Cross-matching or crossmatching is a test performed before a

blood transfusion Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mo ...

as part of blood compatibility testing. Normally, this involves adding the recipient's

blood plasma Blood plasma is a light amber-colored liquid component of blood in which blood cells are absent, but contains proteins and other constituents of whole blood in suspension. It makes up about 55% of the body's total blood volume. It is the int ...

to a sample of the donor's

red blood cells Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "hol ...

. If the blood is incompatible, the

antibodies An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of ...

in the recipient's plasma will bind to

antigen In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune respon ...

s on the donor red blood cells. This antibody-antigen reaction can be detected through visible clumping or

destruction Destruction may refer to: Concepts * Destruktion, a term from the philosophy of Martin Heidegger * Destructive narcissism, a pathological form of narcissism * Self-destructive behaviour, a widely used phrase that ''conceptualises'' certain kind ...

of the red blood cells, or by reaction with anti-human globulin. Along with

blood typing Blood compatibility testing is conducted in a medical laboratory to identify potential incompatibilities between blood group systems in blood transfusion. It is also used to diagnose and prevent some complications of pregnancy that can occur whe ...

of the donor and recipient and screening for unexpected blood group antibodies, cross-matching is one of a series of steps in pre-transfusion testing. In some circumstances, an electronic cross-match can be performed by comparing records of the recipient's ABO and Rh blood type against that of the donor sample. In emergencies, blood may be issued before cross-matching is complete. Cross-matching is also used to determine compatibility between a donor and recipient in

organ transplantation Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transpor ...

Types

Immediate-spin cross-matching

Immediate-spin cross-matching (ISCM) is an abbreviated form of cross-matching that is faster, but less sensitive; its primary use is to detect a mismatch between ABO blood types. It is an immediate test that involves combining the patient's serum and donor's red blood cells at room temperature, then centrifuging the sample and observing for agglutination or hemolysis. A lack of agglutination or hemolysis indicates a negative test reaction, or compatible match. ISCM is not appropriate in all circumstances; if the recipient's antibody screen is positive, or if they have had a positive antibody screen in the past, a full crossmatch is performed instead.

Anti-human globulin cross-matching

The AHG crossmatch is done by incubating the recipient serum/plasma with the donor's red blood cells and adding anti-human globulin. It is essentially an indirect

Coomb's test A Coombs test, also known as antiglobulin test (AGT), is either of two blood tests used in immunohematology. They are the direct and indirect Coombs tests. The direct Coombs test detects antibodies that are stuck to the surface of the red blood c ...

. It is also called "full cross-matching", "IAT cross-matching" and "Coomb's cross-matching".

Electronic cross-matching

Electronic cross-matching is a computer-assisted analysis using data, from the

donor A donor in general is a person, organization or government which donates something voluntarily. The term is usually used to represent a form of pure altruism, but is sometimes used when the payment for a service is recognized by all parties as rep ...

unit (where a donor's blood is tested prior to donation) and testing done on blood samples from the intended recipient. This includes ABO/ Rh typing of the unit and of the recipient, and an antibody screen of the recipient. Electronic cross-matching can only be used if a patient has a negative antibody screen, which means that they do not have any active

red blood cell Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "hol ...

atypical

, or they are below the detectable level of current testing methods. If all of the data entered is compatible, the computer will print a compatibility label stating that the unit is safe to transfuse.

Major versus minor

* Major cross-match: Here the Recipient serum is tested against donor packed cells to determine if the recipient has preformed antibodies against any antigens on the donor's cells. This is the required cross-match prior to release of a unit of packed cell from blood bank. * Minor cross-match: Here the Recipient red cells are tested against donor serum to detect donor antibodies directed against a patient's antigens. This is no longer required. It is assumed that the small amount of donor serum and antibodies left in a unit of packed cells will be diluted in a recipient.

Emergencies

As the complete cross-matching process takes approximately 1 hour, it is not always used in emergencies. In the case of an emergency, a type-specific blood to which the recipient has no antibodies, can be requested. It is thought that this lifesaving measure is of more benefit than any risk of an antibody-mediated

transfusion reaction Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but mod ...

. This type of blood has less risk of a serious transfusion reaction because it is both ABO compatible and Rhesus (Rh)-compatible. Universal donor blood, which is both type O and Rh negative, can be given if the recipient's blood group is not known, as may happen in an emergency. It is the policy of some institutions to reserve the releasing of O- blood only for female patients of childbearing age. This serves two purposes. First, it preserves the lower stock of O- blood and secondly, this eliminates the risk of O- negative mothers forming anti-D (Rh) antibodies from exposure to O+ blood. Anti-D (Rh) can cross the placenta during pregnancy and attack an unborn child's RBCs if they are D (Rh) positive causing

haemolytic disease of the newborn Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis foetalis, is an alloimmune condition that develops in a fetus at or around birth, when the IgG molecules (one of the five ...

. In an emergency, blood grouping can be done easily and quickly in 2 or 3 minutes in the laboratory on glass slides with appropriate reagents, by trained technical staff. This method depends on the presence or absence of

agglutination In linguistics, agglutination is a morphological process in which words are formed by stringing together morphemes, each of which corresponds to a single syntactic feature. Languages that use agglutination widely are called agglutinative la ...

(clumping of red blood cells), which can usually be visualized directly. Presence of agglutination indicates incompatibility. Occasionally a light

microscope A microscope () is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic means being invisi ...

may be needed. If laboratory services are not available, the bedside card method of blood grouping may be used, where a drop of the intended recipients blood is added to dried reagents on a prepared card. This method may not be as reliable as laboratory methods, which are preferable.

References

{{transfusion medicine Transfusion medicine Hematology