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immunohematology - 4444 > compatibility testing blakes flashcards > Flashcards

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
Q

Recipient Blood Sample

Sample collection tubes

A
  • Samples may be plasma or serum
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26
Q

Recipient Blood Sample

Age of sample

A
  • The limit is 3 days if the patient has been recently transfused or is pregnant
  • Infants - specimen good till neonate turns 4 months
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27
Q

Recipient Blood Sample

Sample collection and appearance

A

*Hemolyzed samples or samples contaminated with intravenous fluids must be re-collected

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28
Q

Recipient Blood Sample

Specimen Storage

A
  • Sample and sample from donor RBCs must be stored at 1-6oC for 7 days AFTER transfusion.
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29
Q

Previous Records

Current blood ABO and D typing must be compared with
results performed over

A

the past 12 months

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30
Q

Previous Records

  • SECOND sample to confirm
A

ABO/Rh if no history (use of PPID eliminates
need for second sample)

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31
Q

Previous Records

The most significant information is

A

history of clinically
significant antibodies

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32
Q

Previous Records

  • Specificity compared to ______
  • Regardless of current results, _________________________
A
  • Specificity compared to current antibodies detected.
  • Regardless of current results, antigen negative blood MUST be provided.
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33
Q

Previous Records

Previous records must also be consulted for

A

any significant
event related to testing or transfusion

34
Q

Pretransfusion
Testing

Type and Screen

A
  • 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
Q

Pretransfusion
Testing

Crossmatching demonstrates what

A
  • Demonstrates ABO incompatibility
    and clinically significant antibodies
    to RBC antigens
36
Q

Repeat Testing of Donor Blood

 Whole blood and RBCs
must be re-typed to

A

confirm the correct ABO
labeling

37
Q

Repeat Testing of Donor Blood

ABO testing is performed
on

A

all units

38
Q

Repeat Testing of Donor Blood

D testing is performed only

A

on D-negative units

39
Q

Repeat Testing of Donor Blood

Weak D testing is not.

A

required

40
Q

Repeat Testing of Donor Blood

Records are kept for

A

5 years

41
Q

Selection of Donor Units\

D Antigen

A
  • 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
Q

Selection of Donor Units

Recipients
with Antibodies

A
  • Antigen-negative
    units are recommended
    for the following
    antibodies:
  • ABO
  • Rh
  • Kell
  • Duffy
  • Kidd
43
Q

Probability in Blood Banking

A

of units needed/frequency of antigen negativity

 Probability of finding antigen negative units
 Frequency of antigen negative
* 100 – frequency of antigen

44
Q

Probability in Blood Banking formula

A

of units needed/
Frequency of antigen-negative

45
Q

The patient has anti-K. How many units will you
need to antigen type to find 4 compatible units?

A

4/.91= 4.39, approximately 5 units

46
Q

The patient has anti-K and anti-C. How many units
will you need to antigen type to find 4 compatible
units?

A

4/ (.91)*(.32)= 13.7

47
Q

Labeling (“Tagging”)
Blood Products

Requirements for the tag on a crossmatched donor unit:

A
  • Recipient’s two independent identifiers
  • Unique donor unit number or pool number
  • Interpretation of crossmatching
48
Q

Labeling (“Tagging”)
Blood Products

Required to verify and document at time of issue:

A
  • 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
Q

Issuance of Blood Components

-The same approach used to properly identify the
patient before _____________

A

 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
Q

Issuance of Blood Components

The actual product and accompanying record of
testing must be ___________

A

verified as relating to the same
donor unit number.

51
Q

Issuance of Blood Components

 The bedside check just prior to blood
administration is

A

is the most critical step for
prevention of mistransfusion.

52
Q

Issuance of Blood Components

A statement of compatibility must be retained as

A

part of the patient’s permanent medical record if
the blood is transfused.

53
Q

Issuance of Blood Components

A label or tie tag must be attached to the

A

unit
stating the identity of the intended recipient, the
results of pretransfusion testing, and the donor
unit number.

54
Q

Issuance of Blood Components

 Machine-readable, especially barcode patient-
blood unit identification, is ideally suited to

A

is ideally suited to
bedside check requirements and has been
recently reported to significantly improve
transfusion practice.

55
Q

Issuance of Blood Components

A
56
Q

Issuance of Blood Components

Use of radio frequency identification devices
(RFID) to improve

A

identification at every stage
of pretransfusion testing.

57
Q

Issuance of Blood Components

Whatever system is used, the information
should be verified at least

A

twice before the
transfusion of the blood product.

58
Q

Issuance of Blood Components

Before blood is taken from the blood bank
to the patient treatment area, check

A

 ABO and Rh results
 Clinically significant unexpected antibodies
 Adverse reactions to transfusion

59
Q

Issuance of Blood Components

Before transfusion is initiated, a reliable __________

A
60
Q

Issuance of Blood Components

 A system of positive patient identification by
comparison of

A

wristband identification and
compatibility forms must be followed strictly.

61
Q

Unused Blood Products

Blood products may be
reissued if

A

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
Q

Emergency Release

A

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
Q

A massive transfusion is

A

is a total volume
exchange of blood within 24 hours

64
Q

Massive Transfusion

Group O, D-negative unit is given in

A

an emergency

65
Q

Massive Transfusion

If a D-negative unit is unavailable, group

A

group O, D-positive
blood can be given to D-negative individuals who are
not of child-bearing age

66
Q

Massive Transfusion

ABO-identical unit is given once

A

the blood group is
established in the recipient

67
Q

Maximum Surgical
Blood Order Schedule

Average number of blood units
used for surgical procedures is
determined in a __________

A

facility

68
Q

Maximum Surgical
Blood Order Schedule

This number is used as the

A

standard blood order for
surgical procedures

69
Q

Maximum Surgical
Blood Order Schedule

It may also be used as a guide
for the number of

A

autologous
units that can be donated

70
Q

Typing and Screening Procedure

A typing and screening (T/S) procedure includes

A

ABO, Rh, and antibody screening

71
Q

Typing and Screening Procedure

A T/S is ordered when a

A

surgical procedure uses
less than 1 unit of RBCs

72
Q

Typing and Screening Procedure

Crossmatching is performed on the sample if

A

Blood is needed

73
Q

Typing and Screening Procedure

The goal of a T/S is to conserve

A

the blood inventory

74
Q

Crossmatching

Autologous Blood

A
  • 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
Q

Crossmatching

Infants Younger Than
4 Months of Age

A

 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
Q

Intrauterine Transfusions

Blood for intrauterine transfusion must be
compatible with

A

 Blood for intrauterine transfusion must be
compatible with maternal antibodies capable of
crossing the placenta.

77
Q

Intrauterine Transfusions

no fetomaternal what or what

Check for

Crossmatching testing is performed using

A

 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
Q

Non-RBC
Products

A

Frozen plasma, platelet
concentrates, and
Cryoprecipitate do not need to
be crossmatched

79
Q

Non-RBC
Products

Plasma products should be

A

ABO serum
compatible

80
Q

Non-RBC
Products

  • Cryoprecipitate and platelet
    Concentrates may not need
A

to be ABO compatible

81
Q

Non-RBC
Products

Apheresis platelets and
granulocyte concentrates may

A

need to be crossmatched if they
contain more than 2 mL of RBCs

82
Q

Future of Transfusion Medicine

A

 Patient blood management (PBM) programs
 Personalized medicine.

immunohematology - 4444 (17 decks)

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