Cross-matching, in transfusion medicine, refers to the testing that is performed to determine the compatibility of a donated unit of blood with its intended recipient. It is frequently used in determining good candidates for organ transplants. Cross-matching is distinct from tests to determine a blood type, or an antibody screen (indirect Coombs test), which are two entirely different tests that individuals are advised to complete prior to cross-matching. Cross-matching is done by a qualified laboratory technologist in a blood bank, and can be done electronically, with a computer database, or serologically.
Types of cross-matching
Electronic cross-matching
Electronic cross-matching is essentially a computer-assisted analysis of the data entered from testing done on the donor unit and blood samples drawn from intended recipient. This includes ABO/Rh typing of the unit and of the recipient, and an antibody screen of the recipient. Electronic cross-matching can only be used if a patient has a negative antibody screen, which means that they do not have any active red blood cell atypical antibodies, or they are below the detectable level of current testing methods. If all of the data entered is compatible, the computer will print a compatibility label stating that the unit is safe to transfuse.
Serological cross-matching
In serological cross-matching, red blood cells from the donor unit are tested against the plasma of the patient in need of the blood transfusion. If the patient’s serum contains antibodies against the antigens present on the donor red blood cells, agglutination will occur. Agglutination is considered a positive reaction indicating that the donor unit is incompatible for that specific patient. If no agglutination occurs the unit is deemed compatible and is safe to transfuse.
Emergencies
In the case of an emergency a physician can request "uncross-matched blood", or donor units of blood that have not been cross-matched. It is thought that this lifesaving measure is of more benefit than any risk of an antibody-mediated transfusion reaction. In addition, the risk of a serious transfusion reaction can be minimized if the donor unit is both ABO-compatible and Rhesus (Rh)-compatible. Type O and Rh negative blood can be given if the recipient's blood group is not known, as may happen in an emergency. In an emergency, blood grouping can be done easily and quickly in 2 or 3 minutes in the laboratory on glass slides with appropriate reagents, by trained technical staff. This method depends on the presence or absence of agglutination, which can usually be visualized directly, although occasionally a light microscope may be needed. If laboratory services are not available, another system of deciding which type of blood to use in an emergency is the bedside card method of blood grouping, where a drop of the intended recipients' blood is added to dried reagents on a prepared card. This method may not be as reliable as laboratory methods, which are preferable.
External links
- HealthAtoZ.com Blood typing and crossmatching
- Nobelprize.org Interactive online game for blood typing and transfusion (Flash Player 5 required)
