COMPATABILITY
TESTING
Because crossmatch is not enough!
[Link] KUMAR
PG 1ST YR PHYSIOLOGY DEPARTMENT
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DEFINITION
The term compatibility testing or Pre-
transfusion testing refers to a set of
procedures required before blood is
issues as being compatible.
COMPATIBILITY TESTING
PROCEDURE INVOLVES:
[Link] identification of recipients blood sample
[Link] the patients previous records.
[Link] and Rh grouping of recipient
[Link] for irregular antibodies with
identification
[Link] of ABO and Rh compatible donor,free
from blood transmission infection & irregular
antibodies.
[Link] matching
[Link] labelling of donor blood
Identification Of Patient’s Blood Sample
Sample of blood should be collected after proper
identification of the recipient.
Two independent patient identifiers are required.
Ideally, these identifiers include the patient’s first
and last names and an ID number that is unique
to the patient.
Sample should also contain the name and
signature of the phlebotomist.
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Request Form For Blood 6
All recipient’s blood samples must be accompanied 7
by a request form which must contain the following
information about the recipient and should be
signed by the doctor-in-charge of the patient or any
other authorized doctor:
Incomplete request form should not be accepted.
Always record the time of receiving the
request form.
A fresh sample of blood must be asked for, if the
earlier blood transfusion was given more than 72
hours back to repeat the antibody screening.
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Checking the Patient’s Previous Records
If the patient has history of transfusion. His/her
previous records must be checked (if possible) for :
1. ABO & Rh blood group
2. Presence of unexpected antibodies
3. Any problem in compatibility testing
4. Any transfusion reactions
Cross matching 9
To ensure that there are no antibodies present in patient’s serum that will
react with donor cells when transfused.
1. ABO compatibility final check
2. May detect the presence of an antibody in the patient’s serum which will
react with an antigen on donor red cells which was not detected in
antibody screening because of the absence of corresponding antigen in
the screening cells.
Immediate spin technique/Saline room temperature technique
(drawback: inadequate for detection of clinically significant IgG type of
antibodies)
Albumin addition technique at 37ºC
Indirect Anti-globulin Technique ( incomplete antibodies )
Cross matching (Method) 10
1. Put two drops of patient’s serum in a pre labelled
test tube
2. Add one drop of 2-4% suspension of donor red
cells
3. Mix the contents and incubate for 5-10 minutes
for immediate spin method or for 45-60 minutes
for saline room temperature technique.
4. Centrifuge the tubes at 1000rpm for one minute.
5. Examine the tubes for hemolysis or
agglutination.
6. If hemolysis or agglutination is present at this
stage, the cross match is incompatible
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7. If negative, wash the cells three to four times with saline and
decant the last wash completely. Add one drop of AHG reagent.
8. Centrifuge the tubes at 1000rpm for one minute nd look for
hemolysis or agglutination with optical aid.
9. Record the results
10. If the test is negative, add one drop of control IgG coated red
cells. Centrifuge again at 1000rpm for one minute.
11. Look for hemolysis or agglutination. If no agglutination, the
test is invalid. Repeat the procedure.
Interpretation: Hemolysis or agglutination at any stage of the test
procedure except after adding control IgG coated red cells
indicates incompatibility.
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Compatibility Testing In Emergency
When blood is urgently needed, we must weigh the risk of transfusing
uncrossmatched or partially crossmatched blood against the risk of delaying
transfusion until compatibility testing is complete.
Issued in emergency after grouping ABO and Rh for both patient and donor
followed by cross match by immediate spin technique.
In extreme situations where there is no time to obtain sample and to test it, O
Rh(D) negative blood may be given to tide over the situation.
Mention on the label attached to the transfused unit that compatibility testing was not
completed at the time the unit was issued.
Principle of Cross Matching
Cross-matching is based on the serological detection of any
clinically significant abnormal/unexpected antibodies in the
blood of either the donor or the receiver. There are two
varieties of cross-matching:
[Link] Cross Match: It entails comparing the donor’s red cells
with the recipient’s serum to evaluate the presence of any
antibodies that may cause hemolysis or agglutination of the
donor’s red cells. This is more crucial than minor cross-
matching.
2. Minor Cross Match: It entails analyzing donor plasma with
recipient red cells to evaluate the presence of any
antibodies that may cause hemolysis or agglutination.
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MAJOR CROSS MATCH – PROCEDURE
1. PREPARE BLOOD SAMPLES FROM BOTH THE DONOR AND THE RECIPIENT, INCLUDING
THE DONOR’S RED CELLS AND THE RECIPIENT’S SERUM/PLASMA.
2. PREPARE A 3-5% RED CELL SUSPENSION IN SALINE.
3. LABEL A TEST TUBE.
4. ADD TWO DROPS OF THE DONOR’S SERUM AND ONE DROP OF THE RECIPIENT’S SERUM.
5. MIX AND INCUBATE THE TUBES FOR 60 MINUTES AT 37 DEGREES CELSIUS.
6. REMOVE ALL OF THE SERUM AND WASH THE CELLS THREE TIMES IN SALINE.
7. MIX WITH TWO DROPS OF ANTI-HUMAN GLOBULIN (AHG). ALLOW TO STAND FOR 5
MINUTES AT ROOM TEMPERATURE.
8. CENTRIFUGE AT 1500 RPM FOR 1 MINUTE.
9. USING BOTH MACRO- AND MICROSCOPY, SEARCH FOR AGGLUTINATION.
[Link] NO MACROSCOPIC AGGLUTINATION IS NOTICED, A LITTLE AMOUNT SHOULD BE
TRANSFERRED TO A GLASS SLIDE AND EXAMINED FOR MICROSCOPIC AGGLUTINATION.
ROULEAUX DOES NOT SIGNIFY INCOMPATIBILITY.
Result of Cross Matching
Both major and minor cross-matches should reveal no
agglutination between compatible donor and receiver
blood. Blood that is incompatible in a major cross-
match should never be transfused, as the recipient’s
huge plasma volume containing antibodies can
quickly destroy the donor’s red cells.
Minor incompatibility is less significant since the
antibodies in the donor’s serum are diluted in the
recipient’s plasma, rendering them useless.
AGGLUTINATION FORMATION
WHAT HAPPENS IF CROSSMATCH IS POSITIVE?
IF A BLOOD CROSSMATCH TEST IS POSITIVE, IT INDICATES THAT THERE IS AN
INCOMPATIBILITY BETWEEN A RECIPIENT’S BLOOD AND A DONATED BLOOD
PRODUCT.
THIS MEANS THAT THE TRANSFUSION OR TRANSPLANT SHOULD NOT
PROCEED UNLESS ADDITIONAL TESTING OR PRECAUTIONS ARE TAKEN TO
ENSURE THE SAFETY AND SUCCESS OF THE PROCEDURE.
A POSITIVE CROSSMATCH DOES NOT NECESSARILY MEAN THAT THE
TRANSFUSION OR TRANSPLANT CANNOT PROCEED, BUT IT DOES INDICATE
THAT ADDITIONAL TESTING OR PRECAUTIONS MAY BE NECESSARY TO ENSURE
THE SAFETY AND SUCCESS OF THE PROCEDURE.