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IS vs AHG Crossmatch


armymt2002

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I searched the forum and cannot find anything about this topic. I am sure it has been discussed. The facility I work at (military hospital in Germany) still does AHG crossmatches. I would like to do immediate spins on those with negative antibody screens but am meeting resistance from my technical supervisor. We do have a very transient patient population and get many servicemembers who are injured in the war. We don't know what they got in the hospitals down there. Should we stay with an AHG crossmatch or go to IS? How do I convince my technical supervisor that this is safe. Thanks.

Kristine

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I am not sure how you will be able to convince your technical supervisor, but immediate spin crossmatches for patients with negative antibody screens and no previous history of antibodies is pretty well standard. If he/she is worried about stimulating an weak titered antibody, the AHG crossmatch might not help if the antibody screen is negative. If an antibody is re-stimulated, in most cases the patient will just develop a positive DAT and slowly destroy the red cells until it is discovered, at which time it can be identified and then handled with AHG crossmatched, antigen negative units. Every time a patient is transfused there is that chance that an antibody could form and an AHG crossmatch does not prevent that risk. I think as long as the quidelines in Standards are followed, you are doing the best for your patients. Good luck!

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If work load, staffing or turn-around-time are issues IS crossmatches can be a big help without compromising safety. With your transient patient population the patient history is probably very limited. Is this where your technical supervisor is having problems? Another question I have: is IS crossmatches standard in other military hospitals or fairly uncommon? This might also help justify if other facilities have gone to IS. Bottom line is that it is standard throught much of the US and the world. Unless you can address the technical supervisors base concerns there may be little hope until they retire or move on.

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I agree with the posts already listed. One additional point of interest to document any concerns about the patient population would be to look at the number of AHG crossmatches you have performed over a specific period of time - perhaps 6 months. What is the percentage of incompatible crossmatches at AHG that you have encountered on patients with negative antibody screens and no history of clinically insignficant antibodies? One additional step might be to use a two cell screen where the manufacturer provides screening cells that demonstrate homozygous expression for the major significant antibodies -- or you could use a three cell screen.

Hope this is helpfu.

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