Computer Crossmatch Research Articles

Can computer crossmatch really replace antihuman globulin crossmatch? An intriguing case of missing anti-C on routine antibody screen from a multispecialty center in India

Can computer crossmatch really replace antihuman globulin crossmatch? An intriguing case of missing anti-C on routine antibody screen from a multispecialty center in India

ABO rechecking should be performed in the same institution as computer crossmatch

<scp>ABO</scp> rechecking should be performed in the same institution as computer crossmatch

Historic milestones in the evolution of the crossmatch

Abstract The introduction of the serologic crossmatch—first proposed by Hektoen (1907) and first performed by Ottenberg (1908)—made it possible to transfuse blood without fear of unpredictable and potentially disastrous acute hemolytic reactions, most of which were attributable to direct agglutinating (IgM) anti-A, anti-B, or anti-A,B. Previously transfused or previously pregnant recipients continued to experience sporadic hemolytic transfusion reactions as a result of “incomplete” (IgG) blood group antibodies. Coombs’ introduction of the antiglobulin test (1945) made it possible to detect “incomplete” (IgG) antibodies and to develop laboratory methods to identify and transfuse serologically compatible RBCs. During the past 50 years, the antibody screen has evolved to be more effective than the crossmatch for detecting the presence of potential serologic incompatibility and has, in fact, replaced the crossmatch as the key step in pretransfusion compatibility testing. The antibody screen has become the serologic surrogate for the crossmatch and, currently, the computer crossmatch is becoming the electronic surrogate for the crossmatch. In historical perspective, the past 100 years witnessed the rise and fall of the cross-match. Today, hemolytic transfusion reactions are more likely to be the result of misidentifying the intended transfusion recipient than of failure of routine compatibility testing to detect serologic incompatibility. The introduction of the serologic crossmatch—100 years ago—had a major positive impact on all aspects of clinical medicine. As a result of these advances, we are quickly approaching the limits of improving the safety and efficacy of blood transfusions by conventional serologic methods. Future improvements are more likely to be the result of applications of molecular genotyping—which could not have become available at a more perfect time. When Immunohematology publishes its 50th-anniversary issue, the improvements in transfusion science are more likely to be based on molecular methods than on conventional blood bank serology. Immunohematology 2009;25:147–151.

Is a computer crossmatch in the absence of an immediate‐spin antibody screen adequate for persons identified to be at increased risk of forming new blood group antibodies?

Is a computer crossmatch in the absence of an immediate‐spin antibody screen adequate for persons identified to be at increased risk of forming new blood group antibodies?

Transfusion management using a remote-controlled, automated blood storage.

Generally, the safety of transfusion terapies for patients depends in part on the distribution of the blood products. The prevention of adverse events can be aided by technological means, which, besides improving the traceability of the process, make errors less likely. In this context, the latest frontier in automation and computerisation is the remote-controlled, automated refrigerator for blood storage. Computer cross-matching is an efficient and safe method for assigning blood components, based on Information Technology applied to typing and screening. This method can be extended to the management of an automated blood refrigerator, the programme of which is interfaced with the Transfusion Service's information system. The connection we made in our Service between EmoNet and Hemosafe enables real-time, remote-controlled management of the following aspects of blood component distribution: a) release of autologous and allogeneic units already allocated to a patient, b) release of available units, which can be allocated by remote-control to known patients, in the presence of a valid computer cross-match, c) release of O-negative units of blood for emergencies. Our system combines an information database, which enables computer cross-matching, with an automated refrigerator for blood storage with controlled access managed remotely by the Transfusion Service. The effectiveness and safety of the system were validated during the 4 months of its routine use in the Transfusion Service's outpatient department. The safety and efficiency of the distribution of blood products can and must be increased by the use of technological innovations. With the EmoNet/Hemosafe system, the responsibility for the remote-controlled distribution of red blood cell concentrates remains with the chief of the Transfusion Services, through the use of automated computer procedures and supported by continuous training of technicians and nursing staff.

Virtual Blood Banking: A 7-Year Experience

The operating theater blood transaction system (OTBTS) is a virtual blood banking system that allows computer crossmatch–compatible blood ordering and delivery in the operating theater remote from the hospital blood bank. It was developed and implemented our hospital in 1997 and was expanded in 2002 to include an unmatched blood module that allows ordering and issuing unmatched RBCs for intraoperative transfusion. During the past 7 years, the system has handled 6,333 crossmatch requests for intraoperative transfusion and issued 20,073 units of RBCs, including 100 units of unmatched RBCs (group 72 units; group-identical, 28 units). The OTBTS has proven to be efficient (with a turnaround time for blood ordering and issuing <30 seconds), effective (with a reduced crossmatch/transfusion ratio and blood wastage), and error free (no delay or error in transfusion or postponement of operation). Furthermore, our experience with the unmatched blood module has attested to the safety and efficacy of computer-controlled, online ordering and real-time, on-site delivery of unmatched RBCs for emergency transfusion.

The use of the computer cross-match.

The use of the computer cross-match.

The computer crossmatch: a safe alternative to the serological crossmatch.

The crossmatch has evolved from including a wide range of techniques through a test purely to eliminate ABO incompatibility (immediate spin) to computer crossmatching in which no serological testing is carried out and validation ensures the correct ABO/RhD type blood is issued. The crossmatch was always considered to be the most important feature of the compatibility test and in particular the antiglobulin phase; however, there are potential risks associated with serological and computer crossmatching including technical and procedural errors. The use of immediate spin and computer crossmatch change the emphasis for safety of the compatibility test from the crossmatch to the antibody screen. UK guidelines have now been published describing the features necessary for the introduction of computer crossmatching. Computer crossmatching is used by many institutions in various countries. It is considered safe practice and brings benefits to the laboratory and the patient. Compatibility testing is only one element of the blood transfusion procedure; the others are equally as important and include correct patient identification at the time of collection of the blood sample and at the administration of the blood transfusion.

Experiences with "self service" electronic blood banking.

Electronic verification of ABO compatibility (computer crossmatching) has been accepted as the crossmatching procedure for patients without clinically significant alloantibodies. Computer crossmatching offers several advantages over the immediate spin crossmatch and enables the setting up of a self service blood banking system. Self service blood banking saves manpower, improves crossmatch/transfusion(C/T) ratio and makes the maximum surgical blood ordering schedule (MSBOS) redundant. Blood banking service can also be provided at satellite hospitals without stationing blood banking staff there. We have also developed a novel self service system that does not require expensive computer hardware and networking.

From serological to computer cross-matching in nine hospitals.

In 1991 it was decided to reorganise the transfusion service of the County of Funen. The aims were to standardise and improve the quality of blood components, laboratory procedures and the transfusion service and to reduce the number of outdated blood units. Part of the efficiency gains was reinvested in a dedicated computer system making it possible--among other things--to change the cross-match procedures from serological to computer cross-matching according to the ABCD-concept. This communication describes how this transition was performed in terms of laboratory techniques, education of personnel as well as implementation of the computer system and indicates the results obtained. The Funen Transfusion Service has by now performed more than 100.000 red cell transfusions based on ABCD-cross-matching and has not encountered any problems. Major results are the significant reductions of cross-match procedures, blood grouping as well as the number of outdated blood components.

The computer or electronic crossmatch

The computer or electronic crossmatch

The computer or electronic crossmatch

The computer or electronic crossmatch

Remote electronic blood release system.

The Hunter Area Pathology Service provides transfusion services to 4 metropolitan and 11 rural hospitals in Australia. To improve blood availability, conserve blood stocks, and reduce crossmatch-to-transfusion ratios, a networked electronic blood release system (EBRS) has been developed for computer cross-matching within the laboratory and at sites remote from the transfusion laboratory. It is innovative, in that non-laboratory staffs have been trained to release computer-matched blood at remote hospitals without transfusion laboratories. The EBRS software was tested and validated according to the Australian software standards AS 3563.1 and 3563.2 (1991). Over 7000 units were released by the EBRS in a laboratory trial conducted in conjunction with the conventional immediate-spin crossmatch. A further, 12-month study was conducted within the laboratory before the staged implementation of the EBRS at the remote hospitals. The EBRS has resulted in 1) a 25-percent reduction in the number of units requested by the medical staff, resulting from the reduction in time needed to provide compatible blood due to the elimination of the serologic crossmatch; 2) better blood stock management (reducing outdated red cell units by 30%); and 3) significant savings in laboratory workload (savings of approximately 100 hours/month). In addition, the rapid availability of computer-crossmatched red cells in emergency situations has enhanced patient safety. The EBRS is a safe and efficient means of providing red cells within the laboratory and at remote hospitals without laboratory services.

Provision of an out-of-hours blood banking service at a satellite hospital without blood bank staff.

With limited health care resources and financial constraints, many hospitals have to reduce their service. Computer crossmatching has been accepted as a safe crossmatching procedure for patients without clinically significant alloantibodies. We report here a novel way of providing an out-of-hours blood banking service at a satellite hospital. The system is easy to introduce and can provide a safe transfusion service to small hospitals without stationing blood banking staff at these hospitals after regular working hours.

From maximum surgical blood ordering schedule to unlimited computer crossmatching: evolution of blood transfusion for surgical patients at a tertiary hospital in Hong Kong.

The maximum surgical blood ordering schedule (MSBOS) was developed to permit efficient use of blood stocks and reduce blood wastage due to outdating. Success of the MSBOS required full cooperation between surgeons, anaesthetists, blood bankers and house officers. However, clinical staff sometimes disregarded the system or distrusted the ability of the laboratory to provide blood in an emergency. This led to frustration and wastage of laboratory staff effort. We developed a computer crossmatch system that could overcome the shortcomings of the MSBOS. The advantages of this system are reported.

Electronic verification of donor-recipient compatibility: the computer crossmatch.

This article describes standard operating procedures (SOPs) for a computer crossmatch to replace the immediate-spin crossmatch for ABO incompatibility between patient blood samples submitted for pretransfusion testing and the blood component selected for transfusion. These SOPs were developed following recent changes to the Standards for Blood Banks and Transfusion Services of the American Association of Blood Banks (AABB). SOPs were developed, utilizing currently available software, for pretransfusion testing. The SOP for donor unit processing entails bar code entry of the unit number, component name, and ABO/Rh type; computer entry and interpretation of serologic reactions; warning of discrepancies between bar code-entered blood type and result interpretation; and quarantine of the donor unit in such instances. The SOP for patient sample testing requires bar code entry of specimen accession number, which accesses patient demographics; computer entry and interpretation of ABO/Rh tests; repeat blood typing at the time of crossmatch if only one patient blood type is on record; and warning if there are nonconcordant current and historical blood types. The computer crossmatch SOP requires bar code entry of specimen accession and donor unit numbers; release of group O red cells pending resolution of discrepancies; and immediate-spin crossmatch during computer downtime. Tables validated on-site prompt warning messages and prevent both computer crossmatch and release if blood components of the wrong ABO type are selected. These SOPs meet the requirements of the 15th edition of the AABB Standards. Projected annual time savings at this institution are > 100,000 workload recording units. Further benefits include reduced patient sample volume requirements, less handling of biohazardous material, and elimination of unwanted positive or negative reactions associated with the immediate-spin crossmatch. Release of incompatible blood components when the wrong patient blood type is on record is addressed by requiring the use of group O red cells in the absence of two concordant blood types, one of which must be from a current sample. A combination of existing computer programs and carefully developed SOPs can provide a safe and efficient means of detecting donor-recipient incompatibility without performance of serologic crossmatch.

Requirements for the computer crossmatch

TransfusionVolume 34, Issue 2 p. 187-187 Requirements for the computer crossmatch Suzanne H. Butch MA, MT(ASCP)SBB, Suzanne H. Butch MA, MT(ASCP)SBB Blood Bank and Transfusion Service, Department of Pathology, UH2G332, University of Michigan Medical Center 1500 East Medical Center Drive Ann Arbor, MI 48109-0054Search for more papers by this authorW. John Judd FIBMS, MIBiol, W. John Judd FIBMS, MIBiol Blood Bank and Transfusion Service, Department of Pathology, UH2G332, University of Michigan Medical Center 1500 East Medical Center Drive Ann Arbor, MI 48109-0054Search for more papers by this author Suzanne H. Butch MA, MT(ASCP)SBB, Suzanne H. Butch MA, MT(ASCP)SBB Blood Bank and Transfusion Service, Department of Pathology, UH2G332, University of Michigan Medical Center 1500 East Medical Center Drive Ann Arbor, MI 48109-0054Search for more papers by this authorW. John Judd FIBMS, MIBiol, W. John Judd FIBMS, MIBiol Blood Bank and Transfusion Service, Department of Pathology, UH2G332, University of Michigan Medical Center 1500 East Medical Center Drive Ann Arbor, MI 48109-0054Search for more papers by this author First published: February 1994 https://doi.org/10.1046/j.1537-2995.1994.34294143958.xCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume34, Issue2February 1994Pages 187-187 RelatedInformation

An evaluation of computer crossmatch prediction for selecting acceptable cadaver kidney donors for highly sensitized patients

An evaluation of computer crossmatch prediction for selecting acceptable cadaver kidney donors for highly sensitized patients