If a Type and Screen order shows a positive antibody screen, do you automatically crossmatch units?

Yes, we automatically crossmatch two units, unless it is an outpatient who will not be transfused on that admission. Our policy states that a type and screen will be covered by two units withing five minutes of the request, and we cannot do an immediate spin crossmatch for positive antibody screens.

Ditto Banker girl!

If we had a type & screen with a positive, clinically significant antibody we would identify 2 antigen negative units, set them aside with a note but not crossmatch unitl the crossmatch was ordered. We did inform the clinical staff that the patient had a positive antibody screen and most of the time a crossmatch order arrived shortly.

I voted for automatic cross-matching, but, actually, if it were part of a work-up for surgery in say three or four weeks time, we would not cross-match on that sample. We would request one nearer the day.

This was when I was working in a hospital, of course.

At our facility if a pre-op patient has an antibody we automatically have 2 antigen negative units available. THe surgeon is contacted to make the decision if he wants them crossmatched. For in-house patients, we evaluate each case individually.

We crossmatch two antigen negative units automatically for all surgical cases and call to inquire if the physician would like any units crossmatched when we call the positive antibody result, on all other cases. We adopted this protocol because there was usually more than one physician involved in surgical cases and they may not always agree on whether blood was necessary (like never).

When patient is due for procedure, we crossmatch 2 units as per policy. This allows breathing space in event of a sudden loss. This would be for common antibodies with a reasonable % of antigen negative donors. Antibodies to a high incidence antigen is another matter. Once had an anti-Gerbich in a woman with PPH (back in Qz). On questioning, found the woman was a Paua New-Guinea native (wouldn't complete history on requests be a great thing). As luck would haveit, there was a large contingent of PNG native soldiers on training at a nearby barracks. Talk about mobilising the troops.

When patient is due for procedure, we crossmatch 2 units as per policy. This allows breathing space in event of a sudden loss. This would be for common antibodies with a reasonable % of antigen negative donors. Antibodies to a high incidence antigen is another matter. Once had an anti-Gerbich in a woman with PPH (back in Qz). On questioning, found the woman was a Paua New-Guinea native (wouldn't complete history on requests be a great thing). As luck would haveit, there was a large contingent of PNG native soldiers on training at a nearby barracks. Talk about mobilising the troops.

How did you do it Eoin?

Did you have some anti-Ge available to group the donors, or did you give cross-match compatible?

Nothing about BBk........I love the puppy pic! I have 2yr old female merle mantle.

When needs must Malcolm

- although I lived in a regional centre, we were lucky to have a collection / fractionation centre attached to the hospital - this was the middle of the night mind you - we took small EDTA from group compatible soldiers (from their army record) (who were at the centre within 10 minutes of a call going out to the Bandiana Baracks) - rechecked their group and used patient's sera as typing for the Gerbich (she had a ripper antibody). Also taken was a clotted spec and staff quickly put them through the testing on Axsym and other methods for HIV (2nd generation tests in those days), Hep B and VDRL.

Suitable donors had a unit taken. Grps (incl Ge using her sera) were redone on the bags. By then she was in bad shape on just plasma expanders, so 3 uncrossmatched were issued (post issue crossmatched) + 4 more full crossmatched. These were enough to get her through emergency hysterectomy.

We had three nurses and a doctor of the blood collection staff in, 2 of us in Bloodbank lab, 2 in biochemistry and one in virology. I had those staff with me after calling them within 15 mins.

It was a very hairy-scary night, but outcome was successful and afterwards I reflected that this was one of the days when I knew that being a Med Scientist was really very OK and that disaster plans did work and were not a waste of time.

The anti-Ge was confirmed the next day at the reference centre.

Regards

Eoin

We crossmatch two antigen negative units automatically for surgery and L&D only. Obviously if we had a case like Eoin's, that would not be an immediate thing (good job Eoin!), since we are not a donor center. In those cases, we usually call and recommend that they postpone surgery if at all possible. Otherwise we crossmatch on physician order.

Obviously every blood banks policy is to crossmatch 2 units on hold. But because the request is for a T/S, first you will need to notify the clinician so they can expect a delay in the results and perhaps help you with additional information about the patient which couldhelp you solve the antibody problem more efficiently. We have to identify what Ab the patient may have anyway before setting up units which may take longer depending how complex the reactions are.

George W made an executive decision to set up 2 units for prudent patient care.

Ours varies by situation. OR's are 2 units plus 2 ahead while in OR. L&D is notified and they let us know if we should crossmatch, however we do get ag negative available. Routine patients are TS only. ICU patients, it would depend on recent usage.

For those of you that antigen type units but don't crossmatch, do you charge the patient for the antigen typing if the units are never crossmatched? Also, what if you would need to have units sent in by your supplier who would charge you for all those antigen types? Did you charge the patient for those antigen typings too?

We used to notify the physician that the patient had an unexpected antibody and suggest that he order crossmatches for however many units he wanted. While we were waiting for his response, we would automatically proceed to find 2 units of antigen-negative, crossmatch-compatible packed cells. However, eventually the most common physician response was "Nah.......I don't think I'll need any." (Makes one wonder if he felt so confident, why did he order a Type & Screen to begin with?) So we no longer automatically spend the time and reagent expense to locate appropriate donor units.

However, I usually look up the patient's diagnosis, hemoglobin, planned surgical procedure, etc., and will do the additional testing and find a couple units if I think it's likely that the patient will need blood. (But we do not charge the patient for the additional testing unless the physician orders crossmatches.)

When needs must Malcolm

- although I lived in a regional centre, we were lucky to have a collection / fractionation centre attached to the hospital - this was the middle of the night mind you - we took small EDTA from group compatible soldiers (from their army record) (who were at the centre within 10 minutes of a call going out to the Bandiana Baracks) - rechecked their group and used patient's sera as typing for the Gerbich (she had a ripper antibody). Also taken was a clotted spec and staff quickly put them through the testing on Axsym and other methods for HIV (2nd generation tests in those days), Hep B and VDRL.

Suitable donors had a unit taken. Grps (incl Ge using her sera) were redone on the bags. By then she was in bad shape on just plasma expanders, so 3 uncrossmatched were issued (post issue crossmatched) + 4 more full crossmatched. These were enough to get her through emergency hysterectomy.

We had three nurses and a doctor of the blood collection staff in, 2 of us in Bloodbank lab, 2 in biochemistry and one in virology. I had those staff with me after calling them within 15 mins.

It was a very hairy-scary night, but outcome was successful and afterwards I reflected that this was one of the days when I knew that being a Med Scientist was really very OK and that disaster plans did work and were not a waste of time.

The anti-Ge was confirmed the next day at the reference centre.

Regards

Eoin

Thanks Eoin. Sounds like you did a really fantastic job.

I'm glad it was you and not me!!!!!!!!

:D

We recently installed Dia Med Micro Typing System, and doing Type & Screen , our policy is

to Cross match Negative Blood Units if Ab screen is Positive

We only set up units on inpatients. New antibodies on outpatients just generated a call from the medical director to the attending physician.