Blood Grouping on bags prior to issue

[aafrin]

Hello,

 

I have a query - do you all do blood group of blood bag on slide just before issue? We do.

 

The reason I am asking this is that two days ago a B Positive patient was cross-matched with AB Positive Bag (which was mislabeled as B Positive) and found to be compatible with manual gel technique. At the time of issue when slide group showed AB Positive the blood was not issued & re-checked. The donor wasA2B positive; the reaction with anti-A was +2 in tube method and the serum group also tallied.

 

We re-did the cross-match 3 times in gel, even with washed cells as well and every time it was compatible. I am confused how this was possible.

 

By tube method it looked compatible to the naked eye, but did show +1 clumps under the microscope after incubation and IAT procedure. Same in immediate spin also.

 

We even do blood group from plasma segment (reverse type) at the time of FFP issue.

 

I am really worried of the consequences if that blood had been transfused.

[R1R2]

When you say manual gel technique are you using IgG or buffer card or both?  Do you do a repeat ABO on the unit when you receive it from the supplier in gel or tube or just a slide test before issue?  Did this occur in the US?

[SMILLER]

Also, in the US, an IS crossmatch is required in cases like this.  Apparently, gel and solid-sphase do NOT detect all ABO incompatabilities.

 

Scott

[aafrin]

We are using IgG+c3d card for cross-matching.

 

We are not in US, but we do repeat ABO & Rh upon receipt of blood by tube and at the time of issue by slide. Apparently the tech who did the group by tube made a mistake.

 

But the IS cross-match was also negative until carried further after incubation to  IAT,  when it showed +1 agglutination under the microscope. If seen visually it looked negative.  That was frightening.

[Sheryl Kochman]

There have been reports that some weak ABO incompatibilites are not detected in low ionic atrength test systems. The gel test system is a low ionic strength test system and can miss some very weak ABO incompatibilities. That is the reason that in the US, the IS crossmatch is supposed to be done in test tubes and NOT in the gel system.

[R1R2]

This may be the "perfect storm".  Error when doing initial reytpe of the unit, a unit mislabeled as a group B by the blood center and crossmatched with a group B patient with a (probably) weak reverse.  I am also thinking that the unit was not an A2B but a different subgroup.   I asked if you were in the US because the error by the blood center may be FDA reportable.