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STANDARD OPERATING PROCEDURE FOR

IMMEDIATE SPIN CROSSMATCH

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

TITLE: STANDARD OPERATING PROCEDURE FOR


IMMEDIATE SPIN CROSSMATCH

1.0 Principle
To demonstrate ABO compatibility between donor red cells and recipients
plasma/serum when the antibody screen is negative and there is no previous
history of clinically significant antibodies.

2.0 Scope and Related Policies


2.1

Before red cells are transfused, compatibility testing must be performed.


Incompatible or uncrossmatched donor units should only be transfused when
a clinical situation justifies an exception. Any exception shall be approved
by the medical director or his or her designate. Authorization must be
documented according to facility procedure.

2.2

When the antibody screen indicates the presence of a clinically significant


red cell antibody or the recipient has a previous history of clinically
significant antibodies, the red cells shall be crossmatched using an
antiglobulin technique.
2.2.1

If the method used for the AHG crossmatch is unable to detect


ABO incompatibility then an immediate spin crossmatch must be
performed as well.

2.3

For recipients that may need additional units, the original blood specimen
may be used for crossmatch within the 96 hour period post transfusion of the
first unit of blood.

2.4

The ABO type of the red cells collected and prepared by the blood supplier
must be confirmed if a serological crossmatch is not performed before
transfusion of the red cells.

2.5

Related Standard Operating Procedures:


2.5.1 NL2010-012 Determining Specimen Suitability
2.5.2 NL2010.013 Patient History Check
2.5.3 NL2012-033 Preparation of Red Cell Suspensions
2.5.4 NL2012-042 Quality Control of Reagents and Antisera

_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 2 of 9

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

3.0 Specimens
3.1

EDTA anticoagulated whole blood

3.2

Serum (Do not use samples drawn into tubes with neutral gel separators)

4.0 Materials
Reagents:
Isotonic saline
Supplies:
Test tubes (10x75mm)
Transfer pipettes
Test tube rack
Equipment:
Serological centrifuge
Donor Unit (s)

5.0 Quality Control


5.1

Any ABO discrepancy shall be resolved and the resolution documented


before issuing red cells.

5.2

Quality control of blood components and equipment shall be retained for


five years.

_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 3 of 9

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

6.0 Process Flowchart


6.1

Process Flow

_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 4 of 9

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

7.0 Procedure
7.1

Determine specimen suitability.

7.2

Centrifuge specimen. (Speed and time as recommended by manufacturers


directions.)

7.3

Check specimen after centrifuging (e.g.hemolysis).

7.4

Perform a patient history check.


7.4.1

If the patient has a history of clinically significant antibodies


perform an AHG crossmatch. If the method used to perform an
AHG crossmatch does not detect ABO incompatibility, perform an
IS crossmatch as well.

7.5

Ensure patient information on the sample corresponds with the patient


information on the worksheet.

7.6

Select the appropriate donor unit from the blood bank refrigerator.

7.7

Visually inspect each donor unit.

7.8

Record the donor unit number on the patients worksheet.

7.9

Label 2 tubes with a donor number label from the donor bag (if the donor
number label is not available, label with at least the last 4 digits from the
donor unit number) for each red cell unit to be crossmatched. One tube will
be used for preparing the donor cell suspension and the other will be the
crossmatch tube.

7.10 Detach one donor segment from the unit, cut and express contents in
appropriate labelled tube. Return the donor unit (s) to the blood bank
refrigerator.
7.11 Wash the donor cells once with isotonic saline and make a 3-5% cell
suspension.

_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 5 of 9

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

7.12 Add the following to each labelled crossmatch tube:


2 drops of patients plasma or serum
1 drop of the donor cell suspension
7.13 Mix the contents of each tube.
7.14 Centrifuge tubes. (Speed and time as recommended by manufacturers
directions.)
7.15 Examine for hemolysis. Record if present.
7.16 Immediately resuspend the cells by gentle agitation; examine the tubes
macroscopically for agglutination.
7.17 Grade and record results.
7.18 Prepare a crossmatch/transfusion card with at least the following
information:
Recipients name
Recipients identification number
ABO and Rh group
Name of the component
Donor unit number
Compatibility status of the unit
Date and time of crossmatch
7.19 Compare applicable information on the crossmatch/transfusion card with the
donor unit.
7.20 Place the donor unit with the crossmatch/transfusion card in the blood bank
refrigerator with the oldest unit in the front.

8.0 Reporting
8.1

No agglutination or hemolysis indicates that the donor unit (s) are


compatible with the patients plasma.

8.2

Agglutination or hemolysis indicates that the donor unit (s) are


incompatible.

_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 6 of 9

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

9.0 Procedural Notes


9.1

For the purpose of this document a crossmatch/transfusion card is the card


generated when the IS crossmatch is completed; it is placed with the donor
unit until it is issued to the recipient for transfusion.

9.2

Incompatible and/or hemolysis reactions must be investigated and resolved.


9.2.1 Repeat ABO group on recipient and donor units if all the units are
incompatible.
9.2.2 If some of the units are incompatible, repeat the ABO on the
incompatible units.
9.2.3 Compare results of the recipients current antibody screen and
previous test results.
9.2.4 Perform a DAT on the incompatible unit. If the DAT is positive
quarantine the unit and inform the blood supplier. Select another donor
unit for the crossmatch.
9.2.5 Examine the incompatible tubes microscopically for rouleaux. If present:
9.2.5.1 Wash the donor cell suspension 3 times with isotonic saline and
make a 3-5% cell suspension.
9.2.5.2 Add the following to an appropriately labelled tube:
2 drops of 22% albumin,
2 drops of patient plasma and
1 drop of washed donor cells
9.2.5.3 Mix the contents if the tubes.
9.2.5.4 Centrifuge and check for hemolysis. Record if present.
9.2.5.5 Immediately examine microscopically for agglutination.
9.2.5.6 Grade and record results.
If unable to resolve consult with senior technologists for further investigation.

9.3

If clotted or hemolysed segments are found on the donor units use another
segment for crossmatching. If all segments are clotted or hemolysed, do not
use the donor unit and notify the blood supplier.

9.4

Failure to perform the IS crossmatch procedure properly can cause falsenegative results and failure to detect ABO-incompatible donor RBC units.
There should be no delays in centrifuging or reading the reaction after
centrifugation.

_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 7 of 9

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

10.0 Records Management


10.1 The recipient transfusion data file in the Transfusion Medicine Laboratory
shall be retained indefinitely.
10.2 All transfusion records in the recipients medical chart shall be retained in
accordance with health care facility policy.
10.3 Quality control of blood components, blood products, reagents and
equipment shall be retained for 5 years.
10.4 Date and time of specimen collection and phlebotomists identification shall
be retained for 1 year.
10.5 Request form for serologic tests shall be retained for one month.
10.6 Documentation of staff training and competency must be kept for a
minimum of ten years.

11.0 References
11.1 CSA Standards for Blood and blood Components, Z902-04, Canadian
Standards Association, 2004.
11.2 CSTM Standards for Hospital Transfusion Services, Version 3.0, Canadian
Society for Transfusion Medicine, 2011, Ottawa, Ontario.
11.3 Manitoba Provincial Blood Coordinating Office. Manitoba transfusion
quality manual for blood banks Version 2.0. Winnipeg (MB).Manitoba
Provincial Blood Programs Coordinating Office; 2007.
11.4 Roback, J., Grossman, B., Harris, T & Hillier, C. Technical manual 17th ed.
Bethesda, Maryland: AABB; 2011.
11.5 Sharpe, Gail. Eastern Health Immediate Spin Crossmatch PRC-TRM-034
Ver. 2. St. Johns, NL: Eastern Health; 2011.
11.6 Transfusion Ontario Programs Ottawa Office. Ontario regional blood
coordinating network standard work instruction manual. Ottawa (ON):
Transfusion Ontario Programs Ottawa Office; 2009.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 8 of 9

Standard Operating Procedure for


Immediate Spin Crossmatch
Provincial Blood
Coordinating Program

11.7 TraQ Program of the British Columbia Provincial Blood Coordinating


Office. Technical resource manual for hospital transfusion services, 2nd
edition. British Columbia: British Columbia Provincial Blood Coordinating
Office; 2005.

_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011.018
Version: 2.0
Effective Date: 2012-09-30
Page 9 of 9