Type & Screen, Immediate Spin Crossmatch

[ckcheng]

I would like to know some current practice of T&S, IS crossmatch.

 

(1) Do you retype the patient's ABO/Rh if there is no historical blood group?

 

(2) Do you recheck the donor blood with a segment attached to the blood bag?

 

(3) In case of massive transfusion, and running out plasma in the sample tube, would you shift back to unmatch using Group O red cells even the patient is Group A or B?

 

(4) How do you issue blood to neonate? Since you might not have sample to do immediate spin?

 

Thank you very much.

Edited July 16, 2014 by ckcheng

[David Saikin]

1. Yes

2. Yes, but upon receipt only unless there is a defined transfusion reaction

3. Give ABO group specific once type is verified

4. VERY RARE to transfuse neonate here - would give O Neg rbcs/AB plasma

Edited July 16, 2014 by David Saikin

[SMILLER]

Pretty much the same as David S. above, here.

Scott

[AMcCord]

Pretty much like David S. with the exception of the neonate. We do get enough sample to perform an immediate spin crossmatch and we give type specific blood when possible. Our procedure also allows us to use mom's blood for the crossmatch if we have a current sample/antibody screen, which we often do, and give O neg blood for transfusion. We don't transfuse very many babies here.

Edited July 16, 2014 by AMcCord

[Andersli]

Same as David for 1 & 2. 

 

3)  During a massive transfusion, we only give type O RBCs emergency release.  We do perform the crossmatch post transfusion, but only on the first 10 units given.  After that we put in a comment that crossmatch is not required due to massive transfusion. 

 

4)  For our neonates we perform a type and screen usually on admission.  If we detect anything, then we would use a sample from the mom to ID and order antigen negative blood and crossmatch.  Majority of our neonates have a negative antibody screen and we only give type O RBCs, unless we have a directed donation.  In those situations where the neonate is type A, B or AB and the directed donor is not type O, we do perform compatibility testing prior to the transfusion of the first aliquot. 

 

Lisa

[tbostock]

1. Yes, but with a separately drawn sample

2. Yes, upon receipt or for a transfusion reaction

3. No, we would keep them in type specific as long as we had the two blood types on file. After 10 units transfused you can skip the IS crossmatch, but we verify that we have the right type in our hands and we deliver it directly to the patient.

4. We have to have a sample for a neonate, usually it is the cord blood if delivered here, or we draw another sample if the baby was transferred in. We do not do the second type requirement on the baby since we exclusively give type O Neg red cells here.

[ckcheng]

Thanks for the comments.

 

However, since computer system is not developed or during downtime, the only way we issue blood is via immediate spin, if there is a running out of plasma to perform immediate spin for final checking of the blood group, how can I issue group specific blood for transfusion, cuz I can neither put [iS  -compatible] nor [EXM - compatible] in the crossmatch form. 

 

Thanks.

[David Saikin]

You need to have a downtime policy/procedure inclulding some type of manual backup for patient related info (could be a stand alone computer/desktop).  If you run out of specimen - I guess you should tell the docs you need more, if you can get it.  If you have given more than 10u your MTP should address the fact that you don't need to perform xm on an emergent basis.

[jojo808]

1.  Yes

2.  Yes

3.  No, when MTP is implemented (>10 units in <24 hours, or 4-5 units/hr) we start an abbreviated or "electronic" crossmatch

     where we also skip an immediate spin crossmatch and give type specific units.

4.  not applicable to our hospital. 

[aafrin]

Same as Terri above, but we use O Rh Positive red cells, if both mother and baby are Rh Positive otherwise Rh Negative. We also do blood group from bag segment when releasing red cells or FFP.

[Mosaics]

(1) Do you retype the patient's ABO/Rh if there is no historical blood group?

We use gel and tube methods.  We use gel to first get the ABO/Rh Reverse type, then we redo types, forward typing only, in tube on same specimen.  We especially repeat this procedure on cord bloods because not all weak D's are picked up in gel method. 

If the doctor has ordered blood on the patient, we ask for another specimen to be drawn to verify blood type (we do in tube, forward typing only).

 

(2) Do you recheck the donor blood with a segment attached to the blood bag?

Forward typing only.  We only do D on Rh negative blood.

 

(3) In case of massive transfusion, and running out plasma in the sample tube, would you shift back to unmatch using Group O red cells even the patient is Group A or B?

I have not come across this too often.

 

(4) How do you issue blood to neonate? Since you might not have sample to do immediate spin?

We have O negative blood that is CMV negative, irradiated, and sickle cell negative blood for neonates. We make aliquots when the doctor orders blood, and only do crossmatches if mother has antibody.