A reappraisal of pre-transfusion testing procedures in a hospital blood bank

Abstract

In recent years, experience with screening protocols for the detection of red cell antibodies has led to a reappraisal of pre-transfusion testing procedures. In the U.S.A. in particular, it has become accepted practice to perform only an antiglobulin crossmatch when an antibody screen has been negative. There is now debate in that country regarding the necessity of retaining even the antiglobulin crossmatch. In this laboratory, as is usual in Australia, room temperature, enzyme and antiglobulin tests are used for both antibody screening and crossmatching. A review was therefore conducted of the results of screening 58,227 samples from approximately 40,000 patients, involving 126,771 crossmatched blood units over a 53 mth period. Eight hundred and seventy-two red cell antibodies were detected in 718 patients. Forty-four of these antibodies were detected only in the crossmatch, and of these 23 were of potential clinical significance. Fourteen of the 23 were detected by the antiglobulin test, 8 by an enzyme test and only 1 by the saline method. Of 107 antibodies detected only in the room temperature phase, none were of clinical significance. The results indicate that exclusion of room temperature tests from all pre-transfusion testing, and deletion of enzyme tests from the crossmatch will not compromise patient safety.