Debre Birhan Referral Hospital Laboratory
Standard Operating Procedures for
Compatibility Testing (Immediate Spin Cross
Matching)
Debre Birhan Referral Hospital Laboratory Effective date: Nov.
11,2017
SOP for Compatibility testing (Immediate spin
Version No:2
Cross matching)
Compiler: DBRHL-HEM-SOP/5.5-01
Demeke Endalamaw Signature:
Page No: 2 of 8
Approver: Getaw Alemayehu Signature:
Effective Date: Nov. 11,2017 Version No. 2
Document No: DBRHL-HEM-SOP/5.5-01 Copy No.2
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Compiled by: Getabalew Engidaye Authority: DBRHL
Any document appearing in a paper form with a stamp of `CONTROLLED BY DBRHL’ is a controlled
document for internal use only.
Debre Birhan Referral Hospital Laboratory Effective date: Nov.
11,2017
SOP for Compatibility testing (Immediate spin
Version No:2
Cross matching)
DBRHL-HEM-SOP/5.5-01 Page No: 3 of 8
Principle
To determine ABO compatibility between donor red cells and recipients plasma/serum
when the antibody screen is negative and there is no previous history of clinically
significant antibody.
Purpose of compatibility testing
The purpose of compatibility testing (cross matching) is to prevent a transfusing reaction
by ensuring:
The ABO group of the blood to be transfused is compatible with the patient’s
ABO group.
There are no detectable irregular antibodies in the patient’s serum that will react
with the donor’s red cells, causing their destruction or reducing their normal
survival
Specimens
EDTA anti-coagulated whole blood
Serum (Do not use samples drawn in to tubes with neutral gel Separators)
Materials
Reagents: -isotonic saline
Supplies: -test tubes (10x75mm)
Transfer pipettes
Test tube rack
Equipment:- Serological centrifuge
Donor unit (s)
Quality control
Compiled by: Getabalew Engidaye Authority: DBRHL
Any document appearing in a paper form with a stamp of `CONTROLLED BY DBRHL’ is a controlled
document for internal use only.
Debre Birhan Referral Hospital Laboratory Effective date: Nov.
11,2017
SOP for Compatibility testing (Immediate spin
Version No:2
Cross matching)
DBRHL-HEM-SOP/5.5-01 Page No: 4 of 8
Any ABO discrepancy shall be resolved and the resolution documented before issuing
red cells Quality control of blood components and equipment shall be retained for 5
years.
Blood group to use
The first choice of blood for a patient should be blood of the same ABO group (and when
applicable, Rhesus group) as the patient. Avoid transfusing group O blood to those who
are not group O, particularly when needing to use whole blood because group O blood
can contain dangerous immune anti-A and anti-B haemolysins (particularly in tropical
countries). The risk is reduced when using concentrated red cells. When there is no blood
or insufficient blood of the same ABO group as the patient sample is available, select
blood as shown in the following chart.
Group of Choice of blood
patient 1st 2nd 3rd 4th
Group A Gp- A Gp- O --------------- --------------
Group B Gp- B Gp O -------------- ---------------
Group O Gp-O ---------- ------------- ---------------
Group AB Gp- AB Gp A* Gp- B Gp-O
*Group A is the second choice of blood because anti-B in Gp-A blood is likely to be
weaker than anti-A in Gp-B blood.
Compatibility testing
A compatibility test is a final check on the compatibility of blood for a patient,
particularly ABO compatibility. Several techniques are available for cross matching
blood to detect ABO incompatibility and clinically important irregular antibodies in a
patient’s serum. Compatibility testing is essential when prior antibody screening is not
performed (situation in most district laboratories due to unavailability of cell panels). In
district laboratories, a simple to perform single tube technique comprising the following
three stages is recommended
Compiled by: Getabalew Engidaye Authority: DBRHL
Any document appearing in a paper form with a stamp of `CONTROLLED BY DBRHL’ is a controlled
document for internal use only.
Debre Birhan Referral Hospital Laboratory Effective date: Nov.
11,2017
SOP for Compatibility testing (Immediate spin
Version No:2
Cross matching)
DBRHL-HEM-SOP/5.5-01 Page No: 5 of 8
Detection of ABO incompatibility in saline at room temperature: Donor’s cells are
mixed with patient’s serum at room temperature, centrifuged and examined
visually for agglutination. When there is no agglutination or haemolysis, proceed
to next stage.
Detection of antibodies agglutinating at 37 oc in saline. The tube is incubated at
37 oc for 20minutes, re-centrifuged and examined for agglutination. When there is
no agglutination or haemolysis, proceed to the third stage.
Detection of immune IgG antibodies that have sensitized donor’s cells and are
only agglutinated by using antiglobulin (AHG) reagent:* An indirect antiglobulin
test (IAT) is performed in which red cells after being incubated in patient’s serum
aretested after washing for bound antibody
Procedure
1. Determine specimen suitability
2. Centrifuge specimen (1000g for 2 minutes)
3. Check specimen after centrifuging (e,g hemolysis)
4. Perform a patient history check. If the patient has a history of clinically significant
antibodies perform an AHG cross match. If the method used to perform an AHG
cross match does not detect ABO incompatibility, Perform an IS cross match as
well.
5. Ensure patient information on the sample corresponds with the patient
information on the work sheet
6. Select the appropriate donor unit from the blood bank refrigerator
7. Visually inspect each donor unit.
8. Record the donor unit number on the patients worksheet
9. Label a slide with a donor number label from the donor bag (if the donor number
label is not available, label is not available, label with at least the last 4 digits
from the donor unit number)
Compiled by: Getabalew Engidaye Authority: DBRHL
Any document appearing in a paper form with a stamp of `CONTROLLED BY DBRHL’ is a controlled
document for internal use only.
Debre Birhan Referral Hospital Laboratory Effective date: Nov.
11,2017
SOP for Compatibility testing (Immediate spin
Version No:2
Cross matching)
DBRHL-HEM-SOP/5.5-01 Page No: 6 of 8
10. Detach one donor segment from the unit, cut and express contents in appropriate
labeled slide. Return the donor unit (s) to the blood bank refrigerator.
11. Add 2 drops of plasma or serum on the donor cell.
12. Mix the content properly
13. .Examine the mixture macroscopically for agglutination. Record if present
14. Record the result
15. Prepare a cross match/transfusion card with at least the following information:
Recipients name
Recipients identification number
ABO and RH group
Name of the component
Donor unit number
Compatibility status of the unit
Date and time of cross match
16. Compare applicable information on the cross match/transfusion card with the
donor unit
17. Place the donor unit with the cross match/transfusion card in the blood bank
refrigerator with the oldest unit in the front.
Reporting
1. No agglutination or hemolysis indicates that the donor unit (S) are compatible
with the patients plasma
2. Agglutination or hemolysis indicates that the donor unit (s) are incompatible
Reference
1. Monica Cheesbrough. District Laboratory Practice in Tropical Countries
Part 2, Second Edition
Compiled by: Getabalew Engidaye Authority: DBRHL
Any document appearing in a paper form with a stamp of `CONTROLLED BY DBRHL’ is a controlled
document for internal use only.
Debre Birhan Referral Hospital Laboratory Effective date: Nov.
11,2017
SOP for Compatibility testing (Immediate spin
Version No:2
Cross matching)
DBRHL-HEM-SOP/5.5-01 Page No: 7 of 8
Declaration
I, the undersigned laboratory personnel, certify that I am conducting every steps of the
procedures incorporated in this SOP after a prior reading.
S/N Full Name Signature Date Remark
Compiled by: Getabalew Engidaye Authority: DBRHL
Any document appearing in a paper form with a stamp of `CONTROLLED BY DBRHL’ is a controlled
document for internal use only.
Debre Birhan Referral Hospital Laboratory Effective date: Nov.
11,2017
SOP for Compatibility testing (Immediate spin
Version No:2
Cross matching)
DBRHL-HEM-SOP/5.5-01 Page No: 8 of 8
Compiled by: Getabalew Engidaye Authority: DBRHL
Any document appearing in a paper form with a stamp of `CONTROLLED BY DBRHL’ is a controlled
document for internal use only.