Compatibility Testing and Blood Administration Flashcards
Fresh Whole Blood
Very rare
Must be exact same blood type as person receiving
Stored Whole Blood (WB) Info
Volume: 450 mL
Increase: O2, Carrying capacity, Hct by 3-5%, Hgb by 1.0-1.5g
pRBCs Volume
250 mL
Leukocyte Reduced Blood Components Use
Prevent Immunosuppression
Prevent Sensitization to Leukocyte Antigens
Decrease Transmission of Viruses (especially CMV)
Leukocyte Reduced Blood Components Values
<5 x 10^6 WBCs (1/3 power reduction)
With Bedside Filter: <1 x 10^6 to 1 x 10^4
Irradiated Blood Components
Eliminates T Cells
Prevents Graft vs Host Disease
Directed Units from Blood Relatives
Frozen RBCs
Volume <180 mL
Decreased WBcs
No Plasma/platelets
Frozen RBCs Use
Rare/special blood types
Autologous units
Frozen RBCs Storage Info
MUST coat in glycerol (prior to freezing)
Expires 24 hrs after thaw and deglycerol (wash)
Washed RBCs Purpose
Decreases chance for allergic reaction
Patient with IgA deficiency or IgA antibodies
Washed RBCs Info
Washed with Saline
Removes plasma
Removes some WBCs
Expires 24 hours after wash
Plasma Products
Fresh Frozen Plasma (FFP)
Cyroprecipitate (Cryo)
Factor Concentrates
Platelet Concentrates
Fresh Frozen Plasma (FFP) General Info
Contains plasma and clotting factors
Expires 1 year
Volume: approx 220 mL
Fresh Frozen Plasma (FFP) Uses
Coagulation deficiencies
Volume Loss
Fresh Frozen Plasma (FFP) Transfusion Consideration
Must be ABO compatible
No allo-antibodies present
No leukodepleted, irradiated, or required to be CMV Negative
Cryoprecipitate Contains
Factor 8, 1, VWF, and 13
Cryoprecipitate Information
Volume approx. 15 mL
Frozen at 18 C or lower
Expires 6 days after thaw
Store at RT after thaw
Cryoprecipitate Compatibility
ABO only
Factor Concentrates
Handled by Pharmacy
8 and 9
Factor Concentrates Transfusion
ABO not an issue
Platelet Concentrates Preparation
Previously pooled
Single donor apheresis used frequently
Platelet Concentrates Volume
Volume 300 mL
Contains 3 x 10^11 platelets
Platelet Concentrations Transfusion
ABO Compatible if possible
Increased survival
RBC contamination possible
Consider Rh positive units to Rh negative patients a concern
Compatibility Testing Purpose
To select products for patients that will survive well
Will not cause significant RBC destruction
Compatbility Testing Sample Requirements
Test Request Form
Proper Labeling
Patient Armband (specific for Blood Bank)
No hemolysis
Crossmatch sample expiration (72 hrs)
- Kept for 7 days (at minimum) after transfusion
Compatibility Testing Neonates
Lower volume transfusions
Cold stress concerns
MUST be CMV negative
Laboratory Procedures for Recipient
Verify Identification
Record Check
Perform ABO/Rh (Weak D not required)
Perform Antibody Screen (ID Ab if present - Auto Control)
Laboratory Procedure for Donor
Verify Identification
Record Check
Infectious Dx Testing
Perform ABO/Rh (Weak D IS required)
Perform Antibody Screen
ID Ab if present (Not Used for Transfusion)
Crossmatch Types
Major Crossmatch
Minor Crossmatch
Abbreviated Crossmatch
Extended Crossmatch
Computer Crossmatch
Major Crossmatch
Patient Serum + Donor Cells
Minor Crossmatch
Patient Cells + Donor Serum
Abbreviated (IS) Crossmatch
Can only Perform if:
No antibody in history
Negative Screen
Extended Crossmatch
Perform if:
Antibody in history
Positive screen
Computer Crossmatch
Can only perform if:
A type and retype has been performed (on patient and pRBC)
No history of antibodies
Negative screen
Causes of Incompatible Crossmatches - RBC products
ABO Incompatibility
Patient alloantibody reacting with Donor Cells
Patient autoantibody reacting with Donor Cells
Positive DAT on Donor Cells
Rouleaux
Selection of Blood Products for Transfusion
ABO Compatibility
Rh Specificity
Antigen Negative Blood
Labeling of Crossmatched Units
ABO Compatibility
ABO/Rh specific if possible
ABO Compatible
- If whole blood, must match FFP and pRBC ABO requirements
- If pRBC must match ABO requirements only
Rh Specificity
IF patient is Rh neg, must give Rh negative pRBC
Antigen Negative Blood
Donor pRBC MUST be Antigen negative for corresponding patient antibodies
ex/ patient is anti-C, must receive C negative blood
Labeling of Crossmatched Units
Receive a patient specific tag (pulled from “general” supply)
Length of Time Blood Can be Checked Out
30 minutes if not used (length of time out of fridge to avoid bacterial proliferation)
If using cooler, can be maintained for 7-8 hours
** PLATELETS NEVER GO IN COOLER **
Types of Transfusion
Routine Transfusion
Autologous Transfusion
Massive Transfusion
Emergency Transfusion
Neonatal Transfusion
Routine Transfusion
Random Donor
Directed Donations
Autologous Transfusion
Patient’s own blood
Massive Transfusion
Replacement of 1 or more blood volumes in 24 hrs
Exchange Transfusion in Neonate
** Requirement to follow transfusion protocol after 5 units **
Emergency Transfusion
Negative pRBCs (O negative and AB plasma)
Uncrossmatched
Neonatal Transfusion
Small Amount (50-80 mL)
Fresh Blood (<7 days)
CMV Negative - must be confirmed CMV negative
Irradiation Recommended (required)
Blood Administration
Verify Patient Identification
Bedside Filters
Leukocyte Depleted
Blood Warmers
Routine Crossmatch, Negative Antibody Screen
ABO/Rh - no weak D required
IAT - negative
XM - US only (verify ABO compatibility)
ABO/Rh verify - performed by another tech (retype)
Routine Crossmatch, Positive Antibody Screen
ABO/Rh - no weak D required
IAT - positive
Antibody Identification panel - must identify antibodies
Antigen type patient - patient should be negative for antigen corresponding with antibody
Antigen type units - Antigen negative units required in some cases
XM - extended, including AHG
ABO/Rh verify - retype
Routine Crossmatch, Autologous Units
ABO/Rh - No weak D required
IAT - if positive, perform antibody identification
Units are not XM, but assigned to the patient
ABO/Rh - retype
Routine Crossmatch, add on to current specimen
Crossmatch sample is valid for 72 hrs
- ABO/Rh - always perform when sample is removed from storage
- IAT - not repeated
- XM - IS or extended, depending on original IAT results
Type and Screen - no units requested
ABO/Rh - no weak D required
IAT - if positive, perform antibody identification
- IAT is positive, call physician and inform (may request units)
ABO/Rh - retype
Retype of ABO/Rh
No previous record of patient
Sample is removed from storage for additional testing
Take over another tech’s work
Neonate Crossmatch
ABO/Rh - no reverse group or weak D required
IAT - usually also include A1 and B cells (looking for maternal anti A and/or B, if positive, identify antibody)
XM - unit is usually not crossmatched, but assigned to neonate or aliquots of a unit are used, if antibodies are present must be considered in crossmatch
Neonate Definition
Less than 4 months of age
Neonate Sample
Cannot be cord blood
Must be drawn from baby
Compatibility Testing for FFP, Cryo, or Platelets
ABO/Rh - no weak D
ABO/Rh - retype
RBCs antigen negative not required
Lea, Leb
P1
M, N
Bga, Bgb
Sda
Lua
I, H, IH
RBCs E antigen negative
Should also type for c antigen
If c negative, selected E negative units for transfusion
RBCs C antigen negative
Also typed for E antigen
If E negative, select c negative and E negative units for transfusion
RBCs antigen negative cells
Cw
D, C, e
K, k
Kpa, Kpb
Jsa, Jsb
Jka, Jkb
S, s, U
Lub
Fya, Fyb
