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AHG Crossmatch


jschlosser

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Our facility transfuses only about 200 RBCs a year so we are small. I'm a generalist who works three 12 hours days in the lab and in my "spare time" am considered the blood bank supervisor so I visit this site a lot for answers. My question is how archaic are we because we perform AHG(gel) and IS(gel) crossmatches on every RBC transfusion despite a negative antibody screen?

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It very much depends if your group and antibody screen are performed by automation, and the result transferred to your computer by the automation or whether your screen is performed manually and put onto the computer manually.

 

If there is no human intervention, the you could perform electronic issue, but if there is any human intervention, then an AHG (serological) crossmatch is the order of the day.

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If your screen is negative (and there is no history of antibodies), you could do an immediate spin only crossmatch.  That would save quite a bit of time.  See AABB standard 5.16.1.1:  "If no clinically significant antibodies were detected in tests performed in Standard 5.14.3 and there is no record of previous detection of such antibodies, at a minimum, detection of ABO incompatibility shall be performed."

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Like they say above - if your ab screeen is negative and no history of antibodies the immed spin xm is pretty much the standard of care (at least in almost all the places I know or have inspected).  My only kudo to this is if you have a patient who does not have a reverse grouping - I think it is prudent to perform the ahgxm in this instance.  I have not seen a standard that addesses this but . . . if you don't have detectable abo isoagglutinins your i.s. xm cannot be valid (in my opinion).

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Maybe I am over reading this or maybe because its Friday but - if you are in the USA and are AABB or CAP accredited, yes, you are very archaic because nothing in these standards require a full crossmatch unless you have a history of antibody issues! My guess is that your institution is nervous about blood banking in general with such a low number of products going out the door and someone long ago felt that a full crossmatch on everyone insured the safety of the product for the patient? How's that for pop psychology?

Do you have a medical director you can approach with changing to immediate spin crossmatches on patients with a history of negative antibody screens? I had to do this at a larger institution near Boston in 2000 because the pathologist had no blood bank background and was petrified we would kill someone. I had to show him all kinds of scientific articles that "proved" that IS was OK for many patients. Good luck!

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