Crossmatching (also known as compatibility testing) establishes compatibility or incompatibility of a donor's and a recipient's blood. It's the best antibody detection test available for avoiding lethal transfusion reactions. After the donor's and the recipient's ABO and Rh-factor type are determined, major crossmatching determines compatibility between the donor's red blood cells (RBCs) and the recipient's serum. Minor crossmatching determines compatibility between the donor's serum and the recipient's RBCs. Because the antibody-screening test is routinely performed on all blood donors, minor crossmatching is often omitted.
Because a complete crossmatch may take from 45 minutes to 2 hours, an incomplete (10-minute) crossmatch may be performed in an emergency, such as severe blood loss due to trauma. In an emergency, transfusion can begin with limited amounts of group O packed RBCs while crossmatching is completed. Incomplete typing and crossmatching increase the risk of complications.
After crossmatching, compatible units of blood are labeled and a compatibility record is completed.
Clinical Alert: The most carefully performed crossmatch may not detect all the possible sources of patient-donor incompatibility.
Procedure and posttest care
Absence of agglutination indicates compatibility between the donor's and the recipient's blood, which means that the transfusion of donor blood can proceed. Note that this doesn't guarantee a safe transfusion.
A positive crossmatch indicates incompatibility between the donor's blood and the recipient's blood, which means that the donor's blood can't be transfused to the recipient. The sign of a positive crossmatch is agglutination, or clumping, when the donor's RBCs and the recipient's serum are correctly mixed and incubated. Agglutination indicates an undesirable antigen-antibody reaction. The donor's blood must be withheld and the crossmatch continued to determine the cause of the incompatibility and identify the antibody.
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