Pretransfusion Testing

NAEEM ULLAH
Lecturer MLT (pathology),
NWIHS
BS MLT (Gold Medalist), KMU
M.Phil MLSc (Gold Medalist),
UOH
PhD MLT (Conti..), UOH
 REQUESTS FOR
TRANSFUSION
• Requests for blood and blood components
may be submitted in an oral, electronic, or
written format.

 Requests must contain sufficient information for accurate

recipient identification (ID).

 Two independent patient identifiers are required, and

they ideally include the patient’s first and last names and
an ID number that is unique to the patient.
• Other information necessary to process a request for
transfusion includes the kind and amount of the
component requested, any special requests such as
irradiation, the gender and age of the recipient, and the
name of the physician who is ordering the transfusion.

• The recipient’s diagnosis and a history of transfusion and

pregnancy may provide useful information to guide
testing, product/ component selection, or both.
 IDENTIFICATION OF RECIPIENTS

• Collection of a properly labeled pre transfusion blood

specimen from the intended recipient is critical to safe
blood transfusion.

• The majority of hemolytic transfusion reactions arise

from misidentification of patients or pre transfusion
specimen labeling errors.
 Patient Identification

• Identification Wristband.
• Most institutions require hospitalized patients to wear an
ID wristband, which contain Patient Name, hospital ID
and usually date of birth.

• The phlebotomist is required to identify the patient by

carefully examining the information on the wristband.

• If wear wrong Band then what to do?????

 Specimen Labeling
• The phlebotomist must label each blood specimen tube,
with Patient name, ID and date of collection.

• Either handwritten or imprinted labels may be used

provided that the information on the label is identical to
that on the wristband and the transfusion request
 Confirming Specimen in Lab
• When a pre transfusion specimen is received in the
laboratory, laboratory personnel must confirm that the
information on the specimen label and the information on
the pretransfusion testing request are identical.

• If there is any doubt about the identity of the patient or

about the labeling of the specimen, a new specimen
must be obtained
 SPECIMEN REQUIREMENTS

• Pretransfusion red cell compatibility testing is performed

on red cells and on either serum or plasma.

• Whereas both serum and plasma may be used for a

variety of testing methods, plasma is often preferred.

• For example, incompletely clotted serum specimens may

contain small fibrin clots that trap red cells into
aggregates and cause false-positive results with Colum
agglutination technology.
Specimen Hemolysis and Lipemia

• The use of hemolyzed or lipemic specimens may create

difficulties in evaluating test results.

• Tests with a hemolyzed specimen may mask antibody-

induced hemolysis;
• Therefore,

• Whenever possible,

• A hemolyzed sample should be replaced with a new

specimen.
 Specimen Age

• When performing pretransfusion testing for a patient who has

been pregnant or transfused within the previous 3 months, or if
the pregnancy history and transfusion history are uncertain,
the pretransfusion sample used for testing must be no more
than 3 days old at the time of intended transfusion, because
recent transfusion or pregnancy may stimulate production of
unexpected antibodies.

• If the histories of transfusion and pregnancy are certain and if

no transfusion or pregnancy has occurred in the previous 3
months, no limit exists to the length of time that a
pretransfusion sample is valid for donor red cell selection
 Retention and Storage of Recipient and
Donor Specimens

• The recipient’s blood specimen and a specimen of the

donor’s red cells must be stored at refrigerator
temperature for at least 7 days after each transfusion.

• Retaining both the patient’s specimen and the donor’s

specimen allows for repeat or additional testing if the
patient has a transfusion reaction.
 PRETRANSFUSION TESTS

• The patient’s ABO group and Rh type must be

determined in order to transfuse ABO- and Rh-
compatible components.

• The red cells of the intended recipient must be typed for

ABO and Rh, and the serum or plasma must be tested
for expected and unexpected antibodies before
components containing red cells are issued for
transfusion
 ABO Group and Rh Type of the Recipient

• To determine the ABO group of the recipient, red cells must be tested
with anti-A and anti- B, and the recipient’s serum or plasma must be
tested with A1 and B red cells.
• The patient’s red cells must also be tested with anti-D.

• The weak D test is used to detect forms of the D antigen that are not
agglutinated directly by anti-D reagents but that require an IAT for
detection.

• Weak D testing is required for typing of donated red cell components

but not for pretransfusion testing on patients. Because many institutions
do not perform weak D testing on transfusion recipients, weak D
individuals are considered Rh negative and will receive Rh negative
Red Blood Cell (RBC) units without risk of D allo immunization
 Detection of Unexpected Antibodies

• The goals of antibody detection testing are

as follows:
• To detect as many clinically significant
antibodies as possible.
• To detect as few clinically insignificant
antibodies as possible.
• To complete the procedure in a timely
manner.
• In general, an antibody is considered
potentially clinically significant if antibodies of
its specificity have been associated with
hemolytic disease of the fetus and newborn
(HDFN), with a hemolytic transfusion
reaction, or with notably decreased survival of
transfused red cells.
• Antibodies reactive at either 37 C or in the
AHG test phase are more likely to be clinically
significant than are cold reactive antibodies
• The Food and Drug Administration (FDA)
has licensed reagent red cells to detect
specific antibodies that are considered
potentially clinically significant.
• To this end, reagent red cells must
express the following antigens:
• D, C, E, c, e, M, N, S, s, P1, Lea, Leb, K,
k, Fya, Fyb, Jka, and Jkb.
 DONOR RBC UNIT SELECTION

• ABO Compatibility
• Whenever possible, patients should
receive ABO-identical blood; however, it
may occasionally be necessary to make
alternative selections.
• If the component to be transfused contains
2 mL or more of red cells, the donor’s red
cells must be ABO-compatible with the
recipient’s plasma
 Rh Type
• D-positive blood components should routinely be
selected for D-positive recipients.

• D negative units will be compatible but should be

reserved for D-negative recipients.

• D-negative patients (especially females of

childbearing potential) should receive red-cell-
containing components that are negative to avoid
immunization to the D antigen and possible HDFN.
 COMPATIBILITY TESTING OR
CROSSMATCH

• Unless there is an urgent need for blood, a

cross match must be performed before a
red cell transfusion.
• Inventory
• A sufficient number of ABO- and Rh
compatible units must be placed into
inventory for each patient who might need
blood
 LABELING OF BLOOD AND
BLOOD COMPONENTS WITH THE
RECIPIENT’S INFORMATION

• The following activities are required at the

time of issue:
• A tag or label indicating the recipient’s two
independent identifiers, the donor unit
number, and the compatibility test
interpretation, if performed, must be
attached securely to the blood container.
A final check of records maintained in the blood bank for
each unit of blood or component must include the following:
1. Two independent identifiers, one of which is usually the
patient’s name.
2. The recipient’s ABO group and Rh type.
3. The donor unit or pool ID number.
4. Donor’s ABO group and, if required, Rh type.
5. The interpretation of the crossmatch tests (if performed).
6. The date and time of issue.
7. Special transfusion requirements (eg, cytomegalovirus
reduced risk, irradiated, or antigen-negative).