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compatibility testing blakes flashcards

1
Q

Blood transfusions needed to

A

Recipient Identification & Sample Collection and Processing

Blood Bank Testing
Blood Type and Antibody

Compatibility Blood Selection and compatibility

Recipient Identification & Transfusion

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2
Q

Compatibility testing involves all the steps in the

A

identification and testing of a donor unit and a
proposed recipient’s blood

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3
Q

Crossmatching is a part of

A

is part of compatibility testing

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4
Q

Compatibility Testing

Involves mixing _________

No what or what indicates compatibility

A
  • Involves mixing donor RBCs and recipient serum or plasma
  • No agglutination or hemolysis indicates compatibility
  • Agglutination or hemolysis indicates incompatibility
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5
Q

Crossmatching serves and provides secondary means of

A
  • Serves as a double check of ABO errors
  • Provides a second means of detecting antibodies
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6
Q

According to the AABB Standards, crossmatching:

A
  • “shall use methods that demonstrate ABO incompatibility
    and clinically significant antibodies to red cell antigens and
    shall include an antiglobulin phase.”
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7
Q

IS Crossmatch

A
  • IS crossmatching is
    performed when the recipient has
    no evidence of an antibody
  • In the current sample OR
  • In the historical record
  • Recipient serum and donor RBC
    suspension are mixed and
    immediately centrifuged
  • Fulfills AABB standards
    for detecting ABO incompatibility
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8
Q

Extended crossmatch

A
  • All phases (IS, 37° C, antihuman
    globulin [AHG]) are performed if the
    patient demonstrates a
    clinically significant antibody
  • In the current sample OR
  • In the historical record
  • If the patient has
    autoantibody, autoadsorbed serum
    may be used
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9
Q

Causes of Positive Results in the
Serologic Crossmatch

A

 Incorrect ABO grouping of the patient or donor

 An alloantibody in the patient’s serum reacting
with the corresponding antigen on donor RBCs

 An autoantibody in the patient’s serum reacting
with the corresponding antigen on donor RBCs

 New alloantibody

 Alloantibody to low-incidence

 Warm-reactive autoantibody

 Donor positive DAT

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10
Q

Computer
Crossmatching
(EXM)

Makes a final check of

A

ABO
compatibility in the selection of
units instead of a serologic IS
procedure

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11
Q

Computer
Crossmatching
(EXM)

The recipient must not have what

A

The recipient must not have an
antibody (or antibodies) in the
current sample or have a
history of antibodies

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12
Q

Computer
Crossmatching
(EXM)

what are used to provide anther measure of safety

A

Bar codes

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13
Q

Limitations of crossmatching

A

 An acceptable crossmatch
does not guarantee
a successful transfusion
– Adverse transfusion
reactions may still occur
– A negative antibody screen
does not guarantee that the
recipient does not
have significant antibodies
– A compatible crossmatch
does not
Guarantee survival of RBCs

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14
Q

Pretransfusion Will…

If performed correctly

A

Verify in most
cases components are ABO
Compatible.

Detect most
clinically significant unexpected
antibodies.

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15
Q

Transfusion Request Form

A
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16
Q

Transfusion Request Form

can be

A

Can be oral, electronic or written and must include information sufficient to positively
ID patient.

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17
Q

Transfusion Request Form

How many identifiers required and what types

A

2

  • Patient full name
    *Unique ID number
    *Other identifier
    *DOB
    *Driver’s license number
  • Photographic ID
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18
Q

Transfusion Request Form

what is a drug and requires what

A

Blood is a drug and requires physician prescription.

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19
Q

Transfusion Request Form

Special Needs:

A

CMV negative, Irradiated, etc.

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20
Q

Transfusion Request Form

Reject Requisition if

A

Information incomplete or lacking

inaccurate

Illegible

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21
Q

Specimens

General Patients

A

 Expires on 3rd day at midnight

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22
Q

 Neonates specimens

A

 Expires at 4 months of age
 Give type O RBCs

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23
Q

 Elective Surgery Patient’s specimens

A

 Up to 30 days prior to surgery
 Restrictions:
1. No history of alloantibodies
2. No history of pregnancy or transfusion within the last 3 months
3. Negative antibody screen

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24
Q

Recipient Blood Sample

Patient identification and sample labeling

A
  • Full Name, Unique ID Number, Date and Time, Phlebotomist ID
  • Labeled at patient bedside
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25
Recipient Blood Sample Sample collection tubes
* Samples may be plasma or serum
26
Recipient Blood Sample Age of sample
* The limit is 3 days if the patient has been recently transfused or is pregnant * Infants - specimen good till neonate turns 4 months
27
Recipient Blood Sample Sample collection and appearance
*Hemolyzed samples or samples contaminated with intravenous fluids must be re-collected
28
Recipient Blood Sample Specimen Storage
* Sample and sample from donor RBCs must be stored at 1-6oC for 7 days AFTER transfusion.
29
Previous Records Current blood ABO and D typing must be compared with results performed over
the past 12 months
30
Previous Records * SECOND sample to confirm
ABO/Rh if no history (use of PPID eliminates need for second sample)
31
Previous Records The most significant information is
history of clinically significant antibodies
32
Previous Records * Specificity compared to ______ * Regardless of current results, _________________________
* Specificity compared to current antibodies detected. * Regardless of current results, antigen negative blood MUST be provided.
33
Previous Records Previous records must also be consulted for
any significant event related to testing or transfusion
34
Pretransfusion Testing Type and Screen
* ABO and D typing * Discrepancies should be resolved before transfusion * Antibody detection * Unpooled reagent RBCs should be used * When done correctly, will detect 99.9% of unexpected antibodies
35
Pretransfusion Testing Crossmatching demonstrates what
* Demonstrates ABO incompatibility and clinically significant antibodies to RBC antigens
36
Repeat Testing of Donor Blood  Whole blood and RBCs must be re-typed to
confirm the correct ABO labeling
37
Repeat Testing of Donor Blood ABO testing is performed on
all units
38
Repeat Testing of Donor Blood D testing is performed only
on D-negative units
39
Repeat Testing of Donor Blood Weak D testing is not.
required
40
Repeat Testing of Donor Blood Records are kept for
5 years
41
Selection of Donor Units\ D Antigen
* D-negative units should be given to D- negative recipients, especially women of child-bearing age * Antigen-negative blood should be given if anti-D antibody is formed
42
Selection of Donor Units Recipients with Antibodies
* Antigen-negative units are recommended for the following antibodies: * ABO * Rh * Kell * Duffy * Kidd
43
Probability in Blood Banking
 Probability of finding antigen negative units  Frequency of antigen negative * 100 – frequency of antigen # of units needed/frequency of antigen negativity
44
Probability in Blood Banking formula
of units needed/ Frequency of antigen-negative
45
The patient has anti-K. How many units will you need to antigen type to find 4 compatible units?
4/.91= 4.39, approximately 5 units
46
The patient has anti-K and anti-C. How many units will you need to antigen type to find 4 compatible units?
4/ (.91)*(.32)= 13.7
47
Labeling ("Tagging") Blood Products Requirements for the tag on a crossmatched donor unit:
* Recipient's two independent identifiers * Unique donor unit number or pool number * Interpretation of crossmatching
48
Labeling ("Tagging") Blood Products Required to verify and document at time of issue:
* Recipient's two independent identifiers * Recipient's ABO group and Rh type * Unique donor unit number or pool number * Donor ABO group and, if required, Rh type * Interpretation of crossmatch * Special transfusion requirements * Expiration date * Date and Time of issue
49
Issuance of Blood Components -The same approach used to properly identify the patient before _____________
 The same approach used to properly identify the patient before sample collection must now be applied to verify that the recipient is indeed the same person who provided the initial blood sample for testing.
50
Issuance of Blood Components The actual product and accompanying record of testing must be ___________
verified as relating to the same donor unit number.
51
Issuance of Blood Components  The bedside check just prior to blood administration is
is the most critical step for prevention of mistransfusion.
52
Issuance of Blood Components A statement of compatibility must be retained as
part of the patient’s permanent medical record if the blood is transfused.
53
Issuance of Blood Components A label or tie tag must be attached to the
unit stating the identity of the intended recipient, the results of pretransfusion testing, and the donor unit number.
54
Issuance of Blood Components  Machine-readable, especially barcode patient- blood unit identification, is ideally suited to
is ideally suited to bedside check requirements and has been recently reported to significantly improve transfusion practice.
55
Issuance of Blood Components
56
Issuance of Blood Components Use of radio frequency identification devices (RFID) to improve
identification at every stage of pretransfusion testing.
57
Issuance of Blood Components Whatever system is used, the information should be verified at least
twice before the transfusion of the blood product.
58
Issuance of Blood Components Before blood is taken from the blood bank to the patient treatment area, check
 ABO and Rh results  Clinically significant unexpected antibodies  Adverse reactions to transfusion
59
Issuance of Blood Components Before transfusion is initiated, a reliable __________
60
Issuance of Blood Components  A system of positive patient identification by comparison of
wristband identification and compatibility forms must be followed strictly.
61
Unused Blood Products Blood products may be reissued if
the closure has not been entered and If the unit has been kept between the upper and lower temperature conditions (1° to 10° C for RBCs) If the unit was stored at room temperature, it should be returned within about 30 minutes or within a time determined by the facility
62
Emergency Release
Release must be signed by physician Tag on donor unit indicating emergency release: compatibility and/or infectious disease Patient name and identifiers Donor unit number(s), ABO and D typing, expiration date Retain segments from units for crossmatching
63
A massive transfusion is
is a total volume exchange of blood within 24 hours
64
Massive Transfusion Group O, D-negative unit is given in
an emergency
65
Massive Transfusion If a D-negative unit is unavailable, group
group O, D-positive blood can be given to D-negative individuals who are not of child-bearing age
66
Massive Transfusion ABO-identical unit is given once
the blood group is established in the recipient
67
Maximum Surgical Blood Order Schedule Average number of blood units used for surgical procedures is determined in a __________
facility
68
Maximum Surgical Blood Order Schedule This number is used as the
standard blood order for surgical procedures
69
Maximum Surgical Blood Order Schedule It may also be used as a guide for the number of
autologous units that can be donated
70
Typing and Screening Procedure A typing and screening (T/S) procedure includes
ABO, Rh, and antibody screening
71
Typing and Screening Procedure A T/S is ordered when a
surgical procedure uses less than 1 unit of RBCs
72
Typing and Screening Procedure Crossmatching is performed on the sample if
Blood is needed
73
Typing and Screening Procedure The goal of a T/S is to conserve
the blood inventory
74
Crossmatching Autologous Blood
- Procedures must be in place to ensure that units are located and transfused to the recipient  The process is monitored manually or through computerized tracking methods
75
Crossmatching Infants Younger Than 4 Months of Age
 ABO and D typing must be performed  Serum testing is not necessary  Antibody screening is performed on the infant’s or mother’s sample  If antibody is present, antigen-
76
Intrauterine Transfusions Blood for intrauterine transfusion must be compatible with
 Blood for intrauterine transfusion must be compatible with maternal antibodies capable of crossing the placenta.
77
Intrauterine Transfusions no fetomaternal what or what Check for Crossmatching testing is performed using
 Fetal ABO and Rh known/not known situations for group-specific/group O Rh negative products  Check for maternal antibodies/donor antigens.  No fetomaternal ABO or Rh incompatibility  Crossmatch testing is performed using the mother’s serum sample.
78
Non-RBC Products
Frozen plasma, platelet concentrates, and Cryoprecipitate do not need to be crossmatched
79
Non-RBC Products Plasma products should be
ABO serum compatible
80
Non-RBC Products * Cryoprecipitate and platelet Concentrates may not need
to be ABO compatible
81
Non-RBC Products Apheresis platelets and granulocyte concentrates may
need to be crossmatched if they contain more than 2 mL of RBCs
82
Future of Transfusion Medicine
 Patient blood management (PBM) programs  Personalized medicine.

Immunohematology - 4444 (17 decks)

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