IMMUNOHEMATOLOGY

MODULE 9

Title : Compatibility Testing

Introduction :

Compatibility testing is performed to determine if a particular unit of blood can be

transfused safely into a certain patient. This includes ABO-Rh blood typing,
antibody screening (for unexpected red blood cell antibodies that could cause problem in the
recipient), and cross-matching. Included in this testing is both the testing for donor sample and
patient’s sample.
Objectives:

1. To be able to know the procedures in compatibility testing.

2. To be able to learn the specimen needed for cross matching.
3. To be able to learn the four phases of crossmatching.

CONTEXT/ DISCUSSION:

 Blood transfusion has been part of therapy for less than a century.
 Compatibility testing includes
 ABO and Rh ID on both donor and recipient
 Screening of donor’s and patient’s sera for unexpected Ab
 Crossmatch
o Its primary purpose is to ensure the best possible results of a blood transfusion.
o Transfused red cells should have an acceptable survival rate, and there should not be
significant destruction of recipient’s own red cells.

The following are important to ensure safe transfusion therapy:

1. ID of the patient and donor and collection of appropriate samples for testing
2. Testing of the donor sample
3. Testing of the patient sample and review of past blood bank records
4. Selection of appropriate donor units
5. Crossmatching
6. Reidentification of patient before infusion of blood.

Remember : no testing procedure can prevent sensitization of recipient to foreign red blood cell
antigens.
--- Testing cannot guarantee normal survival of transfused cells in the patient’s circulation.
--- Adverse responses to transfusion cannot always be avoided, however, it would be favourable to us
if pretransfusion testing is carefully performed, and results of laboratory testing show no
incompatibility between donor and patient.
 SAQ:
Compatibility testing is composed of different types of testing. What are these three tests or
procedures included in compatibility testing? (10 points)

PROCEDURES:
1. COLLECTION AND PREPARATION OF SAMPLES
a. Positive Patient Identification
Clerical errors – remain as the greatest threat to safe transfusion therapy.
48% transfusion death is clerical errors
--- misidentification of the patient
b. Collecting Patient Samples
--- careful technique to avoid mechanical hemolysis.
--- hemolyzed samples cannot be used for testing coz activation of complement by antigen-
antibody complexes will be masked.

Serum or plasma may be used for pretransfusion testing.

---most blood bank technologists prefer serum because plasma may cause small fibrin clots, and this
may be difficult to distinguish from true agglutination.
---tubes must be labelled before leaving the patient’s bedside.
---venous samples should not be drawn from above an infusion site but maybe drawn from below the
site.
--patient samples should be tested as soon as possible after collection, serum must be separated from
the patient’s cells as soon as possible after the sample has clotted
c. Donor’s sample
-- donors red cells can be obtained from the segments of a blood bag.
Techniques:
1. Use a lancet to make a tiny hole in the segment. The hole is essentially self – sealing.
Cut the red cell end of the segment and use an applicator stick to remove cells.

SAQ :

Why is it that serum is a much preferred specimen for crossmatching and not plasma? (5 points)
COMPATIBILITY TESTING PROTOCOLS
1. Testing of the donor sample
ABO, Rh, Antibody screening
All testing must be performed using in-date, licensed reagents
2. Testing of Patient Sample
 ABO – slide or tube method, high end equipment
 Rh – anti D, or the DAT
 Antibody screening – detect clinically significant antibodies that are reactive at 37C
Remember: ABO grouping results are more critical to transfusion safety than Ab screening.
Antibody screening offers several advantages over direct crossmatch testing for detection of
Antibodies:
1. Testing is performed using selected group O red cells
2. Testing can be performed well in advance of the anticipated transfusion,, allowing
ample time for ID of unexpected antibodies.
Sensitivity of antibody detection tests can be enhanced by:
a. Increasing the amount of serum added to the test
b. Increasing the length of incubation time at 37C
c. Adding albumin or other enhancement medium to the test.
SELECTION OF APPROPRIATE DONOR UNITS
---type specific
--- Rh negative can be given to Rh positive
---Type O packed red cells can be given to all patients
CROSSMATCHING
Crossmatch & compatibility testing are sometimes used interchangeably.
Crossmatch – part only of compatibility testing

Compatibility testing include

 Review of patient’s past blood bank history and records
 ABO and Rh grouping of both donor & recipient
 Ab screening of both donor & recipient
 crossmatch

Two parts of crossmatching

1. Major crossmatch – consist of mixing patient’s serum and donor’s cells
2. Minor crossmatch – mixing of donor’s plasma and patient’s red cells
--- has been completely eliminated
Because:
• Donor samples are screened for the more common antibodies
• Presence of low incidence Ab in donor’s plasma would not cause transfusion reaction
because it would be diluted by the patient’s plasma
Methods for Major Crossmatch Tests
1. Immediate spin cross match
2. Antiglobulin crossmatch
Causes of Positive Results in Major Crossmatch
1. Incorrect ABO grouping of the patient or donor
2. Alloantibody in the patient’s serum reacting with the corresponding antigen on donor
red cells
3. An auto antibody in the patient’s serum reacting with the corresponding antigen on
donor red cells.
4. Prior coating of the donor red cells with protein, resulting in a positive AHG test.
5. Abnormalities in the patient’s serum

FOUR PHASES OF CROSSMATCHING

1. Saline
In saline phase, we make use of NSS in this procedure. During the procedure, we mix
patient’s serum plus donor red cell and NSS.
2. Protein
If in the saline phase, there is no agglutination, then we proceed with the next phase
which is the protein phase. In this phase, we make use of 22% bovine albumin. Same
procedure will be done; patient’s serum plus donor red cells and two drops of albumin.
If there is still no agglutination, we proceed with the next phase.
3. Thermal phase = In this phase, we need to incubate the mixture at 37C. We will wait for
at least 20 minutes to allow the reaction between the antigen and antibody. If still,
there is no agglutination, then, we proceed to the next phase.
4. Coombs’ phase = In this phase, we will use AHG or the anti human globulin reagent. We
will be needing patient’s serum plus donor red cells and this reagent, then centrifuge. If
again, there is no agglutination, that is the time that we can report it as COMPATIBLE,
wherein the blood can be transfused to the patient.

Compatibility Testing in Special Circumstances

a. Emergencies
In extreme emergencies, where there is no time to obtain and test a pre transfusion sample,
Group “O” Rh (+) PRBC can be given to patients
b. Transfusion of non-group specific blood
c. Compatibility Testing for Transfusion of Plasma Products
Compatibility testing procedures are not required for transfusion of plasma products. However,
for transfusion of large volumes of plasma and plasma products, a crossmatch test may be
performed although current standards does not require a crossmatch test.
d. Intrauterine Transfusions and Transfusions of the Infant
---blood for intrauterine transfusion must be selected to be compatible with maternal antibodies
capable of crossing the placenta.
e. Massive transfusion
When the amount of whole blood or Packed rec cell components infused within 24 hours
exceeds the patient’s total blood volume, the compatibility testing procedure may be shortened
or eliminated at the discretion of a physician.
f. Autologous transfusion
 This refers to the removal and storage of blood or blood components from a donor for the
donor’s possible use at a later time, usually during or after an elective surgical procedure.

SAQ :

Give the four phases of crossmatching and a brief description of them. (10 points)

BLOOD INVENTORY MANAGEMENT

Many blood bankers are aware of the need to use blood efficiently due to limited blood supplies
and an increasing demand for blood. The MAXIMUM SURGICAL BLOOD ORDER SCHEDULE was
developed to promote more efficient utilization of blood. The goal of MSBOS is to establish a realistic
blood ordering level for certain procedures.

EVALUATION/QUIZ

1-5. Causes of Positive Results in Major Crossmatch

6-9. What should be the information/tests included in compatibility testing

10. Formula for major cross matching.

11-15.. Explain why minor crossmatching is not used any more in blood banking.
Name _____________________________________________________ Date _______________

ANSWER SHEET MODULE 9

SAQ

1. Compatibility testing is composed of different types of testing. What are these three tests or
procedures included in compatibility testing? (10 points)

2. Why is it that serum is a much-preferred specimen for crossmatching and not plasma? (5 points)

3. Give the four phases of crossmatching and a brief description of them. (10 points)
QUIZ:

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11-15 .