody

IS

37C

AHG

TT XMAT PHASES: 1) Most ABO incompat;

Potent other Bld Grp IgM Abs

Typically, Rh Abs react here

Other Bld Grp Abs

Purpose: Washing was adequate

Purpose: AHG reagent added

Purpose: Reagent is working

Sensitized RBCs

COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS

Xmat - electronic: Not a "________" test

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)

COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS

Xmat - electronic: Requirement: Performed only when the recipient's current ABS is _________

COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS

Xmat - electronic: _________: There is no history of any Abs

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

COMPATIBILITY TESTING PROCEDURE, AKA,
TYPE AND CROSS

Xmat - electronic: To _________ the overall Xmat Turn-around Time (TAT)

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.

To expedit the overall Xmat Turn-around Time (TAT): It's only if the patient has an _______ will the TAT is extended.

To expedit the overall Xmat Turn-around Time (TAT): Then you have to do an ____and ____ ...added more time.

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 3 TEST RESULTS RELEASED
TRF contains

STEP 4 LABELING THE DONOR XMAT UNIT(S)

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

Each Xmat unit(s) is / are checked AGAIN (by the CLS) just prior to
distribution

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

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 units need to be available for a surgery patient, the surgery dept usually has a centrally-located, designated BB refrigerator to temporarily store units.

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

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

if the unit(s) need to be placed in a transport container for a surgery
patient, the CLS must

Upon return of the transport container, the temperature of each actual
RBC unit(s) / blood components must be measured.

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.

If the temperature is out-of-range, the unit(s) can NOT be issued.