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Pretransfusion Compatibility TestingLecture  0 .   #|x<6X9`(CourierXx6X@`7X@( U$  A, B,Level 1Level 2Level 3Level 4Level 5   )   _A" ) xdEW A X  XXXXX!MXX X)XX!MVIII.PretransfusionCompatibilityTesting#X!MX)#F F F T$)XX!MMLT1504  66  # ^)#((3$ U!   +FSAZ*Helvetica Regular(CEKQW]cioAutoList31)1)1)1)1)1)1)1)((3$ U!    1)a1 {AZ"Arial RegularSU4#(2Quick A.  .0 1, 2, 3,Level 1Level 2Level 3Level 4Level 5(9 Z 6Times New Roman Regular4#,2Quick 1.  .0  a, b, c,Level 1Level 2Level 3Level 4Level 56#-4Quick a.   .0 hp LaserJet 1300 PCL 5e,,,,00CEMU[cks{AutoList1(1)(1)1)(1)(1)(1)(1)(1)3#37=CIQYag1.a.i.(1)(a)(i)1)a)lB2 (;3$2#  0  .3  0  i) d(C Z(Times New Roman H(CEKQW]cioAutoList21)1)1)1)1)1)1)1)%1)(O;$0  2#  a  .3  0` (#(#(b$0  0` (#(#2#   .3  0 ` (#` (#  *   _A" ) xdEW A X +X$XXX+ X+X$,) + VIII.PretransfusionCompatibilityTesting#+ ,)#,) + 0 < 0<T$<T$0T$T$0DT$T$0DT$DT$0T$T$0LT$T$0LT$LT$MLT1504  66  0@#LT$LT$0@#T$T$0@#T$T$0@#T$T$0@#T$T$0@#T$T$0@#T$T$#+ ,)T#,hAZ*Helvetica Regular(9 Z 6Times New Roman Regular U!   _XXHHBU  X$XXX  VIII.PretransfusionCompatibilityTesting X &(%XX$#& %%&( *X X` XX*A.0  Thepurposeofpretransfusiontestingistoselect,foreachrecipient,bloodcomponentsthat,whentransfused,  willhaveacceptablesurvivalandwillnotcauseclinicallysignificantdestructionoftherecipient'sown_rbcs_.$$ B.0  _AABB_ԀStandardsstatesthatthefollowingprocedures must bepartofpretransfusioncompatibilitytesting.L$$ <X X XX X` X<0    1.0$$Positiveidentificationofrecipientandrecipient'sbloodsample.X$$ 0    2.0$$Reviewoftransfusionservicerecordsforresultsofprevioustestingonsamplesfromtherecipient.  $$ 0    3.0$$Testsondonorbloodasdescribedinthe_AABB_ԀTechnicalManual. ` $$ 0    4.0$$ABOandDtypingofrecipient'sblood.h  $$ 0    5.0$$Antibodydetectiontestsusingtherecipient'sserumorplasma. $$ 0    6.0$$Selectionofbloodcomponentsofthe appropriate ABOandDtypes.p$$ 0    7.0$$Testswithrecipient'sserumorplasmaanddonor's_RBCs_,_ie_,a_crossmatch_.|$$$ 0    8.0$$Labelingofthecomponentswiththerecipientsinformation.,$$ (  (C  .0    PurposeofPretransfusionTesting0X$$( یX$X$ Ќ  ,  0  , 1  .0$$  Transfusionisusuallyabeneficialandsafeprocedurebutadverseaffectscanoccur.,  ی4$$ Ќ  0  0$$a.0$$Donor_RBCs_,orlessfrequently,recipient's_RBCs_,sometimesundergoaccelerateddestruction.<$$ 0  0$$b.0$$Most hemolytic transfusionreactionsresultfrom errorsinpatientorsampleidentity. $$ 0  0$$c.0$$Insomecasesbloodgroupantibodiesexistthatwerenotdetectedbystandardserologicaltechniques. H Pretransfusiontesting willnot detect all unexpectedRBCantibodiesintherecipient'sserum.x  $$ 0  0$$d.0$$Pretransfusiontesting willnot guaranteenormalsurvivaloftransfused_RBCs_.,"$$ 0  2.0$$Ifperformed properly ,pretransfusiontests will:  $$$ *0  0$$a.0$$Ensurethatapatientisissuedthedesignatedbloodcomponents."< &$$ 0  0$$b.0$$Verifyin most casesthatbloodcomponentsareABO compatible. D$!($$ 0  0$$c.0$$Detect most clinicallysignificant unexpected antibodies.%#*$$ D.0  ModernBloodBankingPractices'T%,$$   1.0  Duringthelast10yearstherehasbeenadistinctchangeintheattitudesaboutpretransfusiontesting.\)'.$$ 0   $$   2.0  Compatibilitytestinghasundergoneconsiderablemodificationsincethedevelopmentoftheantiglobulin  +(0 test.+)1$$  l.,4 0  3.0$$Theearly1980'sbecameatimefordecisionstoeliminateportionsofstandardtestingbecauseofthe X restrictingeconomicclimate.Thisenvironmentstimulatedthephilosophythatnotestingshouldbedone 0 unlesstheresultsarelikelytoinfluencepatientcare.$$ 0  4.0$$Ongoingreevaluationandprioritizationhasresultedintheeliminationofmanypractices.`$$ 0  5.0$$Procedureshavebeenstreamlined,bothintheinterestsofcosteffectivenessandpatientsafety,tothepoint h thatvirtuallyallunnecessarypracticeshavebeendiscarded.@$$ 0  6.0$$Thisintelligentapproachcarrieswithittheresponsibilityforpreciseattention,withoutvariation,ofthe    laboratoryprofessional.Requires rigid adherencetoguidelinesandstandards. p $$ 0  7.0$$Protocolshavebeendevelopedbasedonabalancebetweenthefollowing:| $ $$ 0    a.0$$Patientsafety.T $$ 0  0$$b.0$$Thenumberofunwantedreactionseliminated(suchascoldagglutinins)., $$ 0  0$$c.0$$Thespeedwithwhichtestprocedurescanbeperformed. $$ E.0  TransfusionRequestForms\$$ ,    ,1  .0    Bloodrequestforms must containsufficientinformationforpositivepatientidentification.,یd $$ Ќ  0  2.0$$Becausebloodisadrug,andformedical/legalreasons,thenameofthephysicianshouldappearonthe  requisitionform.$$ 0  3.0$$Additionalinformationsuchassexandageofthepatient,diagnosis,andtransfusionandpregnancymay F behelpful.v$$ 0  4.0$$Bloodrequestformslackingtherequiredinformationorcontainingillegibleinformation arenot  & acceptable.$$ 0  5.0$$Computertransmittedrequestsareacceptableaslongastherequiredinformationiscomplete.Z$$ 0  6.0$$Telephonedrequestsshouldbedocumentedbysubsequentsubmissionofaproperlycompletedblood b   requestform.:!$$ F.0  ThePatient(Recipient)BloodSample#$$   1.0  The_pretransfusion_Ԁcompatibilitytestisonlyasgoodasthebloodsampleonwhichitisperformed.!B%$$   2.0  Thecollectionofaproperlylabeledbloodsamplefromthe correct patientis critical tosafeblood J# ' transfusion.&$!($$   3.0  Thepersonwhodrawsthebloodsample must identifythepatientinapositivemanner.Itisbesttoonly %~#* allowpeopleadequatelytrainedtoappreciatetheimportanceofproperidentificationtodrawsamplesfor &Z$+ compatibilitytesting.'2%,$$   4.0  Thelabrequisitionmustbecomparedtotheinformationonthepatient'shospitalarmband.Ifthepatient :)&. doesnothaveanarmbandon thespecimenmustnotbedrawn untilthepatientisbandedoridentified *'/ inanacceptablemanneraccordingtoinstitutionpolicies.*(0$$   5.0  Inanemergencysituation,whenthepatient'sidentityisunknown,anemergencyidentificationnumber ,F*2 oratemporarybandisattachedtothepatientinaccordancewiththeinstitution'sSOP.v-+3$$  &/,5   6.0  _Preadmission_Ԁtesting(PAT)posesaspecialproblem,patient'smayforgettheirwristbandathome.Ifthis X happens,thepatientmustberedrawnandallworkrepeatedwiththenewsample.0$$   7.0  Bloodsamplesmustbedrawnintostopperedtubesand labeledatthepatient'sbedsideusing  informationfromthepatient'sarmband. Minimuminformationrequiredincludes:patient'sfullname, d identificationnumber,date,timeandinitialsoftheindividualdrawingthespecimen.@$$   8.0  Manyinstitutionsutilizecommercialbloodbankarmbandsystems.H$$  0  9.0$$ Serumorplasma maybeusedfor_pretransfusion_Ԁtesting.Serumispreferredbecausewithplasma,small    fibrinclotsmaysometimesformwhichmaymakeitdifficulttodistinguishagglutination. z $$ 0  0$$a.0$$Antibodiesdemonstrableonlythroughcomplementactivationcannotbedetectedifplasmaisused.  *  Anticoagulants,suchas_EDTA_, chelatecalciumandpreventcomplementactivation. Z  $$ 0    b.0$$ItispermissibletocollectbloodfromanIVlineaslongasproperprotocolisfollowed. $$ 0    c.0$$_Hemolyzed_Ԁsamples shouldnot beused.f$$ 0  10.0$$Compatibilitytests must beperformedonbloodsamplescollectedwithin threedays(72hours) before r redcelltransfusionswhenthepatienthasbeentransfusedorpregnantwithinthepreceding3months or  N ifthehistoryisuncertainorunavailable.*$$ 0  0$$0$$a.0 $$Thesampleusedforserologicaltestingmustrepresentthepatient'scurrentimmunological  status.Z $ $ 0  0$$0$$b.0 $$Itisnotpossibletopredictwhensuchantibodieswillbedemonstrable,soa3daylimithasbeen b  arbitrarilyselected.: $ $ 0  0$$0$$c.0 $$Manybloodbanksprefertoseta3daylimitonallspecimensusedfor_pretransfusion_Ԁtesting. $ $ 0  0$$0$$d.0 $$Exceptionsmaybeapprovedwhenapatienthasnotbeenrecentlytransfusedorpregnant.B $ $  ,    ,D011  .0    Requirementforsamplesfrom infantslessthan4monthsoldaredifferent andwillbediscussedin J! detaillater.Buttheydohavemajorexceptions.,D0k0 ی&"$$ Ќ  0  0$$0$$a.0 $$Iftherearenounexpectedantibodiesdetectedbyinitialtests and theinfantreceivesnoblood  ~$ componentscontainingclinicallysignificantantibodies, antibodydetectionand !Z% _crossmatching_Ԁtestscanbeomittedthroughouttheneonatalperiod. "6 & $ $ 0  0$$0$$ $$ 0  0$$0$$b.0 $$Aftertheinfant'sABOandDtypeshavebeendetermined,ABOandDtyping maybeomitted, B$!( providedthebabyreceivesonly_RBCs_Ԁthatareoftheinfant'sABOorgroupO,andare %") eitheroftheinfant'sDtypeorDnegative. %#* $ $ 0  12.0$$Whenasampleisreceivedinthelaboratory,aqualifiedmemberofthestaffmustconfirmthatthe 'N%, informationonthelabelandonthetransfusionrequestform areidentical. ~(&&-$$ 0  0$$0$$a.0 $$Ifthereisanydiscrepancyoranydoubtabouttheidentityofthepatient,anewsample must be 2*'/ obtained.+(0 $ $ 0  0$$0$$b.0 $$Itis unacceptable foranyonetocorrectanincorrectlylabeledsample.,f*2 $ $  r.,4 0  13.0$$Therecipient'sbloodspecimenandasampleofthedonor_RBCs_Ԁmustbesealedorstopperedandkeptat X 16Cforatleast sevendaysaftertransfusion. 0$$ 0  0$$0$$a.0 $$Donor_RBCs_Ԁmaybefromtheremainderofthesegmentactuallyusedinthe_crossmatch_Ԁand  mustbeplacedinasealedorstopperedtube.d $ $ 0  0$$0$$b.0 $$Adonorsegmentremovedjustbeforeissuingthebloodmaybesaved.l $ $ 0  0$$0$$c.0 $$Keepingthepatient'sanddonor'ssamplesmakesitpossibletodorepeatoradditionaltesting   ifthepatientexperiencesanunfavorableresponsetothebloodtransfusion.   $ $ G.0  PreviousRecords L $$  ,    ,<1  .0    Compatibilitytesting must includecheckingprevioustransfusionservicerecordsfortherecipient's T  serologicalhistory.,<<ی0 $$ Ќ    2.0  Ifthepatienthasbeentestedpreviously,resultsofcurrenttesting must becomparedwithinterpretation   ofprevioustesting.d$$   3.0  Discrepanciesbetweencurrentandprevioustesting must beresolvedbeforebloodisissued.l$$   4.0  Themostsignificantinformationtobeobtainedfromtherecordsistheexistenceofclinicallysignificant   antibodiesreactiveat37Cor_AHG_.$$ 0    a.0$$Thespecificity(identity)ofpreviouslyidentifiedantibodiesshouldbecomparedwiththatof P antibodiesdetectablecurrently.($$ 0    b.0$$Ifanindividualhaseverhadaclinicallysignificantantibodyidentified,antigennegativebloodmust 0 beselected,evenifthepresentantibodyscreenisnegative.$$ H.0  SerologicalTestingcurrentmandatedtestsfor_pretransfusion_Ԁsamplesincludethefollowing:`$$   1.0  ABOGroupingh $$ 0    a.0$$Testingunknown_RBCs_ԀwithreagentantiAandB.@!$$ 0    b.0$$TestingunknownserumwithreagentA1andB_RBCs_"$$ 0    c.0$$Discrepanciesmustberesolvedbeforebloodisgiven.#$$ 0    d.0$$InanemergencysituationgivetheuniversalredcelldonorgroupOorifplasmaisneededAB. p$$$ 0  2.0$$DTypingx" &$$ 0  0$$a.0$$Testingpatient/donorcellswithreagentantiDbydirectagglutination.P# '$$ 0  0$$b.0$$TestswithantiD mustbecontrolled toavoidincorrectinterpretation.($!($$ 0  0$$c.0$$IfaproblemarisesintheinterpretationtransfusewithDnegativeuntilproblemisresolved.%")$$ 0  0$$d.0$$ItisnotnecessarytoperformtheweakDtestonrecipients.Manyfacilitieswillperformthistestone %#* timetodetermineifthepatientisaweakD.&\$+$$   3.0  AntibodyDetectionTestsd( &-$$ 0  0$$a.0$$Standardsstatesthattheserumorplasmaofarecipientmustbetestedagainstsingledonorsuspension <)&. ofcellsselectedtocarrythosebloodgroupantigensnecessaryforthedetectionofthemostimportant *'/ clinicallysignificantunexpectedantibodies.*(0$$ 0  0$$b.0$$ Unexpectedantibodies arethoseotherthanantiAorantiB. ,D*2$$  &/,5 0  0$$c.0$$ Anantibodyisconsideredclinicallysignificantif: X$$ H"X X  hXX X XH  0  0$$1)0 $$ithascausedhemolyticdiseaseofthenewborn(_HDN_)2 $ $ 0  0$$0$$2)0 $$ithascausedanacutehemolytictransfusionreaction  $ $ 0  0$$0$$3)0 $$ithascausedunacceptablyshortenedsurvivaloftransfused_RBCs_. $ $ 0  0$$0$$4)0 $$itisreactiveat37Cand/or_AHG_.b $ $ 0  0$$d.0$$_IgG_Ԅcoated_RBCs_Ԁmustbeusedtodetectfalsenegative_antiglobulin_Ԁtestsduetoinactivationofthe j _Coomb_'sserum.B$$ 0  0$$e.0$$Thereagentredbloodcellssuitableforantibodyscreeningareavailablecommerciallyandareoffered    asasetoftwoorthreevials,eachcontaining_RBCs_Ԁfromasinglegroup0donor. r $$ 0  0$$0$$1)0 $$Thefollowingantigens must bepresent:D,C,E,c,e,M,N,S,s,P1,Lea,Leb,K,k,_Fya_,_Fyb_, z "  _Jka_and_Jkb_.V  $ $ 0  0$$0$$2)0 $$Norequirementsthatotherlowincidenceantigensbepresent,suchas_Lua_,VorCw..  $ $ 0  0$$0$$3)0 $$Norequirementsthathomozygouscellsbepresent.  $ $ 0  0$$0$$4)0 $$Mustnotbeusedbeyondexpirationassomeantigensdeteriorateduringstorage.  $ $ 0   $$ 0  4.0$$TypeandScreen(T&S)Protocol6$$ 0  0$$a.0$$TheT&Sprocedurehasemergedasanacceptablealternativeto_crossmatching_Ԁblood.>$$ 0  0$$b.0$$TheprotocolconsistsofperforminganABO,Dandindirect_antiglobulin_Ԁtest(_IAT_Ԁorantibodyscreen)  forthepresenceof_alloantibodies_.n$$ 0  0$$c.0$$WhenperformedcorrectlytheT&Swilldetect 99.9% ofallunexpectedantibodies.v$$ 0  0$$0$$1)0 $$Whenantibodies are detectedinapatientserumitisidentifiedandappropriateantigennegative R unitsare_crossmatched_.. $ $ 0  0$$0$$2)0 $$Iftheantibodyscreenisnegativeblood isnot _crossmatched_Ԁbutcanbeavailableimmediately  ifneeded.b $ $ 0  0$$d.0$$Thisprotocolhasbeenestablishedasa safeandcosteffective measureinpromotingeffectiveuse j  ofthebloodsupplybyreducingunnecessary_crossmatching_Ԁofblood.F!$$ 0  0$$e.0$$Patientswhoarecandidatesforthisprotocolareobstetricalandpreoperative.Proceduresselected # arethoseforwhichtheriskofexcessivebleedingareminimalbutpossible. v$$$ 0  0$$f.0$$IfunusualcomplicationsproduceanimmediateneedforbloodthepatientcanreceiveABOandD ~"& & typespecificblood,IS_crossmatch_Ԁcompatiblewithin10minutes.V# '$$ 0  0$$g.0$$Thebloodbankmusthaveappropriatedonorbloodavailableforallpatientsundergoingoperations %") onaTypeandScreenbasis.%#*$$ 0  5.0$$LimitationsofAntibodyDetectionTestsAntibodyscreeningtestscannotdetectallantibodiesof '6%, potentialclinicalsignificance.% $ f(&-$$ 0  0$$a.0$$Antibodymaybereactivewithlowincidenceantigen.*'/$$ 0  0$$b.0$$Ifantibodyisexhibiting"dosage"itmaybemissed.Duffy(_Fy_),_Kidd_Ԁ(_Jk_)andRhantibodiesmay +n)1 onlybedetectedwithhomozygouscells.Willinfluencedecisiontouse2or3cellscreen.,F*2$$ 0  0$$c.0$$Antibodymayhavedroppedbelowthelevelof_detectability_.N.+4$$  &/,5 0  6.0$$CompatibilityTestingHistoryX$$ 0  0$$a.0$$Intheearly1980'squestionsaroseaboutthefollowing:theroutineuseofanti_A,B_ԀantiseraandA2  cellsinABOgrouping,repeatDtypingofDpositivedonorunits,Dutesting,repeat_alloantibody_  screeningofdonorunits,DATtestingandtheperformanceofelution.`$$ 0  0$$b.0$$QuestionswereraisedastotheclinicalsignificanceofantibodiesreactiveatRTorbelow,the h usefulnessofalbumininthereactionmixture,andtheappropriatenessofusing_AHG_Ԁinboththe @ antibodyscreenandthe_crossmatch_. $$ 0  0$$c.0$$During198485,theFDAand_AABB_Ԁallowedthe_AHG_Ԁphaseofthe_crossmatch_Ԁtobedeleted ifthe  p  patient'santibodyscreenwasnegative.  L $$ 0  0$$d.0$$In1984,_Judd_Ԁrecommendeddeletingthe_autocontrol_Ԁasapartofroutinetransfusiontesting.T $$ 0  0$$e.0$$By1986,theminor(testingdonorplasmawithpatientcells)_crossmatch_Ԁwasofhistoricinterestonly. $$ 0  7.0$$CompatibilityTesting the_Coomb_'s_Crossmatch_ \$$ 0  0$$a.0$$Patient'swhoareexperiencingclinicalsignsandsymptomsofanemia,activelybleedingpatientsand h patientswhoarehavingsurgicalprocedureswithanticipatedbloodlossmusthaveblood @ _crossmatched_.$$ 0  0$$b.0$$Inthemajor_crossmatch_,patientserumisaddedtoeachpotentialdonorcell(asinanantibodyscreen) p andreadafterthreephases:IS,Albumin37C,and_AHG_.Thesetubesaresetupandreadalongwith H theantibodyscreen.x $$ 0  0$$c.0$$Reactivityatanyphasewasevaluated.Donorcellsreactiveat37C,_AHG_Ԁorcausinghemolysiswould ( requireaninterpretationof" incompatible "and couldnot beissuedfortransfusion.$$ 0  8.0$$CompatibilityTesting theImmediateSpin_Crossmatch_ԀorAbbreviated_Crossmatch_\$$ 0  0$$ a.0$$Whennoclinicallysignificantantibodiesaredetectedintheantibodyscreen,andthereisnohistory h  ofsuchantibodies,the_antiglobulin_Ԁphaseofthe_crossmatch_Ԁisnotrequired.@!$$ 0    b.0$$Rarelyisaclinicallysignificantunexpectedantibodydetectedbythe_AHG_Ԁphaseofthe_crossmatch_ # whentheantibodyscreenisnegative. p$$$ 0  0$$c.0$$Thepolicytoomitthe_AHG_Ԁphaseofthe_crossmatch_Ԁmustbemadebythe medicaldirector. x" &$$ 0  0$$d.0$$Thedecisiontoomitthe_AHG_Ԁphaseshouldbebasedonthefollowing:,$!($$ 0  0$$0$$1)0 $$Incidenceofincompatible_crossmatches_Ԁwhentheantibodyscreenisnegativeandthereasons.%") $ $ 0  0$$0$$2)0 $$Sensitivityofantibodydetectionprocedureused.%#* $ $ 0  0$$0$$3)0 $$Potentialbenefitsofomittingthe_AHG_Ԁphaseinthelaboratory.&\$+ $ $ 0  0$$0$$4)0 $$Expertiseoftheindividualsworkinginthebloodbank.'4%, $ $ -  0  0$$-Ewe  .0$$  Ifclinicallysignificantantibodiesaredetectedintheantibodyscreen, the_AHG_Ԁphaseofthe <)&. _crossmatch_Ԁisrequired. -Ewwی*'/$$ Ќ  0  0$$f.0$$TestsmustbedonetodemonstrateABOincompatibility arerequired .MostplacesperformtheIS *(0 phaseofthe_crossmatch_Ԁanddiscardthetubesafterrecording.+t)1$$  ,/,5 0  9.0$$CompatibilityTesting theComputerized_Crossmatch_. X$$ 0  0$$a.0$$IfacomputersystemhasbeenvalidatedonsitetopreventthereleaseofABOincompatibleblood   components,thenitmaybeusedpriortotransfusiontodetectABOincompatibilityinsteadofa  serologic_crossmatch_.d$$ 0  0$$b.0$$Thefollowingconditions must bemet:l$$ 0  0$$0$$1)0 $$Therehavebeen2determinationsoftherecipient'sABOgroup.Onedeterminationmustbe   madeonacurrentsample.Theseconddeterminationmaybemadeonthesamesample,a    secondcurrentsampleorwithpreviousrecords. x  $ $ 0    0$$2)0 $$Thecomputersystemcontainsthedonorunitnumber,thecomponentname,ABOandDtypes  (  ofthecomponent,bloodconfirmatorytestinterpretationandidentification,andtheABOand X  Dtypesoftherecipient.0  $ $ 0  0$$0$$3)0 $$Thereisamethodtoensurecorrectdataentry.  $ $ 0  0$$0$$4)0 $$Thesystemcontainslogictoalerttheusertodiscrepanciesbetweendonorunitlabelingand 8 bloodgroupconfirmatorytestinterpretationandtoABOincompatibilitiesbetweenrecipientand h donorunit.@ $ $ I.0  Optional_Pretransfusion_ԀTestingtestingofpatientbloodfortransfusionmay optionally includethefollowing:$$ 0  1.0$$ABOGroupingL$$ 0  0$$a.0$$Redcellstestedwithanti_A,B_T$$ 0  0$$b.0$$Serum/plasmatestedwithA2cells.,$$ 0  2.0$$DTyping$$ 0  0$$a.0$$WeakD(Du)testsonpatients.4$$ 0  0$$b.0$$RhcontrolwithchemicallymodifiedreagentsunlesspatientisABpositive.d  $$ 0  3.0$$AntibodyScreening(_IAT_)"$$ 0  0$$a.0$$RTincubation l$$$ 0  0$$b.0$$Additives,suchasalbumin,_LISS_!D%$$ 0  0$$c.0$$Enzymest" &$$ 0  0$$d.0$$_Polyspecific_Ԁ_AHG_Ԁinthe_IAT_L# '$$ 0  4.0$$_Autocontrol_ԀorDAT$")$$ 0  0$$a.0$$Datapublishedby_Judd_ԀetalindicatethatperforminganautocontrolorDATaspartofroutine &T$+ _pretransfusion_Ԁtestingmaybeoflimitedvalue,evenwhenthepatienthasbeenrecentlytransfused.',%,$$ 0  0$$b.0$$StandardsdoesnotrequireanautocontrolorDAT.4)&.$$ 0  5.0$$Microscopicreadingoftests,amagnifierviewinglampisadequate.*(0$$  /,5 0  6.0$$_Crossmatch_X$$ 0  0$$a.0$$37Cand_AHG_Ԁtestingwhenantibodyscreenisnegative,withnoprevioushistoryofclinically 0 significant_alloantibodies_.$$ 0  0$$b.0$$RTincubation$$ 0  0$$c.0$$Enzymetests`$$ 0  0$$d.0$$_AHG_Ԁwith_polyspecific_Ԁ_AHG_8$$ 0  0$$e.0$$Minor_crossmatch_.h$$ J.0  SelectionofUnits $$ 0  1.0$$Wheneverpossiblepatientsshouldreceivebloodcomponentsoftheirown ABOgroup .Whenthisisnot  p  possible,componentsofalternativeABOgroupsmaybeselected.Thefollowingisalistofacceptable  L  alternatives intheorderofselection: | $ $$ 0  0$$0$$0 $$ ABOGROUPOFRECIPIENT0 $ $ABOGROUPOFDONOR0h$$0!h$h$0$!$!$0@$$$ 0 $$$$ 0  0$$0$$0 $$0| $ $O0 | $| $0X $ $0X$X$0$$0`$$Oonly `$`$ 0  0$$0$$0 $$0| $ $B0 | $| $0X $ $0X$X$0$$0`$$B,O `$`$ 0  0$$0$$0 $$0| $ $A0 | $| $0X $ $0X$X$0$$0`$$A,O``$`$ 0  0$$0$$0 $$0| $ $AB0 | $| $0X $ $0X$X$0$$0`$$AB,A,O,B8`$`$ 0  2.0$$ Dpositiveblood shouldbeselectedforDpositiverecipients.Dnegativebloodisacceptablebut,except @ forthefollowingcircumstances,shouldbereservedforDnegativerecipients.Someexceptionsare:$$ 0  0$$a.0$$DnegativedonorunitwhichwillexpiresooncanbegiventoDpos"suregive".t$$ 0  0$$b.0$$MultipleantibodiespresentinthepatientserumwhichtheDnegativeunitlacks.L$$ 0  3.0$$ Dnegativecomponents shouldbeselectedforDnegativerecipientstoavoidimmunizingthepatientto T theDantigen.IfABOcompatibleDnegativecomponentsarenotavailablethereshouldbeconsultation 0 withthebloodbankmedicaldirectorandthepatient'sphysician,whomaypreferpostponingthe  transfusion.$$ 0  0$$a.0$$IftransfusionisurgentlyrequiredfirstutilizeABOcompatibleDnegative.8$$ 0  0$$b.0$$Ifthereisnoalternative,giveDpositive,theriskofimmunizationmustbeweighedagainstthe @! potentiallossofthepatient'slife."$$ 0  0$$c.0$$DependingonthechildbearingpotentialofthepatientitmaybeappropriatetoadministerRhImmune  p$ GlobulintorecipientsofDposcomponents(_ie_,platelets).!H%$$   4.0  Bloodadministeredafternongroupspecifictransfusion cannotbedoneuntilthefollowingcriteriais P# ' met:,$!($$ 0  0$$a.0$$StatusofantiAand/orantiBincurrentsampleoftherecipient'sblood.%#*$$   0  0$$b.0$$Whenserumfromafreshlydrawnsampleiscompatibleatthe_AHG_Ԁphaseofthe_crossmatch_Ԁwiththe '4%, recipient'sownABOgroup,groupspecificbloodmaybeissued.d( &-$$ 0  0$$c.0$$Ifthe_AHG_Ԁ_crossmatch_ԀisincompatibleduetoABOantibodies,continuetransfusingwith_RBCs_Ԁof *'/ thealternativecompatibleABOgroup.*(0$$ 0  0$$d.0$$IfthechangeinvolvedonlytheDtype,changebacktoDtypespecific,D*2$$  $/,5 0  5.0$$ Otherbloodgroups X$$ 0  0$$a.0$$Itisnotnecessarytoselectunitsonthebasisofotherbloodgroups unlesstherecipienthasa   clinicallysignificantunexpectedantibody .$$ _0  0$$b.0$$Iftheantibodyisstronglyreactive,screendonorunitswithrecipientserum,confirmwithreagent @ antisera.p$$ 0  0$$c.0$$Iftheantibodyisweaklyreactiveusecommerciallypreparedantiseratoconfirmthatcompatibleunits   lacktheantigen(s)inquestion.  $$ 0  0$$d.0$$Whencommerciallypreparedreagentsarenotavailable,rawpatientserumordonorantiseracanbe  P  used. ( $$ K.0  TechniquesforAntibodyDetection0 $$ 0  1.0$$Mostcommontechniqueistotestserumofpotentialtransfusionrecipientwith2or3commercially   preparedgroupOcells.`$$ 0    a.0$$Reagent_RBCs_Ԁcontainapreservativebutexpirewithinafewweeksofpreparation.h$$ 0  0$$b.0$$Witheachsetofscreen(orpanel)cellsananalysisoftheantigenspresent(antigenprofileor  "_antigram_")isincluded.$$ 0  0$$c.0$$Caremustbetakenthatthelotnumberofthe_antigram_Ԁcorrespondwiththelotnumberonthescreen H cells.x $$ 0  0$$d.0$$Patientserumisaddedtoscreencellsandobservedforagglutinationand/orhemolysisat3phases: (  $$ 0  0$$0$$1)RTIS,$$ 0  0$$0$$2)afterincubationat37Cwithenhancementmedia,andX$$ 0  0$$0$$3)afterwashingandadditionof_AHG_Ԁreagent.0$$ 0  0$$e.0$$Ifagglutinationand/orhemolysisisobservedinthescreencells,thetemperatureandmodeof 8! reactivitysuggestwhichbloodgroupsystem(s)arethemostlikelytobeinvolved."$$ 0  2.0$$Beforedecidinguponroutineproceduresforantibodydetectionthebloodbankdirectormustdecidewhich  h$ antibodiesareconsidered"significant".!@%$$ 0  0$$a.0$$Thisdecisionmustbegivencarefulconsiderationifthe_AHG_Ԁphaseofthe_crossmatch_Ԁisnotroutinely H# ' done. $!($$ 0  0$$b.0$$Onceaprocedurehasbeenadopted,themethodmustbedescribedintheStandardOperating %x#* Procedure(SOP)manualandeachstaffmember mustknowandfollowthedirectionsaswritten. &P$+$$ 0  3.0$$Theantibodydetectionmethodselectedtobasedonorselectiononshould:\(&-$$ 0  0$$a.0$$Detectasmanyclinicallysignificantantibodiesaspossible. *'/$$ 0  0$$b.0$$Notdetectclinicallyinsignificantantibodies.*(0$$ 0  0$$c.0$$Allowpromptdeliveryofbloodtotherecipient.+d)1$$  /,5 0  4.0$$Theantibodydetectiontechniqueshouldbeofsufficientsensitivitytodetectverylowlevelsofantibody X intherecipient'sserum.0$$ 0  0$$a.0$$Undetectedlowlevelsofantibodyinarecipientspecimenmayresultinrapidproductionofantibody  ifantigenpositivecellsaretransfused.`$$ 0  0$$b.0$$Antibodypresentin donor plasmawillnotharmarecipient.h$$ 0  5.0$$Methodsselectedforantibodydetectionand_crossmatching_Ԁtestsmaybethesameortheymaydiffer,for   example:  $$ 0  0$$a.0$$RTtestssuchasIS_crossmatch_ԀmaybepreferredtodetectABOincompatibilities,butmaynotbe  L  includedinantibodyscreeningtests.| $ $$ 0  0$$b.0$$Theantibodydetectionmethod must demonstrateclinicallysignificantunexpectedantibodiesand ,   must includethe_AHG_Ԁtest. $$ 0  0$$c.0$$The_crossmatch_Ԁ must demonstrateABOincompatibilitybutthe_AHG_Ԁisnotrequired.d$$ 0  6.0$$Allpersonnelinalaboratoryshouldusethesameinterpretationsandnotationsandbeconsistentingrading p reactions.H$$ 0  0$$a.0$$Consistencyingradingisespeciallyimportant.$$ 0  0$$b.0$$HemolysisoragglutinationconstitutesthevisibleendpointofanRBCantigenantibodyinteraction P andmustbeobservedaccuratelyandconsistently.($$ 0  0$$c.0$$Usingalightsourceandopticalaidenhancesthesensitivityandconsistency.0$$ 0    d.0$$Sincebothhemolysisandagglutinationarepossible,thesupernatantfluidshouldalwaysbeobserved  forfreehemoglobin immediately aftercentrifugation,then gently dispersethe_RBCs_Ԁandobservefor ` agglutination.<$$ 0  0$$0$$1)0 $$Themannerinwhichthe_RBCs_Ԁisdislodgedfromthebottomofthetubeaffectsdetectionof D! agglutination." $ $ 0  0$$0$$2)0 $$Thetubeshouldbeheldatananglesothatthefluidcutsacrossthecellbuttonasthetubeis  t$ gentlytilted.!L% $ $ 0  0$$0$$3)0 $$Thereactionstrength(orgrade)shouldbedeterminedwhen all cellshavebeen_resuspended_.T# ' $ $ 0  0$$0$$4)0 $$Overshakingmaybreakuplargeagglutinatesordisperseweaklycohesiveagglutinates.%") $ $ 0  0$$0$$5)0 $$Thestrengthofagglutinationordegreeofhemolysisobservedwitheachcellsampleshouldbe &`$+  RECORDEDASEACHTUBEISREAD. '8%, $ $ 0  0$$e.0$$Microscopicobservationisusefulindistinguishing_rouleaux_Ԁfromtrueagglutinationanddetecting @)&. specificpatternsofagglutinationcharacteristicofsomeantibodies,suchasMFpatternseenwithanti *'/ _Sda_.Routinemicroscopicobservationisnotrequired.*(0$$  (/,5 L.0  GeneralConsiderationsX$$ 0  1.0$$LabelingTubes$$ 0  0$$a.0$$ Eachtubeforserologicaltestingmustbelabeledbeforeuse .`$$ 0  0$$b.0$$Usetherecipient'sinitials(orotheridentifyinginformation)andthedonorunitnumberorreagent l RBCidentification.D$$ 0  2.0$$Youshould never relyonthepositionofatubeinarackorcentrifugeheadtoidentifythecontentsofa    tube. x $$ 0    a.0$$It is goodtechniquetoputtubesinthe_serofuge_Ԁintheorderinwhichyouwillreadandrecord  (  reactions.\  $$ 0  0$$b.0$$Itisimportanttousethesameorganizationaltechniquewhenarrangingtubesintheracktoimprove    organizationandspeed. $$ 0  3.0$$VolumeofSerum<$$ 0  0$$a.0$$Mostserologicprocedurecallfor2dropsofserum.D$$ 0  0$$b.0$$Someresearchershaveproventhat2dropsisinsufficienttoprovideanoptimumratioofantibodyto  antigeninsomecases.t$$ 0  0$$c.0$$Some_alloantibodies_Ԁweredetectableonlywhenthevolumeofserumwasincreasedto3or4drops. |$ Antibodypresentinlowconcentrationwillbepickedupwhentheserumtocellratioisincreased.T$$ 0  0$$d.0$$Thereistremendousvariabilityinthedeliveryvolumeofpipettesandreagentdropper(pipettedrops  smallandhighlyvariable,dropperdropstendtobetoolarge).$$ 0  0$$e.0$$Itisimportanttostandardizethevolumeofserumand_RBCs_Ԁusedinroutinetestsystemsbasedonthe 4 pipettesandreagentsutilizedin your particularlaboratoryespeciallyiflowionicreagentsrequiring d   equalvolumesofserumandreagentareused.@!$$ 0  4.0$$CellSuspension#$$ 0  0$$a.0$$_RBCs_Ԁusedfor_crosssmatching_Ԁshouldbeobtainedfromsealedsegmentoforiginaltubingattachedto !H% bloodcontainer.x" &$$ 0  0$$b.0$$Washonceandprepare24%.Manyworkersprefera2%cellssuspension.($!($$ 0  0$$c.0$$Besttouseweakestcellsuspensionthatcanbeobservedforagglutination.%#*$$ 0  0$$d.0$$Ifcellsuspensionistooheavyweakantibodieswillbemissed.'0%,$$ M.0  TestingTechniques8)&.$$ 0  1.0$$ Salinetests arethesimplestserologicaltechniques.*(0$$ 0  0$$a.0$$Recipientserummixedwithsalinesuspended_RBCs_.Centrifugedimmediately(IS)orincubatedat ,D*2 RTor37C.Maysetup2setsoftubes,oneforRTandonefor37C.t-+3$$  $/,5 0  0$$b.0$$In_crossmatching_ԀtestisusedtodetectABOincompatibility.X$$ 0  0$$c.0$$InantibodytestsisusedtodetectIgMantibodieswhichreactpredominantlyatRT:$$     0  antiM,N,P1,LeandI. $$   0  d.0$$Rareexamplesofantibodiesofother_specificities_Ԁmaybeobserved,butmoreoftenwillbereactive 6 at37Cor_AHG_Ԁaswell.f$$ 0  2.0$$ Bovinealbumin hasbeenutilizedtoenhancedirectagglutinationof_RBCs_ԀbyantibodiesoftheIgGclass   since1945.  $$ 0  0$$a.0$$Albuminisaddedtotheserumcellmixturepriortoincubationat37C. J $$ 0  0$$b.0$$Decreasesamountoftimerequiredforincubationandincreasesuptakeofantibodyontothecells.R $$ 0  0$$c.0$$Thereisstillcontroversyasto how itincreasestheuptake,whetheritreducesthezetapotential   (electricalchargebetweencells),orwhetheritisduetoafunctionoftheionicstrengthofthealbumin    diluent .^$$ 0  0$$d.0$$Manyantibodieshaveenhancedreactivitywhenalbuminisaddedtothetestsystem.j$$ 0  3.0$$ LowIonicStrengthSaline(_LISS_) conditionsshortenstheincubationtimerequiredforthedetectionof  mostantibodies.$$ 0    a.0$$Antibodyuptakeanddegreeofagglutinationareenhanced.N$$ 0    b.0$$Severalimportantfactorsmustbeconsideredwhenusing_LISS_Ԁreagentoradditives.V$$ 0  0$$0$$1)0 $$Theshortenedincubationperiodandenhancedsensitivityinsubsequent_AHG_Ԁtestsdependupon  attainmentofthedesiredionicconditions. $ $ 0  0$$0$$2)0 $$Addingadditionalserumtothetestsystemwill increase theionicstrengthofthemixture.^ $ $ 0  0$$0$$3)0 $$Itisof criticalimportance toadheretotheprocedurerecommendedbythemanufacturer.: $ $ ,    ,)4  .0    PolyethyleneGlycolTest(PEG) isthenewestenhancementmediautilized.,)PیF!$$ Ќ  0  0$$a.0$$Watersoluble,neutralpolymerthathasbeenshowntobeaneffective_potentiator_Ԁofantigenantibody # reactions. z$$$ 0  0$$b.0$$Advantagesoveralbumininclude:"* &$$ 0  0$$0$$1)0 $$increasestherateofdetectionofclinicallysignificantRBCantibodies.Z#!' $ $ 0  0$$0$$2)0 $$Decreasesdetectionofinsignificantantibodies.2$!( $ $ 0  0$$0$$3)0 $$Maydecreasetheneedforotherserologicenhancementtechniques. %") $ $ 0  0$$c.0$$ThetestisreadatISsaline,PEGisadded,andimmediatelyafterincubation,thetestiswashed.There &b$+ isno37Creading.':%,$$ 0  5.0$$ Enzymetechniques aremoreappropriatelyusedforantibodyidentificationthanforroutineantibody B)&. detectionduring_pretransfusion_Ԁtesting.*'/$$ 0  0$$a.0$$Theyareespeciallyusefulwhenincreasedsensitivityisdesired,asininvestigationofdelayed +v)1 hemolytictransfusionreactionswhenantibodiesarenotdetectedbyothermethods.,N*2$$ 0  0$$b.0$$ EnzymesgreatlyenhancethereactivityofRhantibodies. V.+4$$  2/,5 0  0$$c.0$$Enzymes cannot betheonlydetectionmethodutilizedbecause M,N,S,_Fy_Ԁ andcertainotherantigens X areusuallydestroyedsothatantibodiestothoseantigenswouldnotbedetected.4$$ 0  0$$d.0$$Theenzymesutilizedinthebloodbankinclude:papain,_bromelain_,_trypsin_Ԁand_ficin_._Ficin_Ԁtreated  cellsareavailablecommercially.d$$   6.0  LowIonic_Polycation_ԀTestsl$$  0  0$$a.0$$Themanual _Polybrene_Ԁtest(_MPT_) andthe lowionic_polycation_Ԁ(LIP) testarerapidandsensitive   methodstodetectmostbloodgroupantibodies.  $$ 0  0$$b.0$$Cationicpolymerscauseaggregationofnormal_RBCs_,whichcanbedispersedwithsodiumcitrate. | $$ 0  0$$0$$1)0 $$_RBCs_ԀincubatedwithserumunderlowionicconditionsatlowPhtofacilitateantibodyuptake. T  $ $ 0  0$$0$$2)0 $$Aggregationisinducedbyadditionof_Polybrene_ԀorLIP. ,  $ $ 0  0$$0$$3)0 $$Ifantibodyhascoatedthecellstheaggregationwillpersistafteradditionofsodiumcitrate \   (_MPT_)orbufferedsalinesolution(LIP).4  $ $ 0  0$$0$$4)0 $$Ifnoantibodycoatinghastakenplacethecellswilldisperse.   $ $ 0  7.0$$ The_Antiglobulin_Ԁtechnique is required whentestingsamplesfromrecipientsforthepresenceof d unexpectedantibodiesand,insomecasesdiscussedpreviously,forserologicalcompatibilitywith_RBCs_ @ fromdonors.p$$ 0  0$$a.0$$EitherantiIgGor_polyspecific_Ԁ_AHG_Ԁreagentmaybeusedforthe_AHG_Ԁphase. $$ 0    b.0$$Theuseof_polyspecific_Ԁhastheadvantageofdetectingtherareclinicallysignificantantibodieswhich x mayonlybedetectablebecausetheyactivatecomplement,thesehave_Kidd_Ԁ(_Jk_)bloodgroup P specificity.($$ 0  0$$c.0$$Thedisadvantageofusingpolyroutinelyisthatclinicallyinsignificant"nuisance"coldreactiveauto 0 antibodiessuchasantiIor_IH_Ԁaredetected.$$ 0  0$$d.0$$Thedirectorofthetransfusionservicemayconsiderthatthepotentialbenefitsof_polyspecific_Ԁreagents ` indetectingrarecomplementdependentantibodiesarenotworththeamountoftimeexpendedin 8 resolvingproblemscausedbytheseantibodies.h $$ 0  0$$e.0$$Thedecisiononwhich_AHG_Ԁreagenttouseisbasedontheincidenceatwhichclinicallysignificant " antibodiesaredetected.#$$ N.0  InterpretationofAntibodyScreeningand_Crossmatch_ԀResults.!H%$$ 0  1.0$$ NEGATIVEANTIBODYSCREEN,COMPATIBLE_CROSSMATCHES_P# '$$  0  0$$a.0$$Thevastmajorityofsamplestestedwillhaveanegativeantibodyscreenandthe_crossmatches_Ԁwith %") donor's_RBCs_Ԁarecompatible.%#*$$ 0  0$$b.0$$ Thisdoesnotguaranteeabsenceofantibodyornormalsurvivaloftransfusedcells.'4%,$$  0  0$$c.0$$Anegativeantibodyscreensimplymeansthattherearenoantibodiesintheserumdirectedatantigens @)&. presentontheseparticularscreencells,acompatible_crossmatch_Ԁshouldalsobeinterpretedinasimilar *'/ fashion.*(0$$  (/,5 0  2.0$$ POSITIVEANTIBODYSCREEN,INCOMPATIBLE_CROSSMATCHES_ maybedueto X _alloantibodies_,_autoantibodies_,problemswithreagentsor_rouleaux_Ԁformation.4$$ 0  0$$a.0$$ Mustidentifytheproblempriortoissuingbloodfortransfusion,unlesstheneedforbloodis  urgent .Ifthereisnottime:h$$ 0  0$$0$$1)0 $$Thebloodbankphysicianshouldadvisethepatient'sphysicianofthepotentialrisksinvolved.t $ $ 0  0$$0$$2)0 $$Oftentheriskofdeathduetotransfusingincompatibleblood maybeless thantheriskofdeath $  duetodeprivingthepatientofO2carryingcapacity.   $ $ 0  0$$b.0$$Positivereactionsusuallyduetopresenceof _alloantibodies_.  X $$ 0  0$$0$$1)0 $$Performapanelandidentifyantibodyspecificity.d  $ $ 0  0$$0$$2)0 $$Estimatethelikelihoodoffindingcompatible,antigennegativebloodintheavailableinventory.  $ $   0  0$$3)0 $$Useappropriatereagentantiserumtoconfirmthatunitsarenegativeforantigenthatantibody l isdirectedagainst.D $ $ 0  0$$0$$4)0 $$TheTechnicalManualstatethatitisnotnecessarytoconfirmthatbloodisantigennegativefor L antibodiesdirectedagainsttheM,N,P1orLeantigens.Justissue_crossmatch_Ԁcompatible. You $ wouldnotmakethisdecisiononyourown,ratherconsultwithyoursupervisor.  $ $ 0  0$$0$$5)0 $$Ifmultipleantibodiesarepresentandyouareunabletoidentifyall_specificities_Ԁsendasample X toareferencelab.0 $ $ 0  0$$0$$6)0 $$Iftheantibodyisdirectedagainstahighincidenceantigenthemostpromisingsourcewillbe 8 thepatient'ssiblingsor_AABB_Ԁraredonorblood. $ $ 0  0$$c.0$$If,whenperformingtheantibodyworkup,youobtaina positivereactionwiththe _autocontrol_ ,check h thepatient'shistory.B$$ 0  0$$0$$1)0 $$Ifpatienthasbeentransfusedwithinthepreceding23months_alloantibody_Ԁinpatientserum J! maybereactingwithtransfuseddonorcells."" $ $ 0  0$$0$$2)0 $$Mixedfieldagglutinationisusuallynoted,asonlydonorcellspositivefortheantigenarecoated  z$ withantibody.!R% $ $ 0  0$$0$$3)0 $$Performaproceduretoremoveboundantibodyfromcoatedcells( elution )intosolutionand Z#!' identifythespecificity.6$!( $ $ 0    d.0$$ Potentcoldreactiveantibodies maycauseproblemswithABO,Dtypingaswellasantibody %#* detectionand_crossmatching_Ԁtests.&j$+$$  (83" 3"  0  0$$0$$ 3 2  1  )3  0 $$  MostcommonspecificityisantiI.  3 * ݌r(&- $ $ Ќ  " 3"  0  0$$0$$ 3 2  2  )3  0 $$  Importanttodetermineifcold_autoantibody_Ԁmaybemaskingaclinicallysignificant N)&. _alloantibody_. 3 W݌&*'/ $ $ Ќ  " 3"  0  0$$0$$ 32  3  )3  0 $$  Use_prewarmed_Ԁtechnique_prewarm_Ԁcells,serumandsaline.NoIS,washwithwarmsaline *(0 immediatelyafterincubationanduseantiIgG_AHG_Ԁserum. 3݌+~)1 $ $ Ќ  " 3"  0  0$$0$$ 32  4  )3  0 $$  Testpatientserumwithcordblood_RBCs_,shouldget0/1+reaction. 3݌,V*2 $ $ Ќ  " 3"  0  0$$0$$ 3!2  5  )3  0 $$  Cold_autoabsorption_Ԁmaybenecessary.Willbediscussedindetaillater. 3!݌-.+3 $ $ Ќ  " 3"  0  0$$0$$ 32  6  )3  0 $$  TodeterminecorrectABO/Dtypekeepspecimenwarm(or_rewarm_),usecellswashedwith ^.,4 warmsaline. 3݌6/,5 $ $ Ќ  0    e.0$$ Warmreactive_autoantibodies_ rarelycauseproblemswithABOtypingbutfrequentlycause X problemswithDtypingusingahighproteintypingseraandantibodydetectionand_crossmatch_Ԁtests.4$$ 0  0$$0$$1)0 $$UselowproteinantiDreagentwithappropriatecontrol. $ $ 0  0$$0$$2)0 $$Warm_autoantibodies_Ԁwillcausepositiveantibodyscreensandincompatible_crossmatches_. < Theseare very difficulttoworkupandwillbediscussedindetaillater.l $ $ 0    f.0$$ _Rouleaux_Ԁformation isapropertyofserumthatcausesallcellstestedtoappearagglutinatedatRT   and37C,doesnotaffectthe_AHG_Ԁtestbecauseserumisremoved.  $$ 0  0$$0$$1)0 $$Appearancemicroscopicallyisdescribedas"stackedcoins"appearance. T  $ $ 0  0$$0$$2)0 $$Toconfirmthatthe_pseudoagglutination_Ԁis_rouleaux_Ԁusethe salinereplacementtechnique. \   $ $ N"X X  XX X  hXN0  0$$0$$ a)0| $$Spintubesdownagainandremoveserum. | $| $ 0  0$$0$$ b)0| $$Add13dropsofsalineand_respin_. | $| $ 0  0$$0$$0 $$c)0| $ $_Rouleaux_Ԁformationwilldispersewiththeadditionofsaline,trueagglutinationwillnot.h| $| $ 0  0$$g.0$$ Reagentrelatedproblems maybeduetoavarietyofdrugsandadditivespresentinreagentsandcan p cause false positiveresults.L$$ 0  0$$0$$1)0 $$Ifallreagent_RBCs_Ԁarepositivebut_crossmatches_Ԁappearcompatiblesuspectanantibody  reactivewithasubstanceinthepreservativesolution.Willbeeliminatedbywashingreagent  cellspriortouse.X $ $ 0  0$$0$$2)0 $$Ifthereisuniformagglutinationinalltubesconsideranantibodyreactivewithasubstancein ` theenhancementmedia.Resolvebyusingadifferentenhancementmediaordoingsaline 8 testing. $ $ 0  3.0$$ NEGATIVEANTIBODYSCREEN,INCOMPATIBLE_CROSSMATCH_ h$$ 0  0$$a.0$$ThemostcommoncauseistheunithavingapositiveDAT. Wheneveryouhavenegativescreensand t  only1unitisincompatibleperformaDATonthedonorunit. N!$$ 0  0$$b.0$$Rarely,positivereactionsinthe_crossmatch_Ԁmaybeduetoantibodiesto lowincidence antigens # presentonthedonorcellswhichareabsentonthescreencells.PerformtheDATfirst,ifnegative,  $ performapanel.!Z%$$ 0    c.0$$RepeatABOgroupingondonorcellsample.b# !'$$   0  0$$d.0$$Anegativeantibodyscreenandincompatible_crossmatches_Ԁat RTonly withmaybedueto:%")$$ 0  0$$0$$1)0 $$Donor_RBCs_ԀareABOincompatible,retypedonor.%#* $ $ 0  0$$0$$2)0 $$AntiA1intheserumofA2orA2Bindividuals.&n$+ $ $ 0  0$$0$$3)0 $$Other_alloantibodies_ԀreactiveatRT.Performapanel,includeRTincubation.'F%, $ $ 0  0$$e.0$$_Crossmatch_Ԁincompatibleatthe _AHG_Ԁphaseonly maybedueto:&*'/$$ 0  0$$0$$1)0 $$Donor_RBCs_ԀhaveapositiveDAT.+(0 $ $ 0  0$$0$$2)0 $$Antibodyreactiveonlywithcellshavingastrongexpressionofaparticular+)1 $ $ 0  0$$0$$0 $$antigen.Screencellsmaynotpossessasstronganexpressionoftheantigen.,Z*2 $ $ 0  0$$0$$0 $$Performapanel.-2+3 $ $  b. ,4   0  0$$3)0 $$Antibodyreactivewithlowfrequencyantigen.Performapanel.X $ $ O.0  LabelingandReleaseofBlood$$ 0  1.0$$Abloodtransfusionformindicatingthe_recipient;s_Ԁname,identificationnumberandABO/Dtypes must  ` becompletedfor eachdonorunitorcomponent. <$$ 0  0$$a.0$$Onecopyofformforpatient'schart.p$$ 0  0$$b.0$$Onecopymustremainattachedtodonorunit.H$$ 0  2.0$$Theformmustalsoincludethefollowing:  $$ 0  0$$a.0$$Donoridentificationnumber. P $$ 0  0$$b.0$$DonorABO/Dtypes. ( $$ 0  0$$c.0$$Interpretationofcompatibilitytesting.X $$ 0  0$$d.0$$Identificationofthepersonperformingthetest.0 $$ 0  0$$e.0$$Thecurrentstatusofserologictestingwhenbloodmustbeissuedbeforecompatibilityproblemsare   resolved. $$ 0  3.0$$Priortoissuingaunitofblood,bloodbankpersonnelmust:8$$ 0   $$ 0  0$$a.0$$Securelyattachtotheunitofabloodacompatibilitylabelwithalltheinformationmentionedabove.@$$ 0  0$$b.0$$Checktheexpirationdateofthebloodtoavoidissuinganoutdatedcomponent.$$ 0  0$$c.0$$Inspecttheunitforabnormalappearance.H$$ 0  0$$d.0$$Indicateonanappropriateformthe:P$$ __0  0$$0$$1)0 $$Nameoftheindividualissuingtheblood.( $ $ 0  0$$0$$2)0 $$Dateandtimeofissue. $ $ 0  0$$0$$3)0 $$Nameofpersontowhombloodwasissuedordestination. $ $ 0    e.0$$Finalidentificationoftherecipientpriortotransfusionrestswiththe_transfusionist_,whomustidentify 0 thepatientanddonorunitandcertifythatidentifyingforms,tagsandlabelsareinagreement.` $$ P.0  MassiveTransfusion"$$ 0  1.0$$Definedasinfusion,within24hours,ofavolumeofbloodexceedingtherecipient'stotalbloodvolume.  h$ Mayoccur:!@%$$ 0  0$$a.0$$unexpectedlyinsurgicalandmedicalemergencies.H# '$$ 0    b.0$$plannedcircumstancessuchascardiacandvascularsurgery. $!($$ 0    c.0$$exchangetransfusionofaninfantoradult.$")$$ 0  2.0$$Suchasmallvolumeofthepatient'sbloodisleftthatcomplete_crossmatching_Ԁhaslimitedbenefit.&P$+$$ 0    a.0$$ _Pretransfusion_Ԁsample nolongerrepresentscurrentlycirculatingtransfusedblood. X(&-$$ 0  0$$b.0$$OnlyimportanttoconfirmABOcompatibilityofsubsequentlytransfusedblood. *'/$$ 0  0$$0$$1)0 $$RepeatABO/Dtypingondonorcells.*(0 $ $ 0  0$$0$$2)0 $$PerformIS_crossmatch_Ԁonly.+d)1 $ $ 0    c.0$$Whenunexpected_alloantibody_Ԁispresentinthepatient's_pretransfusion_Ԁspecimen,abbreviatingthe l-+3 _crossmatch_Ԁisacceptablefollowingmassivetransfusionsolongasantigennegative,ABOcompatible D.+4 _bloodis_transfused./,5$$ ЇQ.0  ReleaseofBloodinUrgentSituations.X$$ 0  1.0$$Whenthereisadesperateneedforblood,thepatient'sphysicianmustweighthehazardoftransfusing  _uncrossmatched_Ԁorpartially_crossmatched_Ԁbloodagainsttheriskofwaitingwhiletestingiscompleted.$$ 0  2.0$$Whenbloodisreleasedbeforethe_crossmatch_Ԁiscompleted,therecords must containastatementofthe 8 requestingphysicianindicatingthattheclinicalsituationwassufficientlyurgenttorequirereleaseof l blood.D$$ 0  0$$a.0$$Thisdoesnotabsolvethebloodbankpersonnelfromtheirresponsibilitytoissueproperlylabeled    donorbloodofanABOgroupcompatiblewiththepatient. t $$ 0  0$$b.0$$Compatibilitytestingmustbestartedassoonasthespecimenreachesthebloodbank.| $ $$ 0  3.0$$Whenurgentreleaseisrequestedissue_uncrossmatched_Ԁbloodandimmediatelybegincompatibilitytesting ,  procedures.Bloodreleasedshouldbe: $$ 0  0$$a.0$$ABOandDspecific,iftherehasbeentimetoperformABOandDtestingonthepatient'scurrent \ bloodspecimen. Previousrecordsmustnotbeusedtodeterminewhichbloodgrouptoissue.4$$ 0  0$$ b.0$$GroupODnegative_RBCs_Ԁmustbegivenwhenthepatient'sABOandDtypeisunknown.@$$ 0  4.0$$ Indicateinaconspicuousfashion onthebloodbagorcomponentthatcompatibilitytestinghasnotbeen  completedatthetimeofissue.t$$ 0  5.0$$Complete_crossmatches_Ԁ promptly .Ifincompatibilityisdetectedatanystateoftesting, immediately |$ notifythepatient'sphysicianandbloodbankphysician. X$$ 0  6.0$$Ifthepatientdiesfromamedicalproblemunrelatedtothebloodtransfusion,itisnotnecessaryto  completecompatibilitytestingthatmaybepending. Thisdecisionrestswiththephysicianresponsible  forthetransfusionservice. d$$ 0  7.0$$Ifthereis any reasontosuspectthattransfusionaggravatedtheoriginalproblemorcontributedtodeath, l  alltestingshouldbecompleted,includingpanelsandantigentesting.H!$$ R.0  EffectiveBloodUtilization,RoutineSurgicalBloodOrders#$$ 0  1.0$$Increasingblooddemandsandlimitedbloodresourceshavemadebloodbankingincreasinglyconscious !P% oftheneedtousebloodefficiently."( &$$ 0    a.0$$Inmany_ORs_Ԁithadbeenstandardpracticetohaveblood_crossmatched_Ԁandreservedforevery %") individualpatientasa"standby"precaution.%#*$$ 0  0$$b.0$$Sincemostoftheseunitswerenotused,the_crossmatches_Ԁandtheexpandedinventoryneededtomeet '8%, thesedemandswerewastedresources.h(&-$$ 0  2.0$$Routinesurgicalbloodordersinvolvesorderingbloodforcommonelectiveproceduresandarebasedon *'/ previousrecordsofbloodusage.*(0$$ 0  0$$a.0$$Thetransfusionservice_crossmatches_Ԁanagreeduponnumberofbloodunitsbasedonprocedure.,H*2$$  (/,5 0    b.0$$Sincesurgicalrequirementsvaryamonginstitutions,routinebloodordersshouldbebasedonlocal X transfusionutilizationpatternsasdeterminedbythebloodbankmedicaldirector,staffsurgeonsand 0 anesthesiologists.$$ 0  0$$c.0$$Routineordersmustbemodifiedforpatientswithanemia,bleedingdisordersorotherconditionsin ` whichincreaseduseisanticipated.8$$ 0  0$$d.0$$Bloodbankmustbepreparedtoprovideadditionbloodifanunexpectedproblemarises.@$$ 0  0$$e.0$$Orderinglevelsshouldbereviewedperiodicallytomonitorwhethertheminimumnumberofunits    shouldbeincreasedordecreased. p $$ 0  0$$f.0$$TheTypeandScreenprotocolisbestforproceduressuchashysterectomy,_thyroidectomy_,OBpatient x  andotherswherebloodisseldomneeded.P $$ 0  0$$0$$a)0 $$_Uncrossmatched_ԀABO/Didenticalbloodcanbereleasedwith99.9%assuranceofsafety.  $ $ 0  0$$0$$b)0 $$Patientswithdetectableunexpectedantibodiesarenoteligibleandwillhaveantigennegative X units_crossmatched_.0 $ $