First Indian study to establish safety of immediate-spin crossmatch for red blood cell transfusion in antibody screen-negative recipients

Aseem Kumar Tiwari, Geet Aggarwal, Ravi C Dara, Dinesh Arora, Gautam Kumar Gupta, Vimarsh Raina, Aseem Kumar Tiwari, Geet Aggarwal, Ravi C Dara, Dinesh Arora, Gautam Kumar Gupta, Vimarsh Raina

Abstract

Background and objectives: The US Food and Drug Administration and American Association of Blood Banks approved the type and screen approach in 1980s, long after antibody screen (AS) was introduced in 1950s. The present study omits conventional anti-human globulin (AHG) crossmatch and replaces it with immediate-spin (IS) crossmatch as part of pretransfusion testing in AS-negative patients to study the safety and effectiveness of IS crossmatch in recipients.

Materials and methods: This prospective longitudinal study was conducted on over 5000 red cell units transfused to AS-negative patients admitted to the hospital. Pretransfusion testing comprised blood grouping and AS followed by IS crossmatch, at the time of issue of red cell unit. The patients were transfused IS compatible red cell units. AHG crossmatch was performed posttransfusion for all red cell units. Any incompatible AHG crossmatch was followed up as suspected transfusion reaction.

Results: A total of 5023 red cell units were transfused to 2402 patients with negative AS. 99.7% IS compatible red cell units were also compatible on posttransfusion AHG crossmatch. Anti-P1 alloantibody was identified in one patient who was transfused two IS crossmatch compatible units but later both units were incompatible on AHG crossmatch. There was no clinical or serological sign of hemolysis in the patient.

Conclusion: In AS-negative patients, IS crossmatch is as safe as conventional AHG crossmatch and can, therefore, replace conventional AHG crossmatch protocol.

Keywords: Anti-human globulin; immediate-spin crossmatch; pretransfusion testing; red blood cell transfusion; type and screen.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Existing conventional protocol.
Figure 2
Figure 2
Study protocol.

References

    1. Grove-Rasmussen M. Routine compatibility testing: Standards of the AABB as applied to compatibility tests. Transfusion. 1964;4:200–5.
    1. Garratty G. Advances in red blood cell immunology 1960 to 2009. Transfusion. 2010;50:526–35.
    1. Oberman HA, Barnes BA, Friedman BA. The risk of abbreviating the major crossmatch in urgent or massive transfusion. Transfusion. 1978;18:137–41.
    1. Pinkerton PH, Coovadia AS, Goldstein J. Frequency of delayed hemolytic transfusion reactions following antibody screening and immediate-spin crossmatching. Transfusion. 1992;32:814–7.
    1. Heddle NM, O’Hoski P, Singer J, McBride JA, Ali MA, Kelton JG. A prospective study to determine the safety of omitting the antiglobulin crossmatch from pretransfusion testing. Br J Haematol. 1992;81:579–84.
    1. Lee E, Redman M, Burgess G, Win N. Do patients with autoantibodies or clinically insignificant alloantibodies require an indirect antiglobulin test crossmatch? Transfusion. 2007;47:1290–5.
    1. Pathak S, Chandrashekhar M, Wankhede GR. Type and screen policy in the blood bank: Is AHG cross-match still required? A study at a multispecialty corporate hospital in India. Asian J Transfus Sci. 2011;5:153–6.
    1. Agrawal A. Type and screen policy: Is there any compromise on blood safety? Transfus Apher Sci. 2014;50:271–3.
    1. Lange J, Selleng K, Heddle NM, Traore A, Greinacher A. Coombs’ crossmatch after negative antibody screening – A retrospective observational study comparing the tube test and the microcolumn technology. Vox Sang. 2010;98(3 Pt 1):e269–75.
    1. Fung MK, editor. Technical Manual. 18th ed. USA: American Association of Blood Banks; 2014.
    1. Arndt PA, Garratty G, Marfoe RA, Zeger GD. An acute hemolytic transfusion reaction caused by an anti-P1 that reacted at 37 degrees C. Transfusion. 1998;38:373–7.
    1. Thakral B, Bhattacharya P, Agnihotri N, Sharma RR, Marwaha N, Gopalan S. Acute hemolytic transfusion reaction by anti-P1 antibody in pregnancy. Am J Hematol. 2005;78:163–4.
    1. Chaudhary R, Agarwal N. Safety of type and screen method compared to conventional antiglobulin crossmatch procedures for compatibility testing in Indian setting. Asian J Transfus Sci. 2011;5:157–9.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe