Major Crossmatch versus Type&Screen : Why to choose for Type&Screen

Major Vandenvelde Christian, Physician Biologist, Head of Military Service for Blood Transfusion, Head of Brugmann U.H.C. / Queen Fabiola Children U.H.C. / C.T.R. / Heysel R.C. Immuno Haematology Laboratory
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What is a Major Crossmatch ?

Compatible RBC Bag(s) request Patient RBC ABO-D(-CcEe)(-K) Typing Typing-compatible RBC Bag(s) selection Bag(s) RBC crossmatching with Patient plasma
Bag(s) RBC compatible with Patient plasma RBC Bag(s) reservation for Patient What if positive Major Crossmatch ?

What is a Type&Screen ?
Compatible RBC Bag(s) request Patient RBC ABO-D(-CcEe)(-K) Typing + Patient plasma Screening for Irregular anti-RBC Ab by crossmatching with commercially available selected 3-RBCpanel(s)
Patient plasma negative IAT Typing-compatible RBC Bag(s) selection when needed What if positive IAT ?
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What if positive MXM / IAT ?

Positive MXM
Either : further Bag(s) RBC Crossmatching with Patient plasma Or : Patient plasma Screening for Irregular antiRBC Ab

Positive IAT
Irregular anti-RBC Ab Identification with commercially available 11-RBC-panel(s) Typing- & Identification-compatible RBC Bag(s) selection when needed
What if available Bag(s) RBC were not phenotyped for concerned Ag ? What if Patient anti-RBC Ab remain(s) unidentified ?
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What if unidentified Patient Ab / non-phenotyped Bag(s) RBC Ag ?

Available Typing-compatible Bags RBC Crossmatching with Patient plasma Available Typing-compatible Bags RBC phenotyping for concerned Ag Typing- / Identification-compatible RBC Bag(s) searching by B.T.C. in :
national BTI RBC Bags stocks international BTI Frozen-Phenotyped-RBC Bags stocks
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PRELIMINARY CONCLUSION
Most of the time the right question will be : Why to choose either for MXM or for T&S as FIRST RBC compatibility test ? 4 Ways to go :
MXM only Example : Q.A.M.H. Blood Bank T&S only Example : Military Ops Support First T&S, then MXM Example : Brugmann U.H.C. (Laeken + Schaerbeek + Jette sites) / Queen Fabiola Children U.H.C. / Centre for Traumatology & Rehabilitation / Heysel Rehabilitation Centre Blood Bank First MXM, then T&S Example(s) : cfr previous presentation 6

Type&Screen resources constraints

Reagents : commercially available Screening RBC-panels are expensive but Technologists : Screening procedures are easy to automate but Equipments : Screening automates are expensive but RBC Bags stock : Screening allows
an average RBC Bags stock reduction of +/- 33% an average RBC Bags expiry rate reduction of +/95%, especially when a M.S.B.O.S. has been successfully implemented, but
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Type&Screen Patient risks

Screening misses 1 allo-Ab per 3000 RBC compatibility tests but Screening misses 1 weakly-reactive potentially clinically significant allo-Ab per 30000 RBC compatibility tests but Screening-missed allo-Ab likely would not result in life-threatening reactions but Screening misses clerical ABO-compatibility RBC Bags selection / labelling errors but Screening is mandatory followed by an ABOcompatibility check but Screening misses allo-Ab present in residual plasma of RBC Bags but National BTIs have to warrant the absence of clinically significant allo-Ab in produced L.B.C. 8

MXM only : Burn Unit Q.A.M.H. Blood Bank support

Reagents & Equipments :
no de novo allo-Ab in 13 years 3 allo-Ab at admission in 13 years +/- 66% of requested RBC Bags are transfused

Technologists :
no experience in allo-Ab identification 1 MXM for 2 RBC Bags from same apheresis donor presence required for other lab tasks

RBC Bags stock : 2 times the average number of transfused RBC Bags Patients risks : ABO-D-CcEe-Kk-compatible RBC Bags are electronically selected
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T&S only : Military Ops Q.A.M.H. Blood Bank support

Reagents, Technologists & Equipments :
Screening before departure makes field-lab compatibility testing useless Screening-positive soldiers remain in Belgium (0.01%)

RBC Bags stock : 20 refrigerated + 1200 frozen O Rh/K-negative RBC Bags are continuously available Patients risks :
O Rh/K-negative RBC Bags are universal RBC Bags are systematically tested for auto- & alloAb Donor Typing occurs at least 2 times before first donation 10

First T&S, then MXM : Brugmann Blood Bank resources constraints

Reagents : unusually high frequency of alloimmunised, polytransfused & multipregnancy patients Technologists :
important experience in allo-Ab identification 4 years ago, 15% of requested RBC Bags were transfused

Equipments : 4 years ago, unusually high frequency of RBC Bags requests RBC Bags stock : after 4 years, RBC Bags needs & expiry rates have already been reduced by 33% & 85%, respectively
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First T&S, then MXM : Brugmann Blood Bank risks management

Extended phenotyping of haematology / oncology patients at first admission As extended as possible electronic-crossmatch for haematology / oncology / childbearing patients Maximal use of ABO-D-CcEe-Kk-DAT-IAT screened RBC Bags Maximal availability of extendedly phenotyped RBC Bags ABO-compatibility check at patients bed
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FINAL CONCLUSION
QUESTION : Why to choose either for Major Crossmatch or for Type & Screen as (FIRST) RBC compatibility test ? ANSWER : It only depends on hospital blood bank human and material resources and patients risks management capabilities
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