JLF

I asked AABB to clarify and received this response:
Please refer to AABB Blood Banks and Transfusion Services Standard 5.16 Crossmatch section (30th edition).
 
Standard 5.16.1 states… “The crossmatch shall use methods that demonstrate ABO incompatibility and clinically significant antibodies to red cell antigens and shall include an antiglobulin test as described in Standard 5.14.3.”
 
Standard 5.16.1.1 states “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.”
 
Standard 5.16.2 states… “If a computer system is used as a method to detect ABO incompatibility, the following requirements shall be met:….”  See standards 5.16.2.1 – 5.16.2.5.
 
In summary, if you are doing an extended/Coombs crossmatch, you also need a method to demonstrate ABO incompatibility.  This is most often done by an immediate spin crossmatch.  Check your manufacturer’s instructions (Gel Cards, PeG, LISS, etc) to see if these reagents state that they also detect ABO incompatibility.  Most of the time they do not, which is why an immediate crossmatch is performed along with the antiglobulin test.
 
An electronic crossmatch can be done in lieu of the immediate spin phase if the requirements from Standards 5.16.2.1 – 5.16.2.5 have been met.  Keep in mind that an electronic crossmatch can only detect ABO incompatibilities and does not include an antiglobulin test.  So if the patient needs an extended/Coombs crossmatch, how is the ABO incompatibility being demonstrated?  Is the LIS validated to combine an electronic crossmatch with an extended/Coombs crossmatch (this is usually no), does the antiglobulin test detect ABO incompatibility (this is usually no), or do you need to do an immediate spin crossmatch?
 

This actually has helped. I have been trying to implement Liquid Plasma and this may help.

If the blood is labeled as uncrossmatched and placed in a cooler or monitored refrigerator, it should be acceptable to apply the patient's name and MRN at the bedside just before transfusion, in an emergency situation. If anyone is using a Bloodsafe refrigerator to store emergency uncrossmatched blood in an ER, the patient identity is established in the clinical area by clinical personnel. I do not see how this is different. Having a made up dummy name complicates the process if the name is not being assigned by patient registration. In a true emergency situation or mass casualty situation occurs, the most accurate means of identifying who received what would be at the bedside, especially if there are multiple patients receiving transfusions. A patient chart label could be applied to the Transfusion tag prior to start of the unit.

It is always a good idea to have at least one set of 3% screening cells. Even if you are only buying one set a month. You can always dilute to 0.8% and use in Gel testing system to avoid waste. It is even a good idea to have the 3% set from a different vendor. It allows more flexibility and is worth the cost in our experience.