For a patient who may need a transfusion, should I perform a type‑and‑screen and hold the sample instead of doing a full cross‑match in advance?

Type and Screen vs. Crossmatch: When to Use Each

For most elective surgical procedures with low transfusion probability, perform a type-and-screen and hold the sample rather than routinely crossmatching units in advance. This approach is 99.99% effective in preventing incompatible transfusions while dramatically improving blood bank efficiency and resource utilization 1, 2.

Clinical Decision Algorithm

Use Type-and-Screen (No Routine Crossmatch) For:

• Elective surgeries with low transfusion rates (<10% probability of needing blood), including most cesarean sections, abdominal hysterectomies, and vaginal hysterectomies 3, 4
• Patients with negative antibody screens who have no history of clinically significant antibodies 1, 2
• Non-bleeding patients in obstetric and gynecologic settings, even those considered high-risk 4

Perform Full Crossmatch in Advance For:

• Massive hemorrhage or active bleeding requiring immediate transfusion 5
• Patients with positive antibody screens or known clinically significant antibodies 1, 2
• Sickle cell disease patients requiring extended antigen matching beyond ABO/RhD 5
• Procedures with high transfusion probability (>50% likelihood of needing blood) 3

How Type-and-Screen Works

The type-and-screen protocol involves:

• ABO and RhD typing of the patient 5
• Antibody screening using reagent red cells to detect clinically significant antibodies 1, 2
• No crossmatch performed unless transfusion becomes necessary 1, 2

If transfusion is needed: Compatible blood can be provided within 15-20 minutes by performing an immediate crossmatch or issuing type-specific blood after a 15-second saline spin 2, 3, 4.

Safety and Effectiveness

The type-and-screen method is 99.99% effective in preventing incompatible transfusions because screening reagent red cells detect 96% of clinically significant antibodies, and when antigen frequencies are considered, the incompatibility risk becomes negligible 1, 2.

The immediate spin crossmatch performed when blood is actually needed provides additional safety by:

• Verifying ABO compatibility at the time of issue 2
• Detecting high-titer antibodies against low-incidence antigens that may not be present on screening cells 2

Efficiency and Resource Benefits

Implementing type-and-screen protocols yields substantial improvements:

• Turnaround time reduction: First transfusion TAT decreased from 71.56 to 51.24 minutes; subsequent transfusions from 39.67 to 17.47 minutes 6
• Man-hour savings: 0.33 man-hours saved per sample, totaling 11.6 man-days in one study 6
• Crossmatch-to-transfusion ratio improvement: From 17.6:1 to 4.9:1 in obstetric patients, eliminating 964 unnecessary crossmatches over 3 months 4
• Cost savings: $14,460 saved in 3 months in one obstetric service 4

Critical Timing Considerations

The 72-hour validity rule is paramount for patient safety:

• Standard validity: Type-and-screen samples remain valid for 72 hours (3 calendar days) from collection to transfusion 7
• Recent transfusion/pregnancy: If the patient received transfusion or was pregnant within the past 3 months, the sample expires after only 72 hours due to rapid antibody development risk 7
• Beyond 72 hours: A new sample is mandatory regardless of transfusion history 7

This rule prevents delayed hemolytic transfusion reactions from newly formed antibodies not detected on the original screen 7.

Emergency Situations

In true emergencies requiring immediate transfusion:

• Group O RhD-negative blood is the safest choice when patient type is unknown 5
• Group O RhD-positive is acceptable for male patients to preserve O-negative inventory 5
• Group-specific blood can be issued within 10 minutes once ABO/RhD typing is complete, accepting slightly higher risk in massive bleeding scenarios where circulating antibodies are diluted 5

Common Pitfalls to Avoid

Do not use type-and-screen if:

• The facility lacks adequate blood inventory reserves readily available for emergency crossmatching 2
• The patient has a history of clinically significant antibodies requiring extended workup 1
• Laboratory turnaround time for emergency crossmatch exceeds 20-30 minutes 2, 3

Always ensure:

• Positive patient identification with two identifiers before sample collection 5
• Samples are labeled at the patient's bedside 5
• Two samples are available for initial testing unless a valid historical sample exists 5