CROSSMATCH

CROSSMATCH
MAJOR CROSSMATCH (Donor RBC + Patient Serum)

1. Saline Phase at Room Temperature …...IgM
5% Donor RBC suspension 1 drop+ 1-2 drops patient serum……..45 min at
22oC…...centrifuge & record result
2. Saline Phase at 37oC…...IgG
5% Donor RBC suspension 1 drop+ 1-2 drops patient serum……..45 min at
37oC…...centrifuge & record result
3. Albumin Phase at 37oC …..IgG
5% Donor RBC suspension 1 drop+ 1-2 drops patient serum +1 drop of 20% bovine
Albumin……..30-45 min at 37oC…...centrifuge & record result
4. Coomb’s Phase……...Any antibody or complement
5% Donor RBC suspension 1 drop+ 1-2 drops patient serum……..30-45 min at
37oC…...centrifuge……….3-4 times washing……..+ 1-2 drops of Coomb’s
Reagent……….Centrifuge and record result
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Low Ionic Strength Saline (LISS)
Shortens incubation time to 15 minutes
Reduces chances of non-specific agglutination
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Case 1: 2 Hours …….Full Crossmatch

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Case 2: 1 Hour……...Try to do full crossmatch
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Case 3: Only 20 minutes…………
Step 1: ABO & Rh + Coomb’s Phase (Immediate spin 5 min incubation)

Step 2: Issue blood
Step 3: Perform Full crossmatch
Step 4: If non-compatible inform the transfusionist & Doctor immediately to discontinue
transfusion
Step 5: Perform Crossmatch on new Blood Bag Unit
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Case 4: 2 minutes…….
Just perform Group
Step 2-5 as previous
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Case: 5 No time
Issue O Negative or O Positive Blood
MINOR CROSSMATCH (Donor SERUM + Patient RBC)
Complete Crossmatch Profile

1. Donor Blood Grouping
2. Recipient Blood Grouping
3. Recipient Antibody Screening with 3 Cell Screening Panel
4. Crossmatch (Donor RBCs + Patient Serum)
Crossmatch Problems
In the following situations a saline crossmatch may appear incompatible
1. Donor RBCs are ABO incompatible
In this situation the first thing to do is to confirm the donor's ABO group. Labeling errors are the
most likely to cause this problem than technical errors.
_Most ABO antibodies present in recipient's serum react strongly at room temperature and also
at 37°C or in the antiglobulin test with most mislabeled A, B, or AB RBCs.
_Rarely a unit of blood from a donor whose RBCs have a weak expression of A or B antigens
(e.g. Ax) are incorrectly labeled as group O. In this, the crossmatch with group O serum may be
weakly incompatible only at the antiglobulin phase. Anti A 1 in the serum of A 2 or A 2 B individuals:
If room temperature testing is done, anti A 1 will occasionally be encountered. Some, but not all
group A donor unit may be incompatible.
If the antibody reacts only at room temperature, it is not considered clinically significant, but if it
is reactive at 37°C. crossmatch compatible blood should be given.
2. Other alloantibodies reactive at room temperature: Other alloantibodies such as anti
M. anti N anti S, anti Lu, anti P. and anti Le may be detected in saline crossmatch at
room temperature.
3. Polutinable RBCs. All normal adult sera contain varying levels of naturally occurring
antibodies that react with RBCs with abnormal surface structures that render them
polyagglutinable. These antibodies are rarely a problem because most RBCs do not
manifest the corresponding antigens.
4. Antibodies reactive at 37°C.
_Agglutinations produced by cold agglutinins will disappear or diminish at 37°C.
_Saline acting anti Rh (anti C, E, c, e) antibodies may appear reactive at 37 °C crossmatch.
_Some anti K and anti Le antibodies may also appear reactive at this temperature.
_Suspect anti Le if hemolysis appears.
5. Antibodies reactive at antiglobulin crossmatch. Almost all immune antibodies,

including anti Rh antibodies, anti Fy, anti Jk, anti K antibodies may appear reactive at
this step of crossmatch. The antibody can usually be identified by testing a full panel of
RBCs.
6. Donor RBCs have a positive DAT (Direct Antiglobulin Test). Some donors
occasionally have sensitized RBCs and cause incompatibility in the antiglobulin phase of
crossmatch. The problem can be easily and quickly identified by performing a DAT on
the cells.

CROSSMATCH

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CROSSMATCH

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CROSSMATCH

MAJOR CROSSMATCH (Donor RBC + Patient Serum)

Case 1: 2 Hours …….Full Crossmatch

Step 1: ABO & Rh + Coomb’s Phase (Immediate spin 5 min incubation)

Complete Crossmatch Profile

5. Antibodies reactive at antiglobulin crossmatch. Almost all immune antibodies,

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