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Pre transfusion testing, dr. rafiq

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Pre transfusion testing, dr. rafiq

  1. 1. Pre-transfusion TestingPre-transfusion Testing DR. RAFIQ AHMADDR. RAFIQ AHMAD
  2. 2. Transfusion requestsTransfusion requests  Patient identificationPatient identification  HN, Name, Date of birth, Gender, Age,HN, Name, Date of birth, Gender, Age, DiagnosisDiagnosis  Type and number of unit of componentType and number of unit of component requestedrequested  Physician’s NamePhysician’s Name  Sample labelingSample labeling  Confirming sample identity in theConfirming sample identity in the laboratorylaboratory
  3. 3. Blood sampleBlood sample  Appearance of the sampleAppearance of the sample  Serum normal, hemolysis, tubidity, orSerum normal, hemolysis, tubidity, or lipemiclipemic  Age of sampleAge of sample  Should not more than 3 days oldShould not more than 3 days old  Retaining and storing blood samplesRetaining and storing blood samples  Kept at least 7 daysKept at least 7 days
  4. 4. ProceduresProcedures After proper identification of recipientAfter proper identification of recipient and recipient’s blood sample.and recipient’s blood sample.  ABO and Rh typingABO and Rh typing  Confirmation of ABO group of red cellConfirmation of ABO group of red cell componentscomponents  Confirmation of Rh type of Rh negative redConfirmation of Rh type of Rh negative red cell componentscell components  RBC antibody detectionRBC antibody detection
  5. 5. ProceduresProcedures  Comparison with previous recordsComparison with previous records  Selection of components of ABO andSelection of components of ABO and Rh types appropriate for the recipientRh types appropriate for the recipient  Performance of a serologic (tube/gel)Performance of a serologic (tube/gel)  Labeling of products with theLabeling of products with the recipient’s identifying informationrecipient’s identifying information
  6. 6. Serologic testingSerologic testing 1. ABO and Rh typing of the recipients1. ABO and Rh typing of the recipients 2. Detecting unexpected antibodies to2. Detecting unexpected antibodies to red cell antigensred cell antigens 3. Reading and interpreting reactions3. Reading and interpreting reactions 4. Autologous control4. Autologous control 5. Practical consideration5. Practical consideration 6. Comparison with previous records6. Comparison with previous records
  7. 7. Serologic testingSerologic testing ABO groupingABO grouping  ABO typing: both cell and serumABO typing: both cell and serum groupinggrouping  Any discrepant results should beAny discrepant results should be resolved before blood is given.resolved before blood is given.  If transfusion is necessary beforeIf transfusion is necessary before resolution, the patient should receiveresolution, the patient should receive group O red cells.group O red cells.
  8. 8. Serologic testingSerologic testing Rh typingRh typing  Patients’ red cells must be testedPatients’ red cells must be tested with anti-D.with anti-D.  If problems with D typing arise,If problems with D typing arise, the patient should be given Rh-the patient should be given Rh- negative blood until the problemnegative blood until the problem has been resolvedhas been resolved..
  9. 9. Serologic testingSerologic testing Detecting unexpected antibodies to redDetecting unexpected antibodies to red cell antigenscell antigens  To detect clinically significant antibodiesTo detect clinically significant antibodies  Use unpooled reagent red cellsUse unpooled reagent red cells  Include antiglobulin testInclude antiglobulin test  Use of Coombs’ control cellsUse of Coombs’ control cells  The method chosen should have sufficientThe method chosen should have sufficient sensitivity to detect very low levels ofsensitivity to detect very low levels of antibody.antibody.
  10. 10. Serologic testingSerologic testing Reading and interpreting reactionsReading and interpreting reactions  Hemolysis and agglutination must beHemolysis and agglutination must be observed accurately and consistently.observed accurately and consistently.  The results must be recorded immediatelyThe results must be recorded immediately after reading.after reading.  All personnel in the laboratory must use theAll personnel in the laboratory must use the same interpretation and notations.same interpretation and notations.
  11. 11. Serologic testingSerologic testing Autologous controlAutologous control  This may be useful to identifyThis may be useful to identify patients with auto-antibodies.patients with auto-antibodies.  Sometimes it causes difficulty inSometimes it causes difficulty in finding a compatible blood unit.finding a compatible blood unit.
  12. 12. Serologic testingSerologic testing Practical considerationPractical consideration  Antibody detection tests may be performed inAntibody detection tests may be performed in advance of, or together with, a crossmatch.advance of, or together with, a crossmatch.  Performing Ab detection tests beforePerforming Ab detection tests before crossmatching permits early recognition andcrossmatching permits early recognition and identification of clinically significantidentification of clinically significant antibodies.antibodies.  Allows for the selection of the appropriateAllows for the selection of the appropriate crossmatch procedure and acquisition of unitscrossmatch procedure and acquisition of units with special antigen blood types.with special antigen blood types.
  13. 13. Serologic testingSerologic testing Comparison with previous recordsComparison with previous records  Results of ABO and Rh typing must beResults of ABO and Rh typing must be compared with previous transfusion records.compared with previous transfusion records.  The comparison must be documentedThe comparison must be documented  Review the records forReview the records for  Clinically significant red cell antibodiesClinically significant red cell antibodies  Difficulties in testingDifficulties in testing  Occurrence of significant adverse recationsOccurrence of significant adverse recations  Special transfusion requirementSpecial transfusion requirement
  14. 14. CrossmatchingCrossmatching  Unless there is an urgent need for blood, aUnless there is an urgent need for blood, a crossmatch must be preformed for red cellcrossmatch must be preformed for red cell transfusion.transfusion.  Must use the procedure to demonstrateMust use the procedure to demonstrate ABO incompatibilty and clinicallyABO incompatibilty and clinically significant antibodies to red cell antigens.significant antibodies to red cell antigens.
  15. 15. CrossmatchingCrossmatching  Blood lacking the relevant antigens is to beBlood lacking the relevant antigens is to be selected for transfusion when a patient hasselected for transfusion when a patient has clinically significant antibody identifiedclinically significant antibody identified currently and historically.currently and historically.  Shall include the antiglobulin testShall include the antiglobulin test
  16. 16. Repeat testing of donor bloodRepeat testing of donor blood  Confirm the ABO group of all units ofConfirm the ABO group of all units of RBCsRBCs  Rh typing of RBC units labeled as Rh-Rh typing of RBC units labeled as Rh- negativenegative  Confirmatory testing of weak D is notConfirmatory testing of weak D is not requiredrequired  Any discrepancies are to be resolvedAny discrepancies are to be resolved before the unit is issued for transfusionbefore the unit is issued for transfusion
  17. 17. CrossmatchCrossmatch  Major crossmatch – recipient serum + donor red cells o Detects recipient antibodies against donor antigens o Final check on ABO compatibility  Minor crossmatch – recipient red cells + donor serum – not required by AABB and not recommended  Done in 3 phases – with some variations o Room temperature o 37 °C incubation o Antihumanglobulin phase  An autocontrol is also usually run with the crossmatch
  18. 18. ProceduresProcedures  Donor RBCs used for crossmatching mustDonor RBCs used for crossmatching must be obtained from a segment of tubingbe obtained from a segment of tubing originally attached to the blood container.originally attached to the blood container.  The cell must be washed and resuspendedThe cell must be washed and resuspended to 2% to 5% in saline.to 2% to 5% in saline.  The immediate spin saline technique isThe immediate spin saline technique is designed to detect ABO incompatibilitiesdesigned to detect ABO incompatibilities between donor red cells and recipient serumbetween donor red cells and recipient serum  Antiglobulin test must be included.Antiglobulin test must be included.
  19. 19. Type and Screen (T&S)Type and Screen (T&S)  An ABO and Rh type and an antibody screenAn ABO and Rh type and an antibody screen and antibody identification are done when theand antibody identification are done when the patient is admitted.patient is admitted.  Blood bank must have enough donor bloodBlood bank must have enough donor blood available.available.  Only testing necessary if low probability ofOnly testing necessary if low probability of transfusion.transfusion.
  20. 20. Type and ScreenType and Screen (T&S)(T&S)  ABO and Rh compatible blood can be safelyABO and Rh compatible blood can be safely released after an immediate-spin or computerreleased after an immediate-spin or computer crossmatch, if the antibody screen is negative.crossmatch, if the antibody screen is negative.  If the antibody screen is positive, theIf the antibody screen is positive, the antibodies must be indentified and antigenantibodies must be indentified and antigen negative units must be available for used.negative units must be available for used.
  21. 21. Type and Cross (T & C)Type and Cross (T & C)  Includes an ABO and Rh type and antibodyIncludes an ABO and Rh type and antibody screen and antibody identification.screen and antibody identification.  In addition includes a crossmatch whereIn addition includes a crossmatch where specific units of blood are held back for up tospecific units of blood are held back for up to three days for a particular patient.three days for a particular patient.  For a high probability of transfusionFor a high probability of transfusion
  22. 22. Crossmatch to Transfusion ratioCrossmatch to Transfusion ratio (C:T ratio)(C:T ratio)  Blood is used more efficiently when theBlood is used more efficiently when the number of units set aside for a particularnumber of units set aside for a particular patient (crossmatched) are actually transfused.patient (crossmatched) are actually transfused.  When a patient does not need blood, it is goodWhen a patient does not need blood, it is good practice to get a T& S but not a T & Cpractice to get a T& S but not a T & C  C:T ratio is less than 2:1C:T ratio is less than 2:1
  23. 23. Routine surgical blood ordersRoutine surgical blood orders  A standard number of units of RBCs areA standard number of units of RBCs are crossmatched for a specific surgicalcrossmatched for a specific surgical procedure, based on average use in anprocedure, based on average use in an institution.institution.  ExamplesExamples  angioplastyangioplasty T&ST&S  aortic dissectionaortic dissection T&CT&C 66  ASD repairASD repair T&CT&C 22
  24. 24. Compatibility testing for neonatesCompatibility testing for neonates less than 4 months of ageless than 4 months of age  Obtain pre-transfusion specimen from theObtain pre-transfusion specimen from the infant to determine ABO and Rh typeinfant to determine ABO and Rh type  For ABO typing, test only cell groupingFor ABO typing, test only cell grouping  Serum from either the infant or the motherSerum from either the infant or the mother may be used to detect unexpected red cellmay be used to detect unexpected red cell antibodies and for crossmatchingantibodies and for crossmatching..
  25. 25. Compatibility testing for neonatesCompatibility testing for neonates less than 4 months of ageless than 4 months of age  No need to test the infant’s serum for ABONo need to test the infant’s serum for ABO antibodies unless a non-group O infant is toantibodies unless a non-group O infant is to receive non-group O cells that arereceive non-group O cells that are incompatible with passively acquired anti-Aincompatible with passively acquired anti-A or anti-B.or anti-B.  If no clinically significant unexpectedIf no clinically significant unexpected antibodies are present, it is unnecessary toantibodies are present, it is unnecessary to crossmatch donor red cells for the initial orcrossmatch donor red cells for the initial or subsequent transfusions.subsequent transfusions.
  26. 26. Interpretation of antibodyInterpretation of antibody screening and crossmatch resultsscreening and crossmatch results  Negative results indicate only there is noNegative results indicate only there is no antibody in the patient serum that isantibody in the patient serum that is specific to donor RBC antigen.specific to donor RBC antigen.  Negative Ab screen does not guarantee theNegative Ab screen does not guarantee the the serum does not have clinicallythe serum does not have clinically significant RBC antibodies only that iesignificant RBC antibodies only that ie contains no antibodies that react with thecontains no antibodies that react with the screening cells.screening cells.
  27. 27. Interpretation of antibody screeningInterpretation of antibody screening and crossmatch resultsand crossmatch results  Compatible crossmatch does not guaranteeCompatible crossmatch does not guarantee normal red cell survival.normal red cell survival.  The cause of serologic reaction should beThe cause of serologic reaction should be identified before transfusion.identified before transfusion.  If the patient is found to have clinicallyIf the patient is found to have clinically significant antibodies, units issued forsignificant antibodies, units issued for transfusion should be nonreactive for suchtransfusion should be nonreactive for such antigen when tested with licensed reagentsantigen when tested with licensed reagents..
  28. 28. Labeling and release of crossmatchedLabeling and release of crossmatched blood at the time of issueblood at the time of issue  A tag or label indicating recipient’sA tag or label indicating recipient’s identification , donor unit number andidentification , donor unit number and compatibility test interpretation.compatibility test interpretation.  There must be a process to confirm that theThere must be a process to confirm that the identifying information, the request, theidentifying information, the request, the records and the blood or component are inrecords and the blood or component are in agreement and that discrepancies have beenagreement and that discrepancies have been resolved before issue.resolved before issue.
  29. 29. Selection of other componentsSelection of other components  ABO compatibilityABO compatibility  Use ABO identicalUse ABO identical  Component to be transfused must beComponent to be transfused must be ABO compatible with the recipient’sABO compatible with the recipient’s plasma.plasma.  Rh TypeRh Type  Other blood groupsOther blood groups
  30. 30. In Case of EmergencyIn Case of Emergency Blood used on Emergency BasisBlood used on Emergency Basis  For a patient that is bleeding outFor a patient that is bleeding out  Patient with unknown blood typePatient with unknown blood type  Group O, Rh negative, uncrossmatchedGroup O, Rh negative, uncrossmatched  Recipient may have an unexpectedRecipient may have an unexpected antibodyantibody  Still need to complete the crossmatchStill need to complete the crossmatch
  31. 31. Massive transfusionMassive transfusion  Infusion of a volume of bloodInfusion of a volume of blood approximating the recipient’s total bloodapproximating the recipient’s total blood volume within 24 hours.volume within 24 hours.  The pre-transfusion sample no longerThe pre-transfusion sample no longer represents the blood currently in therepresents the blood currently in the patient’s circulation.patient’s circulation.  Important to confirm ABO compatibility ofImportant to confirm ABO compatibility of units administered subsequentlyunits administered subsequently..
  32. 32. Blood administered after non-groupBlood administered after non-group specific transfusionspecific transfusion  In most cases, the sample is tested and unitsIn most cases, the sample is tested and units of that ABO group are issued for transfusionof that ABO group are issued for transfusion without concern for anti-A and anti-Bwithout concern for anti-A and anti-B remaining from the initial emergency releaseremaining from the initial emergency release unitsunits
  33. 33. Blood administered after non-groupBlood administered after non-group specific transfusionspecific transfusion  When large volumes of red cells areWhen large volumes of red cells are transfused or when young children or infantstransfused or when young children or infants receive transfusions passively acquired ABOreceive transfusions passively acquired ABO antibodies may be detected.antibodies may be detected.  If crossmatch is incompatible because ofIf crossmatch is incompatible because of ABO antibodies, transfusion with red cells ofABO antibodies, transfusion with red cells of the alternative group should be continued.the alternative group should be continued.
  34. 34. The end!!The end!! Thank youThank you

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