Group, Screen and Hold (GSH) Procedure
A Group, Screen and Hold (GSH) involves determining the patient's ABO/Rh blood type and performing antibody screening, with results held on file for immediate access if blood products become needed, but without actually crossmatching or reserving specific blood units.
How GSH is Performed
Initial Blood Sample Collection
- Draw a blood sample (typically 5-10 mL in lavender/EDTA or pink top tube) from the patient
- Label with two patient identifiers at bedside
- Send to blood bank/transfusion service
Laboratory Processing
Blood Typing:
- Determine ABO group (A, B, AB, or O)
- Determine Rh status (positive or negative)
- Perform forward and reverse typing for confirmation
Antibody Screening:
- Screen patient serum/plasma against reagent red blood cells
- Detect clinically significant antibodies (anti-Rh, anti-Kell, etc.) 1
- If antibodies detected, perform antibody identification panel
Result Documentation
- Results entered into blood bank information system
- Typically valid for 72 hours to 28 days depending on institutional policy
- Patient's transfusion history and antibody status maintained in database
Clinical Decision-Making for GSH
When GSH is NOT Routinely Indicated
Low-risk laparoscopic procedures where transfusion rates approach 0%:
- Laparoscopic cholecystectomy 2, 3
- Laparoscopic inguinal hernia repair 3
- Diagnostic laparoscopy 4, 3
- Elective breast surgery including mastectomy with axillary clearance 5
These procedures demonstrate transfusion rates of 0-0.5%, making routine GSH clinically unnecessary and cost-inefficient 2, 4, 3.
When GSH IS Indicated
Consider GSH for:
- Procedures with intermediate-to-high surgical invasiveness 6
- Male patients (independent risk factor, OR 11.31) 2
- Patients with underlying hematological conditions 2
- Procedures where significant blood loss is anticipated 7
- Patients with history of alloimmunization 1
Special Populations Requiring Antibody Screening
- Patients undergoing invasive urologic procedures with foreign material implantation 7
- Hemato-oncology and bone marrow transplant patients 1
- Patients with known alloantibodies (mainly anti-Rh and anti-Kell) 1
Type and Screen Policy Advantages
If antibody screen is negative:
- Subsequent blood requests only require immediate spin test (IST) crossmatch
- Blood units can be released immediately
- AHG (antihuman globulin) crossmatch performed after release
- No clinical or laboratory evidence of hemolysis with this approach 1
If antibody screen is positive:
- Full AHG crossmatch required before release
- Extended time needed for compatible unit identification
- Higher likelihood of requiring transfusion 1
Common Pitfalls to Avoid
- Over-ordering for low-risk procedures: Routine GSH for laparoscopic day cases wastes approximately £18.39 per sample plus laboratory staffing costs 3
- Sample expiration: Ensure awareness of institutional validity periods (typically 72 hours for surgical patients)
- Ignoring risk stratification: Not all surgical procedures warrant GSH regardless of institutional protocols 7
- Inadequate patient identification: Two-identifier verification at bedside is critical to prevent wrong-blood-in-tube errors
Cost Considerations
Eliminating unnecessary GSH testing yields substantial savings: