GUIDELINES FOR PRE-TRANSFUSION TESTING (TYPE AND SCREEN AND CROSSMATCH)

Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

1. Policy Statement
Blood transfusion policies must be developed for each facility administering blood components and blood products. These policies must address: 1.1 The transfusion of group specific and/or group compatible components. Identification of the recipients ABO Group and Rhesus (Rh) type. The significance of the ABO and Rh systems with regards to transfusing ABO and Rh group specific compatible blood components and blood products. A policy shall be in place for the transfusion of Rh positive red cells to an Rh negative recipient when the inventory of Rh negative red cells is impacted such as in cases of trauma, massive transfusion, and emergency situations or if red cells are in short supply

1.2 1.3

1.4

2. Definitions
2.1 Antibodies: specific immunoglobulins produced in response to an antigenic challenge. Antigen: a foreign substance that can elicit an immune (antibody) response. Compatibility Testing: the activities performed before transfusion to ensure that a blood component will not produce a harmful reaction with the recipients blood. Crossmatch: a method used to detect incompatibilities between donor and recipient blood prior to transfusion.

2.2

2.3

2.4

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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

2.5

Type and Screen: a method used to determine ABO Group, Rh Type and screen for antibodies on recipients and donors.

3. General Information
3.1 A type and screen tests a patients blood specimen for ABO group and Rhesus (Rh) type and screens the patients serum/plasma for clinically significant red cell alloantibodies. A crossmatch confirms the ABO compatibility between the patient and the donor units. Tests for detecting red cells antigens and clinically significant antibodies help prevent incompatible reactions.

3.2

3.3

3.4

Two major antigen systems on the red blood cell are the ABO system and the Rhesus (Rh) system. 3.4.1 The ABO system consists of four different blood groups A, B, AB and O which are determined by whether an individuals red cells carry antigen A or antigen B, both antigen A and antigen B or neither. 3.4.1.1 Group A individuals have the A antigen present on their red blood cells. 3.4.1.2 Group B individuals have the B antigen present on their red blood cells. 3.4.1.3 Group AB individuals have antigens A and B present on their red blood cells. 3.4.1.4 Group O have neither antigens A nor B present on their red blood cells The Rh system encompasses multiple antigens. The Rh (D) antigen is more immunogenic than other Rh antigens. The Rh type is identified by the presence or absence of the Rh (D) antigen. 3.4.2.1 Rh (D) negative indicates that the Rh (D) antigen is not present on the red cell.

3.4.2

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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

3.4.2.2 Rh (D) Positive indicates that Rh (D) antigen is present on the red cell. 3.5 In order for the red blood cells of a recipient to be compatible with those of a donor, the ABO group, Rh and any antibodies must be identified. 3.5.1 Normal healthy individuals make antibodies against the A and B antigen. The antibodies are found in the individuals plasma and are referred to as naturally occurring. 3.5.1.1 Group A individuals have anti B antibodies 3.5.1.2 Group B individuals have anti A antibodies 3.5.1.3 Group O individuals have anti A and anti B antibodies 3.5.1.4 Group AB individuals have no antibodies

3.6 Universal Blood 3.6.1 Blood group O is considered the universal donor for red cells because it lacks the A and B antigen. 3.6.1.1 If the recipients blood group is unknown or if group specific blood is not available and there is an immediate clinical need to transfuse, group O Rh negative can be considered for recipients of all blood groups. 3.6.2 Blood group AB is considered the universal donor for platelets, plasma and cryoprecipitate because the plasma products lack the A and B antibody in the plasma. 3.6.2.1 If recipients blood group is unknown and there is an immediate clinical need to transfuse platelets, plasma and/or cryoprecipitate group AB can be considered for recipients of all blood groups.

4. Quality Control
4.1 Samples used for ABO and Rh typing must be properly labelled as per facility policy. All blood components for transfusion shall be checked for ABO and Rh compatibility; refer to Table 1, 2 and 3 for ABO & Rh Compatibility.

4.2

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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

4.3

ABO and Rh shall be checked on the compatibility label/tag attached to blood component, recipient blood group and Rh or crossmatch report on the medical chart and the Canadian Blood Services blood component label. If a discrepancy is found in ABO and/or Rh the Transfusion Medicine Laboratory shall be notified and the blood component shall not be transfused until the discrepancy is resolved.

4.4

5. Process or Procedure
5.1 A type and screen and crossmatch must be requested prior to a recipient receiving red blood cells. For recipients who have not been transfused red blood cells or platelets or pregnant in the past 3 months, specimens can be used for 7 days or a time specified by the Transfusion Medicine Laboratory policy. If the recipient has been transfused or pregnant within the past three months, specimens for type and screen and compatibility are acceptable for 96 hours. The recipients blood work history must be reviewed to confirm the date of collection is within the acceptable time period. If the time period is not acceptable, another specimen must be collected. 5.4.1 If the time period is not acceptable a new specimen must be collected and a type and screen preformed on the new specimen. A crossmatch should be requested for recipients whom a blood transfusion is intended to ensure compatible blood can be placed on reserve for the recipient. Transfusion of red blood cells shall be ABO compatible. Rh positive recipients may receive either Rh positive or Rh negative red blood cells.

5.2

5.3

5.4

5.5

5.6 5.7

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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

5.8

Rh negative cellular components should be transfused to recipients who are Rh negative. A policy shall be in place for transfusion of Rh positive red cells to Rh negative recipients when inventories of Rh negative red cells are reduced. Rh negative red cells shall be transfused to Rh negative female recipients (at or below child bearing age) except in life threatening situations when Rh negative red cells are not available.

5.9

5.10 A policy shall be in place for the transfusion Rh positive red cells to an Rh negative recipient when the inventory of Rh negative red cells is impacted such as in cases of trauma, massive transfusion, and emergency situations or if red cells are in short supply. 5.11 Recipients shall be transfused with plasma that is ABO compatible with the recipients red cells. 5.11.1 Rh specific components for plasma are not required. 5.12 Recipients should be transfused with cryoprecipitate that is ABO compatible with the recipients red cells. ABO group substitution shall be required when ABO compatible cryoprecipitate is not available. 5.12.1 Rh specific components for cryoprecipitate are not required.

6. Records Management
6.1 All transfusion records in the recipients medical chart, including pretransfusion serological test results and worksheets for identification of clinically significant antibodies shall be retained in accordance with health care facilitys policy for medical records. Transfusion request forms for serologic tests shall be retained for one month. Records for the collection of a blood sample including the date and time of collection and the identification of the person taking the sample shall be retained for 1 year.

6.2

6.3

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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

Table 1: Selection of ABO Compatible Donor Red Cells 1st Choice Group O Group A Group B Group AB 2nd Choice none Group O Group O Group A 3rd Choice none none none Group B 4th Choice none none none Group O

Recipient O A B AB

NOTE: Rh negative recipients should be transfused with Rh negative red cells. A policy shall be in place for the administration of Rh positive red cells to any Rh negative recipient when Rh negative red cells are in diminished supply. Table 2: Suggested ABO Group Selection Order for Platelets

Recipient ABO O A B AB

1 Choice O A B AB

st

Component ABO Group 2nd Choice 3rd Choice A B AB (B) AB (A) (A) (B)

4th Choice AB (O) (O) (O)

(Blood groups in parenthesis represent choices with incompatible plasma, listed in least incompatible order.) NOTE: When Rh positive platelets are given to an Rh negative patient, Rh Immune Globulin should be administered.

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This document may be incorporated into each Regional Policy/Procedure Manual.
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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

Table 3: Suggested ABO Group Selection Order for Plasma Recipient ABO O A B AB Component ABO Group 2nd Choice 3rd Choice A B AB (B) AB (A) (A) (B)

1 Choice O A B AB

st

4th Choice AB (O) (O) (O)

(Blood groups in parenthesis represent choices with incompatible plasma, listed in least incompatible order.) NOTE: Rh is not considered when transfusing plasma components.

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This document may be incorporated into each Regional Policy/Procedure Manual.
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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

7. References
7.1 Becher. M. Technical manual. 15th ed. Bethesda, Maryland: American Association of Blood Banks; 2005. Callum. JL, Pinkerton PH. Blood easy 2, blood transfusion, blood alternatives and transfusion reactions, a guide to transfusion medicine. 2nd ed. Toronto (ON): Sunnybrook and Womens College Health Sciences Centre; 2005. Clarke. G, & Blajchman. M. Clinical guide to transfusion. 4th ed. Toronto (ON): Canadian Blood Services; 2006. Canadian Standards Association. Blood and blood components, Z90210.Mississauga (ON): Canadian Standards Association; 2010. Canadian Standards for Transfusion Medicine. CSTM standards for hospital transfusion services. Version 3.0. Ottawa: Canadian Society for Transfusion Medicine; 2011. Manitoba Provincial Blood Programs Coordinating Office. Manitoba transfusion medicine best practice resource manual for nursing. Version 1.Winnipeg (MB): Manitoba Provincial Blood Programs Coordinating Office; June 2007. Newfoundland and Labrador Provincial Blood Coordinating Program. Guidelines for Blood Component Substitution in Adults. Version 3.0. St. Johns (NL).Newfoundland and Labrador Provincial Blood Coordinating Program; 2010. Newfoundland and Labrador Provincial Blood Coordinating Program. Policy for blood component and blood product administration. Version 3.0. St. Johns (NL). Newfoundland and Labrador provincial Blood Coordinating Program; 2010. Newfoundland and Labrador Provincial Blood Coordinating Program. Standard Operating Procedure for Determining Specimen Suitability

7.2

7.3

7.4

7.5

7.6

7.7

7.8

7.9

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Guidelines for Pre-Transfusion Testing (Type and Screen and Crossmatch)

Provincial Blood Coordinating Program

Version 1.0. St. Johns (NL). Newfoundland and Labrador Provincial Blood Coordinating Program; 2010. 7.10 Triulzi, D. Blood transfusion therapy, a physicians handbook. 8th ed. Bethesda, Maryland: AABB; 2005. 7.11 Turgeon, M. Fundamentals of immunohematology.2nd ed. USA: Williams & Wilkins; 1995.

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This document may be incorporated into each Regional Policy/Procedure Manual.
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