Compatibility Testing PDF

Compatibility Testing REVIEW ⚫ ABO VS RH ⚫ OTHER BLOOD GROUP ⚫ AHG TESTING ⚫ ANTIBODY SCREENING ⚫ ANTIBODY IDENTFICATION ⚫ WHY? ⚫ TODAY :CROSSMATCHING TESTING LEARNING OBJECTIVE ⚫ To understand the principle of cross match procedure and significance of compatibility test...

Compatibility Testing REVIEW ⚫ ABO VS RH ⚫ OTHER BLOOD GROUP ⚫ AHG TESTING ⚫ ANTIBODY SCREENING ⚫ ANTIBODY IDENTFICATION ⚫ WHY? ⚫ TODAY :CROSSMATCHING TESTING LEARNING OBJECTIVE ⚫ To understand the principle of cross match procedure and significance of compatibility tests ⚫ To understand the procedure of cross matching in special circumstances ⚫ To emphasize of the significance of carrying out compatibility procedure before issue of a unit of blood in a proper scientific manner. ⚫ understand methods and significance of correct cross matching procedures ⚫ be able to select proper unit, perform cross match for special situations pre-assessment https://www.mentimeter.com/app/presentation/n/al7rj26utmbf2nma qdxhwucxwe4b77fk/edit?question=aownbs5r4s88 WHAT IS COMPATIBILITY TESTING? ⚫ Also called pretransfusion testing ⚫ Purpose: ⚫ To select blood components that will not cause harm (safe) to the recipient and will have acceptable survival (of the component) 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 COMPATIBILITY TESTING? ⚫ There are several components of compatibility testing ⚫ Proper specimen collection ⚫ Reviewing patient transfusion history ⚫ ABO, Rh, and antibody testing (screen/ID) ⚫ Crossmatching ⚫ Actual transfusion COMPATIBILITY TESTING ⚫ Can be divided into 3 categories: ⚫ Pre-analytical procedures ⚫ Serological testing ⚫ Post-analytical procedures  Patient identification PRE-ANALYTI Specimen CAL PHASES collection Review of patient history Patient Identification ⚫ Must confirm recipient’s ID from wrist band ON the patient ⚫ Full patient name and hospital number ⚫ Name of responsible physician, who admit him UNKNOWN PATIENTS! ⚫ If the patient does not have a wristband or if the patient’s identity is unknown, some form of positive identification must be attached to the patient before collection of samples. Sample Identification ⚫ The sample should also have the full patient name, hospital number, Location, and physician ⚫ Date and time of collection, phlebotomist’s initials ⚫ All of this should also be on the request form and the sample. And should be matched. Specimen Tubes Lavender Top - EDTA Red Top – No additives  Collected in tube with EDTA or no additives If the venipuncture causes hemolysis, the sample may be SPECIMEN rejected COLLECTION True hemolysis in the patient is the result of complement activation Samples are labeled at the bedside (pre-labeling is not recommended) SPECIMEN COLLECTION IF THE SAMPLE IS DRAWN FROM AN IV TESTING SHOULD BE PERFORMED ON LINE, THE IV INFUSION SHOULD BE SAMPLES LESS THAN 72 HOURS OR STOPPED 5-10 MINUTES PRIOR TO ELSE COMPLEMENT DEPENDENT BLOOD DRAWING AND THE FIRST 10 ML ANTIBODIES MAY BE MISSED DISCARDED (COMPLEMENT CAN BECOME UNSTABLE) ⚫ Note: You must keep donor and recipient samples for a minimum of 7 days after transfusion. ⚫ The samples should be stoppered and refrigerated at 1-6°C, carefully labeled, and adequate in volume so that they can be re-evaluated if the patient experiences an adverse response to the transfusion. GETTING THE HISTORY LOOK AT RECIPIENT’S PREVIOUS TRANSFUSION RECORDS FOR ANY PRIOR REACTIONS UNEXPECTED ANTIBODIES  COMPATIBILITY PRE-ANALYTICAL TESTING DIVIDED PHASE INCLUDE. DISCUSSION INTO 3 CATEGORIZES , LIST GIVE SOME EXAMPLE ? /THINK-PAIR ALL 3? SHARE WHAT IS THE PURPOSE OF PRE-TRANSFUSION TESTING ? SEROLOGICAL TESTING ⚫ 3 tests: ⚫ ABO/Rh(D) ⚫ Antibody Screening/identification ⚫ Crossmatch  In the ABO typing, the forward and reverse MUST match, otherwise ABO/RH(D) there is ??? TYPING Both of these will indicate what type of blood should be given ANTIBODY SCREEN AND/OR ID ⚫ The antibody screen will detect the presence of any unexpected antibodies in patient serum ⚫ If antibodies are detected, identification should be performed using identification panel cells (with an autocontrol) ⚫ IS ⚫ 37°C (LISS) ⚫ AHG ⚫ If an antibody is present, units negative for the antigen must be given (remember calculations?) ⚫ Formula: # units screened = # units needed/frequency of antigen-negative donor units ⚫ Proceed to the crossmatch… CROSSMATCHING ⚫ donor cells + recipient serum ⚫ Purpose: ⚫ Prevent transfusion reactions ⚫ Increase in vivo survival of red cells ⚫ Double checks for ABO errors ⚫ Another method of detecting antibodies CROSSMATCH ⚫ Two types of crossmatches ⚫ Major – routinely performed in labs ⚫ Minor – not required by AABB since 1976 ⚫ An autocontrol is also usually run with the crossmatch https://www.youtube.com/watch?v=VkDa32WGtFc Recorded your observations: Regent used Phases Any other notes Major vs Minor Crossmatch ⚫ Why is the minor cross-match unnecessary? ⚫ Donated units are screened for antibodies ⚫ Most blood is transfused as packed cells, so having little antibodies (antibodies are found in the plasma component) Major: Patient serum crossmatched with donor red cells. Minor: Donor serum crossmatched with patient red cells. Antibody screen testing on donor samples has replaced the minor crossmatch.  Major Crossmatch No agglutination ~ compatible Agglutination ~ incompatible Donor RBCs Patient serum (washed suspension)  CROSSMATCH (Major) - donor cells + recipient serum ⚫ emergencies excepted ⚫ Must demonstrate ABO incompatibility & CS abs 26 © Faye E. Coleman Old Dominion University  X-MATCH METHODS ⚫ Extended thru AGT - req. when unxptd abs present ⚫ Immediate Spin/Abbreviated allowed by Stds when no CS unx abs and 27 no record of same © Faye E. Coleman Old Dominion University  Preparation of donor cells for cross-matching Select appropriate unit of blood from inventory Check for Donor ID Blood Group Expiry date Hemolysis / leakage Detach a segment from the blood bag, cut ends of segments and pour the contents in a labeled test tube Wash red cells with saline 3 times and prepare 5% suspension It is very important to check the unit for donor ID, blood group, expiry and any evidence of hemolysis or bacterial contamination. In case of bacterial contamination, the color of the unit will be dark violet with foul smell and there may be reddish discoloration of the supernatant plasma. It is also important that main unit of blood is not opened for taking out the sample. Donor samples can be obtained by detaching the segment of the tubing attached to the unit. The procedure Cross matching should be performed at following phases saline phase at room temperature AHG phase Cross matching can be performed using conventional test tubes or by using newer technologies such as Column Agglutination Technology Solid Phase Technology Electro Magnetic (EM) Technology ⚫ 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 Discussion What is cross-match? What is the differences between IS vs AHG crossmatch? List the steps of the cross-match test ? cases A 72 year old man was admitted to the hospital for an aneurysm repair. The physician ordered a type and crossmatch for 6 units of blood in preparation for surgery. The patient history included surgery in 2016 during which he was transfused with 4 units of RBCs. patient’s blood type: A positive antibody screen: negative what type of unite you need to select for cross matching and what type of cross matching should be performed in this case ? Transfusion Medicine Case Studies (tamu.edu)  PRE-TRANSFUSION TESTING Patient Sample ⚫ non-hemolysed ⚫ plasma or serum or may be used ⚫ no more than 3 days old * Donor Sample ⚫ obtained from integral tubing ⚫ both stored @ 1-6 0 C *if transfused or pregnant last 3 mos 44 © Faye E. Coleman Old Dominion University  Donor Testing- Collecting Facility ⚫ ABO ⚫ A-HBc ⚫ Rh, including wk ⚫ HIV 1 RNA D ⚫ A-HIV 1 ⚫ Ab Screen * ⚫ A-HIV 2 ⚫ STS ** ⚫ A-HTLV 1 ⚫ HBsAg ⚫ A-HTLV 2 ⚫ A- HCV ⚫ WNV RNA ⚫ HCV RNA ⚫ HBV DNA ⚫ Chagas’ Disease 45 *if transfused or pregnant last 3 mos © Faye E. Coleman Old Dominion University DRI ** reinstated 1991 by AABB  DONOR TESTING- TRANSFUSING FACILITY ⚫ Use blood from integral tubing ⚫ Confirm ABO ⚫ Confirm Rh on NEG units Wk D not required 46 © Faye E. Coleman Old Dominion University  PATIENT SAMPLE TESTING ⚫ Check previous records verify current results ab may be subdetectible ⚫ ABO ⚫ Rh - Ab Screen - must detect clinically significant abs. 47 © Faye E. Coleman Old Dominion University POST-ANALYTICAL PHASE ⚫ Involves labeling, inspecting, and issuing the blood unit ⚫ Labeling form includes patient’s full name, ID number, Location, ABO/Rh(D) of patient and unit, donor #, compatibility results, and tech ID ⚫ Form is attached to the donor unit and only released for the recipient ⚫ The unit is visually inspected for abnormalities, such as bacterial contamination, clots, etc ISSUING BLOOD ⚫ When it’s time to release a blood product to the nurse or physician, a few “checks” must be done ⚫ Requisition form ⚫ Comparing requisition form ⭢ donor unit tag ⭢ blood product label ⚫ Name of persons issuing and picking up blood ⚫ Date and time of release ⚫ Expiration date  Blood can be returned to the blood bank if it is not needed for transfusion WHAT IF Unit closure has to remain unopened THE UNIT IS Storage temperature must UNUSED? have remained in the required range (1° to 10°C for RBCs) If not at correct temp, unit must be returned within 30 minutes of issue  https://www.mentimeter.co m/app/presentation/n/alk mid-lecture activity mad713mpsfmqtcmyw3k7 h7ut4awxx/edit?question= yh28eaexnyg1 Special Circumstances  In an emergency, there may not be enough time to test the recipient’s sample In this case, blood is released only when signed by the physician (O negative) EMERGENCY The tag must indicate it is not RELEASE crossmatched Segments from the released units should be retained for X-matching Every detail is documented (names, dates..)  Once the specimen is received, ABO/Rh typing and antibody screening should be performed Crossmatching the segments from the released unit should be tested EMERGENCY RELEASE In addition, the lab may crossmatch additional units as a precaution if more blood is needed If death should occur, testing should be complete enough to show that the death was unrelated to an incompatibility WHAT CAN BE GIVEN IN AN EMERGENCY? ⚫ Group O Rh(D)-negative red cells or AB plasma ⚫ Emergency release ⚫ Women below or of childbearing age ⚫ Group O Rh(D)-positive red cells ⚫ Used as a substitution if O negative is not available ⚫ Male or elderly females  MASSIVE TRANSFUSION Defined as a transfusion approaching or exceeding the recipient’s own blood volume (about 5 liters or 10-12 units in an adult male) within 24 hour period The original sample no longer represents the patient’s condition Complete crossmatch not necessary (if no antibodies were detected originally) Give ABO identical units If antibodies were originally ID’s, continue to give antigen negative units ⚫ ABO specific blood should Patient’s 1st Other always be given first. Type Choice Choices ⚫ When ABO-specific blood is not available or is in less O O None than adequate supply, A A O alternative blood groups are chosen as summarized in B B O the following table; AB AB A, B, O only one of the three should be used for a given patient DONOR SELECTION: APPROPRIATE DONOR UNITS TO GIVE  Rh-negative blood can be given to Rh-positive patients, however, good inventory management should conserve this limited resource for use in Rh-neg recipients. If Rh-neg units is near expiration, the unit should be given rather than wasted. SELECTION OF APPROPRIATE DONOR UNITS. ABO group specific/identical for WB ABO group compatible for RBC components SELECTION OF APPROPRIATE DONOR UNITS. ⚫ Rh-pos blood should not be given to Rh(D) -neg women of childbearing age. ⚫ Transfusion of Rh-neg male patients and female patients beyond menopause with Rh-pos blood is acceptable as long as no performed anti-D is demonstrable in the sera. ⚫ Rh neg recipients > Rh neg (WB) & RBCs ⚫ Rh pos recipients >Rh pos or neg (WB) & RBCs ⚫ (WB) & RBCs should lack ags corresponding to CS abs i.e. donor blood must be phenotyped!!!! TYPE & SCREEN Used to conserve blood inventory On average, a surgical procedure uses about 1 unit of RBCs, however, many times the units are on “hold” in the lab an will not be needed (reducing inventory) For this reason, only a type & screen are performed and if any blood is needed, the sample can be retrieved for crossmatching (only the IS phase is required) If antibodies are identified, then antigen negative blood is reserved or crossmatched AUTOLOGOUS CROSSMATCHING ⚫ Autologous refers to a donation from the recipient for later use ⚫ Special procedures/protocols must be available so that the autologous unit is found and transfused to the recipient Autologous Transfusions ⚫ ABO, Rh - collecting institution ⚫ If shipped, TAH & TAV tests req. permission req. of physician biohazard label ⚫ Repeat testing requirements apply ⚫ Ab screen and X-match are optional  SPECIAL CIRCUMSTANCES Intrauterine Transfusions ⚫ Give O, Rh neg Ag neg for corresponding maternal ab irradiated CMV neg < 5 days old 66 © Faye E. Coleman Old Dominion University OTHER COMPONENTS ⚫ Other components to be given do not need to be crossmatched because they have been thoroughly screened for antibodies ⚫ Fresh Frozen plasma ⚫ Platelet concentrate ⚫ Cryoprecipitate ⚫ Platelets pheresis ⚫ Granulocyte concentrates ⚫ Give ABO compatible units worksheet +case study Discussion What can be given in emergency situations ? What does post analytical phase include ? How can you cross-match blood for neonate ?