Unit 10 MEDT409

Volume; 24

A maximum crossmatch limit exists at the point at which the patient's blood ___________ has been replaced via transfusion, usually within equal to or less than___ hours. (CCHS uses 6-8 hour limit - 10 RBCs)

A negative, O negative; A, AB

A negative patient blood has these compatible donor RBCs and these compatible donor plasma

A antigens; Anti-B antibodies

A positive and A negative patient blood type have these antigens; and these antibodies

A positive, A negative, O positive, O negative; A, AB

A positive patient blood has these compatible donor RBCs and these compatible donor plasma

A & B antigens; None

AB Positive and AB Negative patient blood type have these ABO antigens; and these ABO antibodies

O negative, A negative, B negative, AB negative; AB

AB negative patient blood has these compatible donor RBCs and these compatible donor plasma

ALL; A,B

AB positive patient blood has these compatible donor RBCs and these compatible donor plasma

2

According to AABB Regualtions: Patient Samples; Blood samples shall be identified with an affixed label bearing sufficient information for unique identification of the patient, including ______ independent identifiers

True

According to AABb Regualtions: Patient Samples, Summarizied : label affixed to tube at bedside, identify date of sample and phlebotomist, TSL shall accept only those specimens that are completely, accurately, and legibly labeled (T or F)

AABB

According to ________ regulations: Requests, the transfusion service shall accept only complete, accurate, and legible requests and requests for blood, bood components, test, and records accompanying blood samples from the patient shall contain sufficient information to uniquely identify the patient, including two independent identifiers

B negative, O negative; B, AB

B negative patient blood has these compatible donor RBCs and these compatible donor plasma

B positive, B negative, O positive, O negative; B, AB

B positive patient blood has these compatible donor RBCs and these compatible donor plasma

Transfusion Committee

BB activities are monitored by internal _______________ _________________

100%; 1%

Compatibility testing has the following limitations: cannot guarantee ______% success, indicator of probable success, transfusion reactions still occur in approximately ______% of blood transfusions (several types of reactions)

3; 3; unavailable

Compatibility testing must be done if patient has been transfused within the last ___ months with red cell product; or if patient has been pregnant within last ___ months; or if patient history is uncertain or _________________

antisera

Controls must be run when using antigen phenotyping _____________

Red cell Antibody

Emergency release or uncrossmatched ASSUMES recipient serum does not contain _______ _______ _____________

Maternal

For EXCHANGE ONLY in a neonatal crossmatch, you must crossmatch neonates serum/plasma with mother's serum/plasma if significant antibody is identified in ______________ serum/plasma

inventory

For effective blood utilization, one must establish target ________________ levels

Immediate spin crossmatch

For this crossmatch, this is the ONLY STEP required by the AABB --> if: patient has no previous record of Ab AND If patient's Ab screen is presently negative

Labeling

Full name, unique identifier (hospital ID#, SS#, etc), date of sample collection (time helpful also), and phlebotomist ID all constitute the ______________ for the positive ID of patient

Non Emergency

If O NEGATIVE blood is expiring in a _______ _______________ situation, then you can give the patient O NEGATIVE blood

12th; midnight

If collected sample today, April 9th at 08:17 then the sample is good until April ____ at ______________

ABO Incompatibility

If no clinically significant antibodies were detected and there is no record of previous detection of such antibodies, then at a minimum, detection of ______ ___________________ shall be performed

2 RBCs and Full Crossmatch

If patient has POSITIVE screen (current or historical) [antibody is identified like current or historical OR patient is phenotyped for corresponding Ag] , then use crossmatch order to give ____ RBCs and use ___________ __________________ to screen first

Negative

If patient's antibody screen is _____________, then crossmatch of donor unit = INCOMPATIBLE at IS only

A or AB; alloantibodies

If patient's antibody screen is negative, then crossmatch of donor unit = INCOMPATIBLE at IS only because : _____ or ____ recipient could have anti-A1 reacting with donor RBCs or other ________________________ reacting at IS (anti-M, e.g.)

Rouleaux

If patient's antibody screen is negative, then crossmatch of donor unit = INCOMPATIBLE at IS only because : of ______________________, a shiny orange color (this isn't true agglutination but looks compatible at first)

Low

If patient's antibody screen is negative, then crossmatch of donor unit = incompatible at AHG: Patient has antibody to ________ incidence antigen

dosage

If patient's antibody screen is negative, then crossmatch of donor unit = incompatible at AHG: antibody demonstrating ____________

Positive DAT

If patient's antibody screen is negative, then crossmatch of donor unit = incompatible at AHG: donor cells have ______________ DAT

AHG

If patient's antibody screen is negative, then crossmatch of donor unit = incompatible at _________ (not IS only)

ABO

If there is a negative screen and a negative history, you still need to do ______ incompatibility

2

If you dont ahve history but only have 1 documented blood typing you AND you can get 1 more sample then you can do electronic crossmatch because you have this amount of identical, documented blood typing results available (ABO/Rh) _______

O negative; O, A, B, AB

O negative patient blood has these compatible donor RBCs and these compatible donor plasma

No antigens; Anti-A, Anti-B, Anti-AB antibodies

O positive and O negative patient blood have these antigens; and these antibodies

O positive, O negative; O, A, B, AB

O positive patient blood has these compatible donor RBCs and these compatible donor plasma

True

OR, ED, oncology, labor and delivery physicians, safety officer, etc are represented in the transfusion committee (T or F)

Incompatible Crossmatch

Possible causes of incompatible ___________________ : Patient has antibody, donor has antigen; Patient has antibody to low incidence antigen, donor has antigen; patient mistyped, incompatible blood selected; donor mistyped, or donor units on wrong shelf in refrigerator, incompatible blood selected

Donor has POSITIVE DAT

Possible causes of incompatible crossmatch: Donor has _____________ DAT, antihuman globulin testing yields incompatible crossmatch

Albumin/gamma

Possible causes of incompatible crossmatch: Patient has condition that causes imbalance in ______________/____________ globulin ratio

Naturally occurring; passively transfused

Possible causes of incompatible crossmatch: ________________ occurring or ________________ transfused antibody in patient reacts with donor cells (That could be platelet product that is not ABO compatible but patient still receives it)

IS only

Possible causes of incompatible crossmatch: patient has cold reacting antibody at _____ only, ABSC does not include this phae

Rzr = cDE/cde is heterozygous so it can be used as a positive control

R1r = Cde/cde or Rzr = cDE/cde; Which one can be used as a positive control?

Maximum Surgical Blood Order Schedule

The MSBOS stands for

(# of units) / (Ag negative frequency) = # of units to crossmatch

The calculation to discover how many units to cross match

Uncrossmatched

The crossmatching interpretations for neonates will usually say ___________________

(2)/(.91) = 2.2 [But you cannot crossmatch 2.2 units of RBCs so you would select 3 units] [; however, if the options on the exam is 2, 4, 6, or 8 you would select 4]

The frequency of K Ag is 9% and you need 2 K negative RBCs for your patient. Whats the answer?

In vitro; in vivo

The purpose of compatibility testing is for prior to transfusion one must use in __________ test procedures to predict in_______ survival in potential recipient

True

The target inventory levels are calculated based upon historical usage, hospital size, Trauma OR ED - Oncology - Transplant....activities (T or F)

Pretransfusion Testing

These factors are all tested for _____________________ testing of patient blood: ABO Group, Rh Type, Unexpected Antibodies to Red Cell antigens, and comparison with previous records

80%; 20%

This % of patients are A1 positive and this % of patients are A2 positive

Full (Coombs) crossmatch

This cross match ENSURES complete compatibility and may be capable of detecting Ab to low incident Ag

Full (Coombs) crossmatch

This cross match is routinely used for patients with current or historical antibody production

Immediate spin crossmatch

This crossmatch detects ABO incompatibility ONLY

Full (Coombs) crossmatch

This crossmatch incorporates all phases used for antibody detection/identification, including AHG phase

Immediate spin crossmatch

This crossmatch is based upon presumption that a recipient with a NEGATIVE ANTIBODY SCREENING TEST can be safely transfused (95% confidence) with ABO compatible blood

Emergency release or uncrossmatched

This crossmatch is based upon theoretical compatibility of group O blood as the "universal donor" - Usually O negative RBCs, sometimes O positive RBCs used

Immediate spin crossmatch

This crossmatch is immediate spin phase only

Electronic Crossmatching

This crossmatch is used when patient has NO current unexpected antibodies present, patient has NO HISTORY of unexpected antibodies, or patient must have TWO identical, documented blood typing results available (ABO/Rh)

Emergency release or uncrossmatched

This crossmatch is utilized in trauma centers - urgent need for blood

Electronic crossmatch

This crossmatch: eliminates physical crossmatch, requires TWO separate blood type determinations on recipient, allows computerized crossmatch of ABO/Rh type compatible untis, and this method requires FDA approval prior to implementation

Major Crossmatch - routine

This crossmatching only performed prior to transfusion of blood products containing RED BLOOD CELLS (rbcs, granulocytes, etc)

Serologic Crossmatch

This describes what: Before issue, a sample of the recipient's serum or plasma shall be crossmatched against a sample of donor cells from an integrally attached Whole Blood or Red Blood Cell segment. The crossmatch shall use methods that demonstrate ABO incompatibility and clinically significant antibodies to red cel antigens and shall include an antiglobulin test

Serologic Crossmatch

This describes what: patient plasma in tube, drop of cell suspension from donor, spin, and look for agglutination, add enhancements look for agglutination, wash and dry, add anti-IgG and look for agglutination, if still negative add checked cells

Full (Coombs) crossmatch

This describes which crossmatch: IS, 37C with LISS enhancement, AHG

Electronic Crossmatching

This describes which crossmatch: Select blood from refrigerator and WAND IN barcoded number under the patient's ID number, and computer will check historical and current records, and if no exceptions exist, will state "units eligible for electronic crossmatch - continue?"

Massive Transfusion Protocol

This describes which protocol: BB Medical Director can determine point at which maximum crossmatch limit exists

MSBOS

This establishes "REALISTIC" blood usage based upon surgery type

MSBOS

This helps eliminate OVER-ORDERING - products not used

Rouleaux

This is caused by a protein imbalance

Positive Control

This is the control that is heterozygous positive for the corresponding antigen (e.g. K+k+)

Negative Control

This is the control that is negative for the corresponding antigen (e.g. K-k+)

Anogram or panel

This tells you if the cells are heterozygous or homozygous

Compatitbility testing

This term means that all transfusion testing performed on a transfusion recipient and the appropriate donor blood to ensure product will have desired clinical effect; crossmatch between recipient and donor cells

Minor Crossmatch - obsolete

This type of crossmatch has an exception - considerations with Bone Marrow Transplant (BMT), Hematopoietic Stem Cell Transplant (HSCT), organ transplant

Major Crossmatch - routine

This type of crossmatch has the purpose to detect the presence of ANTIBODY in the potential RECIPIENT that may react with the donor cells

Minor Crossmathc - obsolete

This type of crossmatch occurs when ADDITIVE solutions currently used in blood collection allow MINIMAL amount of donor plasma to be contained in packed RBC donor units

Major Crossmatch - routine

This type of crossmatch occurs when PATIENT'S SERUM is cross matched against donor cells (segments from blood bag)

Minor Crossmathc - obsolete

This type of crossmatch occurs when testing DONOR'S SERUM against patient red blood cell

Major Crossmatch - routine

This type of crossmatch stimulates "mini-transfusion" in vitro

True

Thses are the interpretations of crossmatches: "crossmatch compatible" vs. "IS crossmatch compatible" vs. "Crossmatch incompatible" vs. "Least incompatible" (T or F)

minimum and maximum

To establish target inventory levels, there should be _________________ and ________________ levels of each blood type/product

Antigen negative

We use heterozygous positive cells with the positive control because we want blood that is antigen _____________ to give to the patient

Negative

When a maximum crossmatch limit: IF there is a known antibody, then it is preferred to at least provide antigen _____________ blood if time permits

Ends

With Massive transfusion protocol (aka point where maximum crossmatch limit exists), you can resume crossmatching when emergency _______

PHYSICIAN

With an Emergency release or uncrossmatched, who takes responsibility for the crossmatch?

Exchange Transfusion

With neonatal crossmatch, you may need to perform minor crossmatch of components if ______________ ________________ is ordered

Specific

With the selection of blood for transfusion (RBCs), the FIRST choice should always be Type ____________ Blood (e.g. Recipient O POS, Donor O POS or Recipient A POS, Donor A POS)

Compatible

With the selection of blood for transfusion (RBCs), the SECOND choice should always be TYPE _______________ Blood (e.g. Recipient A POS, 1st choice Donor A POS, and 2nd choice Donor A NEG, O POS, and O NEG or Recipient B NEG, 1st choice Donor B NEG, 2nd Choice Donor O NEG)

Neonatal Crossmatch

With this crossmatch, ABO/Rh compatible with baby and mother (O positive or O negative RBCs)

Neonatal crossmatch

With this crossmatch, patients are phenotyped for any antigens corresponding to maternal significant antibodies

Emergency release or uncrossmatched

With this crossmatch, you pull and retain segments for subsequent crossmatching retrospectively

Compatibility

You can begin antigen phenotyping after establishing ______________________

Room

You cannot use ________ number for identification. Name, medical record number, and date of birth must be used

Positive

You do NOT do an autocontrol unless antibody screen comes up _____________

3

You must collect sample within ____ days of possible transfusion

Antisera

You want this to detect the weakest expression of the antigen because you don't want it to give antigen positive cells to the patient

Antigen negative blood

[During antigen phenotyping] if possible HTR, patient needs antigen _____________ blood