Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
1.0 Policy Statements
1.1
All Regional Health Authorities in which blood components and blood
products are administered shall have policies in place for:
1.1.1
The identification and investigation of the recipients ABO and
Rhesus (Rh) groups and clinically significant red cell
alloantibodies
1.1.2
The selection of group specific and/or ABO compatible
products/components.
1.1.3
The transfusion of Rh (D) positive red cells to an Rh (D) negative
recipient when the inventory of Rh (D) negative red cells is
impacted.
1.1.4
Emergency transfusion policies when there is insufficient time to
complete the ABO and Rh group of the recipient or a sample
cannot be obtained.
1.1.5
Special transfusion requirement requests; defining appropriate
recommendations for use as clinically indicated.
Note: Please refer to each facility Transfusion Medicine policy regarding Pretransfusion testing guidelines for neonates less than 4 months.
2.0 Linkages
2.1
Guidelines for CMV Negative Blood Components. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/cmv_version_1.pdf
2.2
Guidelines for Irradiated Blood Components. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/irradiated_version_1.p
df
2.3
Guidelines for Transfusion Orders for Blood Components and Blood
Products. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/transfusion_orders_ve
rsion_2.pdf
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
Page 2 of 9
Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
2.4
Guidelines for Emergency Issue of Blood Components. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/emergency_issue_bloo
d_components.pdf
2.5
Standard Operating Procedure for Patient History Check. Available at:
http://www.health.gov.nl.ca/health/bloodservices/pdf/patient_history_check.
pdf
3.0 Scope
3.1
This policy applies to all health care professionals responsible or directly
involved with ordering, processing and transfusion of blood components
and/or administration of blood products. These guidelines shall be used in
conjunction with Regional Health Authority established guidelines for pretransfusion testing.
4.0 General Information
4.1
Two major antigen systems found on the surface of red blood cell are the
ABO and the Rhesus (Rh) systems.
4.1.1
Within the ABO system there are four major blood groups A, B,
AB and O which are determined by the presence of an antigen on
the individual’s red cells.
4.1.1.1 Group A individuals have the A antigen present on their red
blood cells.
4.1.1.2 Group B individuals have the B antigen present on their red
blood cells.
4.1.1.3 Group AB individuals have both A and B antigens present
on their red blood cells.
4.1.1.4 Group O have neither antigens A nor B present on their red
blood cells.
4.1.2
The Rh (D) antigen is the most clinically significant, since it is
more immunogenic than other Rh antigens. The Rh type is
identified by the presence or absence of the Rh (D) antigen.
4.1.2.1 Rh (D) negative indicates that the Rh (D) antigen is not
present on the red cell.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
Page 3 of 9
Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
4.1.2.2 Rh (D) Positive indicates that Rh (D) antigen is present on
the red cell.
4.2
The identification of ABO and Rhesus (Rh) groups along with the
investigation of any clinically significant alloantibodies is essential in
selecting compatible donor red blood cells.
4.2.1
Normal healthy individuals make antibodies against the A and B
antigens. The antibodies are found in the individual’s plasma and
are referred to as naturally occurring.
4.2.1.1 Group A individuals have anti B antibodies.
4.2.1.2 Group B individuals have anti A antibodies.
4.2.1.3 Group O individuals have both anti A and anti B antibodies.
4.2.1.4 Group AB individuals have neither anti-A nor Anti B
antibodies.
4.3
A type and screen involves the testing of a recipient’s blood specimen for
ABO and Rhesus (Rh) groups, and for clinically significant red cell
alloantibodies.
4.4
A crossmatch confirms the ABO and Rhesus (Rh) compatibility between the
patient serum/plasma and the donor’s red blood cells.
4.5
Universal Blood
4.5.1
Blood group O is the universal donor for red cells; it lacks both the
A and B antigen.
4.5.1.1 If the recipient’s blood group is unknown or group specific
red blood cells are not available and there is an immediate
clinical need to transfuse, group O Rh (D) negative can be
considered for recipients of all ABO blood groups.
4.5.2
Blood group AB is considered the universal donor for platelets,
plasma and cryoprecipitate; the plasma products lack both the A
and B antibodies.
4.5.2.1 If recipient’s blood group is unknown and there is an
immediate clinical need to transfuse platelets, plasma and/or
cryoprecipitate group AB can be considered for recipients of
all ABO blood groups.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
Page 4 of 9
Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
4.6
Transfusion of Rh (D) positive red cells to an Rh (D) negative recipient shall
only occur when the inventory of Rh (D) negative red cells is impacted.
Such cases may include; trauma, massive transfusion, and emergency
situations or when Rh (D) negative blood is in short supply.
4.7
Rh positive recipients may receive either Rh (D) positive or Rh (D) negative
red blood cells.
5.0 Process
5.1
Quality Control
5.1.1
Samples used for ABO and Rh typing shall be labeled in the
presence of the recipient at the time of collection.
5.1.2
All Red Blood Cells for transfusion shall be tested for ABO and
Rh compatibility; (Refer to Table 1 for ABO & Rh compatibility).
5.1.3
ABO and Rhesus (Rh) groups shall be checked against:
5.1.3.1 The compatibility label/tag attached to blood components.
5.1.3.2 Recipient’s type and screen and crossmatch report.
5.1.3.3 The Canadian Blood Services components labels.
5.2
Procedure (N/A)
5.3
Guidelines
5.3.1
A type and screen, and crossmatch shall be performed prior to the
transfusions of red blood cells.
5.3.2
If the recipients transfusion medicine history does not indicate
previous transfusion of blood components containing red blood
cells and/or pregnancy within the preceding three months,
specimens for type and screen and compatibility testing can be
used for a length of time specified by the facility’s Transfusion
Medicine Laboratory policy.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
Page 5 of 9
Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
Note: Platelets contain a small portion of red blood cells; and shall be considered as a
transfusion of a red blood cell containing blood component.
5.3.3
If the recipient has been transfused or pregnant within the
preceding three months, specimens for type and screen and
compatibility testing are acceptable for 96 hours from time of
collection.
5.3.4
The recipient’s transfusion medicine history must be reviewed to
confirm the date and time of collection is within the acceptable
time period. If the time period is not acceptable, another specimen
must be collected and compatibility test performed on the new
specimen.
5.3.5
A crossmatch should be requested for recipients for whom a blood
transfusion is anticipated to ensure compatible blood is reserved
for the recipient.
5.3.6
Rh (D) negative cellular components should be transfused to
recipients who are Rh (D) negative.
5.3.7
Recipients shall be transfused with plasma that is ABO
compatible with the recipient’s red cells.
5.3.7.1 Rh specific components for plasma are not required.
5.3.8
Recipients should be transfused with cryoprecipitate that is ABO
compatible with the recipient’s red cells. ABO group substitution
shall be required when ABO specific cryoprecipitate is not
available.
5.3.8.1 Rh specific components for cryoprecipitate are not
required.
5.4
Materials (N/A)
6.0 Acronyms (N/A)
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
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Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
7.0 Definitions
Word
Antibodies
Antigen
Compatibility Testing
Crossmatch
Special Transfusion
Requirements
Type and Screen
Definition
A protein produced after stimulation by an antigen
that acts specifically against the antigen in an
immune response.
Any substance foreign to the body that evokes an
immune response.
The activity performed pre-transfusion to ensure
that a blood component will not produce a harmful
reaction to the recipient blood.*
A method used to detect incompatibilities between
donor and recipient blood prior to transfusion.
Requirements for blood products/components that
are necessary for a particular clinical indication or
treatment process
A term used to reference the determination of
ABO and Rhesus (Rh) groups and screens for
clinically significant red blood cell alloantibodies.
*Compatibility testing can include testing for ABO and Rh, test for clinically significant antibodies, and
crossmatch testing. The specific test will depend on the receipt; the situation, and the blood component
being transfused, as specified in the Standard Operating Procedures (SOP) manual of the Transfusion
Medicine services at each facility.
8.0 Records Management
8.1
All transfusion records in the recipient’s medical chart, including pretransfusion serological test results and worksheets for identification of
clinically significant antibodies shall be retained in accordance with health
care facility’s policy for medical records.
8.2
Transfusion request forms for serologic tests shall be retained for one
month.
8.3
Records for the collection of a blood sample including the date and time of
collection and the identification of the person taking the sample shall be
retained for one year.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
Page 7 of 9
Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
8.4
The Transfusion Medicine Laboratory shall retain the recipient
administration data file indefinitely.
8.5
All administration records in the recipient’s medical chart shall be retained
in accordance with the health care facility policy.
8.6
Each facility shall have a record system that ensures a copy of all
information relating to the patient and the administered blood components
and blood products forms a permanent record for the patient. The record
system shall be organized and maintained in such a way that it is possible to
trace blood components and blood products from their distributor to final
disposition (i.e. administration or destruction). The records system shall also
provide a means to locate and access all records in the facility related to a
given product.
9.0 Key Words (N/A)
10.0 Supporting Documents
10.1 Process Flow/Algorithm (N/A)
10.2 Tables/Charts
Table 1: Selection of ABO Compatible Donor Red Cells
Recipient
O
A
B
AB
1st Choice
Group O
Group A
Group B
Group AB
2nd Choice
none
Group O
Group O
Group A
3rd Choice
none
none
none
Group B
4th Choice
None
None
None
Group O
NOTE: Rh negative recipients should be transfused with Rh negative red cells. Refer to
section 4.6 for exception. Clinical consult and Hematologist approval shall be obtained
before transfusion of Rh (D) positive Red Cells to an Rh (D) negative recipient.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
Page 8 of 9
Provincial Blood
Coordinating Program
Transfusion Medicine Best Practices
Guidelines for Pre-Transfusion Testing
(Type and Screen, and Crossmatch)
References
Callum, JL., Lin, Y., Pinkerton, PH., Karkouti, K., Pendergrast, JM., Robitaille,
N., …Webert, KE. (2011). Bloody easy 3: Blood transfusions, blood
alternatives and transfusion reactions, a guide to transfusion medicine.
Ontario, Canada: Ontario Regional Blood Coordinating Network.
Clarke, G., & Blajchman, M. (2006). Clinical guide to transfusion. (4thed.).
Toronto, ON: Canadian Blood Services.
Canadian Standards Association. (2010). Blood and blood components,
Z902-10. Mississauga, ON: Author
Canadian Standards for Transfusion Medicine. (2011). Standards for hospital
transfusion services (Version 3.0). Ottawa, ON: Author
King, K.E., & Gottschall, J.L. (2008). Blood transfusion therapy: A physician’s
handbook (9thed.). Bethesda, Maryland: AABB
Manitoba Provincial Blood Programs Coordinating Office. (June 2007).
Manitoba transfusion medicine best practice resource manual for nursing
(Version1).Winnipeg, MB: Author
Mish, F.C. (2004). Merriam Webster’s collegiate dictionary. (11thed). USA:
Merriam Webster Incorporated.
Newfoundland and Labrador Provincial Blood Coordinating Program. (2012).
Policy for blood component and blood product administration. (Version 4.0).
St. John’s, NL: Author
Ontario Regional Blood Coordinating Program Network. (2014). Transfusion
technical resource manual (Swim PA 002.). Ontario, Canada: ORBCON.
_______________________________________________________________________
This document may be incorporated into each Regional Policy/Procedure Manual.
NL2011-032 -TMP
Version: 2.0
Effective Date: 2014-11-24
Page 9 of 9