In-vivo Crossmatch

[L106]

See......besides pathologists, we also enjoy working with Blood Bankers who are well-resting and not cranky!

By the way, Liz, I thoroughly enjoyed your post in a different thread when you described your facility (and some of the challenges that are involved.) It was very interesting. Thanks!

Donna

[rravkin@aol.com]

Oh my goodness, I do feel awfully embarrassed. However quoting the AABB Technical Manual:

Copyright © 2008 by the AABB. All rights reserved.

CHAPTER 20

Hemotherapy Decisions and Their Outcomes 579

"Other situations in which all units appear

incompatible include the presence of alloanti-

bodies to high-prevalence antigens, to multi-

ple antibody specificities, or both. If serologic

testing fails to resolve the problem or if the

problem is identified but time is not sufficient

for acquisition of compatible units, consulta-

tion between the transfusion service medical

director and the patient’s clinician is advised

to weigh the risks and benefits of transfusion

and to consider what alternative therapies are

suitable. If the need is sufficiently urgent,

ABO-compatible but crossmatch-incompati-

ble red cells may have to be given. Depending

on the alloantibody’s specificity (or the possi-

ble specificities that have not been ruled out),

incompatible transfusion does not always

result in immediate hemolysis, and the in-

compatible cells may remain in the patient’s

circulation long enough to provide therapeu-

tic benefit.

If time permits and if equipment is avail-

able, the survival of a radiolabeled aliquot of

the incompatible cells can be determined, but

that determination is beyond the capability of

most laboratories and is rarely needed. An

“in-vivo crossmatch†can be performed by

cautiously transfusing 25 to 50 mL of the

incompatible cells, by watching the patient’s

clinical response, and by checking a 30-

minute posttransfusion specimen for hemo-

globin-tinged serum. Such assessment does

not guarantee normal survival but can indi-

cate whether an acute reaction will occur. If

no adverse symptoms or hemolysis are ob-

served, the remainder of the unit can be

transfused slowly with careful clinical moni-

toring. If the transfusion need is life-threaten-

ing, RBC units may sometimes be given

without special testing, but the clinical staff

should be prepared to treat any reaction that

may result."

So since it is the AABB and recent I may add, what are your opinions on this???

Blush Blush !!!

Liz :-D

Thank you Liz for this info. I always learn something new here and I greatly appreciate it. This procedure is probably used in extreme rare cases do to the litigation potential.

[Liz]

See......besides pathologists, we also enjoy working with Blood Bankers who are well-resting and not cranky!

By the way, Liz, I thoroughly enjoyed your post in a different thread when you described your facility (and some of the challenges that are involved.) It was very interesting. Thanks!

Donna

Hi Donna,

I really appreciate what you wrote. Life here becomes routine and a habit, and I never once thought about the challenges that we overcome daily. Thank you!!! That was nice to know, I feel good about our work now..

Cheers

Liz

[Liz]

Thank you Liz for this info. I always learn something new here and I greatly appreciate it. This procedure is probably used in extreme rare cases do to the litigation potential.

Absolutely, only in extreme cases, as rarely will I and any attending physician agree to this.

Thank you for your kind words

Liz

[jeanne.wall]

Liz

The technique has been around forever and I'd say a fair number of folks still have the procedure in their procedure manual. I think it has more to do with providing comfort to the pathologists and physicians. Those folks want to make sure you can say "compatible" to something. My approach would be to not bother with the "in vivo" crossmatch if I can say compatible to something. I use to just note compatible with absorbed plasma, or whatever. As you have seen from the comments most folks don't think the technique is going to offer much benefit, but if it is needed to assist in comfort levels because you can't use the word "compatible" with something, I'd use it and be done with it.

Jeanne