From the Guidelines
Crossmatching with blood products is a critical step that involves not only ABO and Rh typing but also extended red cell antigen matching for specific patient populations, such as those with sickle cell disease, to prevent alloimmunization and ensure compatibility. This process is crucial for minimizing the risk of transfusion reactions, which can range from mild to life-threatening. According to the American Society of Hematology 2020 guidelines for sickle cell disease, prophylactic red cell antigen matching for Rh (C, E or C/c, E/e) and K antigens is recommended over only ABO/RhD matching for patients with sickle cell disease receiving transfusions 1.
The crossmatching procedure typically involves several steps, including:
- An immediate spin crossmatch to detect ABO incompatibilities
- An indirect antiglobulin test to identify other clinically significant antibodies
- An autocontrol to detect autoantibodies For patients with specific genetic mutations, such as the GATA mutation in the ACKR1 gene, which encodes Fy antigens, extended red cell antigen matching may not be necessary for certain antigens 1.
In addition to ABO and Rh typing, extended red cell antigen matching may include testing for other antigens, such as Jka/Jk b, Fya/Fyb, and S/s, to provide further protection from alloimmunization 1. The choice of blood products for transfusion should be guided by the patient's antigen profile, with consideration of their genetic background and previous transfusion history. The use of extended red cell antigen matching can help reduce the risk of alloimmunization and improve patient outcomes, particularly in those with sickle cell disease or other conditions requiring frequent transfusions.
From the Research
Crossmatching with Blood Products
Crossmatching is a crucial step in blood transfusion to ensure compatibility between the donor's and recipient's blood. The process involves testing the recipient's blood against the donor's blood to detect any potential reactions.
Importance of Crossmatching
- Crossmatching helps prevent hemolytic transfusion reactions, which can be life-threatening 2.
- It ensures that the recipient's immune system does not react with the donor's blood cells, reducing the risk of adverse reactions.
Considerations for Platelet Transfusions
- ABO and RhD matching are important considerations for platelet transfusions 3, 4.
- Major ABO incompatibility can result in reduced post-transfusion platelet count increments and increased risk of hemolysis.
- RhD alloimmunization can occur when platelets from RhD-positive donors are transfused to RhD-negative recipients.
Risks Associated with ABO Non-Identical Transfusions
- ABO non-identical transfusions can lead to fatal hemolytic reactions, increased red cell transfusion needs, and other adverse effects 5.
- Immune complexes formed during ABO non-identical transfusions can affect recipient red cell structural integrity, platelet function, and haemostasis.
Practical Solutions for Crossmatching Problems
- Hematologists should have basic knowledge of blood banking procedures and how to use them to handle problems in pretransfusion testing 6.
- Practical tips for handling crossmatch incompatibility and other transfusion problems can help hematologists provide better patient care.