Test Directory

Crossmatch

Containers - Adult

Blue Cap 4.5ml Sarstedt	Volume Range 4.5ml Additive per Container EDTA

Containers - Child

Blue Cap 1.2ml Sarstedt	Volume Range 1.0ml. For more details, see below 'Special instructions for collection' Additive per Container EDTA

Reference ranges

Not applicable

Laboratory Site

SJH

Howden Road West
Howden
Livingston
West Lothian
EH54 6PP

Telephone: 01506 523000

WGH

Crewe Road South
Edinburgh
EH4 2XU

Telephone: 0131 537 1000

Transport arrangements

Sample MUST be received within 24 hours of collection

Sample storage arrangements

Store at 4°;C

Special instructions for collection

NHS Lothian operates a Zero Tolerance approach in relation to blood sample acceptance criteria. Errors in patient identification and sample labelling may lead to ABO-incompatible transfusions.

The demographics on the samples MUST be hand written, legible and MUST match exactly to the accompanying request form. Samples labelled with an addressograph or where evidence of an addressograph have been attached will be discarded. Samples with errors or where patient core identifiers have been obliterated will be discarded.

Sample Labelling

The following patient identifying data and sampler signature is mandatory -

CHI number (or Hospital Number where no CHI number is available - See CHI exceptions)*
Surname
Forename
Date of Birth
Signature

Sample Labelling for Unknown Patients

Surname / Forename = UNKNOWN
Temporary Identification Number = beginning with 700
Gender
Sample dated and signed

Once patients details become known, a new sample must be sent to the laboratory

Request Form Labelling

Addressograph labels are acceptable for request forms. If the form is handwritten then the information must be clear, legible and MUST contain the following data identifiers -

Surname
Forename
Date of Birth
CHI Number (See CHI exceptions)*
Name and signature of the person taking the sample
Name of the requesting clinician. (For component requests, this is the Doctor or authorised Nurse that has prescribed the transfusion)
Clinical details are desirable but are not essential

*CHI Exceptions

Not all patients will have a CHI number. If the patient is a genuine CHI exception then the Hospital number is acceptable and MUST be used. A CHI number may not be available in the following circumstances -

Foreign visitors
Patients from England, Wales and Ireland
Patients not registered with a GP in Scotland
Patients currently remanded within Her Majesty's Prisons
Patients in the armed forces
Newborn infants <3 days old.

A MINIMUM of 2.0ml of blood is required for adult specimens. For paediatric patients, please refer to the link below for specimen types and volume ranges.

Blood Tubes and Volume Ranges for Babies and Children (Blood Transfusion)

How to request

Request Form (Obtained from Blood Transfusion Laboratory WGH / SJH)

Availability

Mon - Fri Routine service 09:00 - 17:00. Sat / Sun Routine service 09:00 - 13:00. Please contact the laboratory for urgent samples outside of routine hours.

Anticipated turnaround

The turnaround time is dependant on the urgency of blood requirement and whether the patient has atypical antibodies.

What happens if the result is positive or abnormal

In certain circumstances, some samples may require referral to an external SNBTS reference laboratory depending upon the complexity of the testing required. This requirement for referral may lead to delays in the provision of red blood cells to the patient for routine transfusions

Referred samples may include -

Those samples where an antibody directed against a high frequency antigen is identified.

These antibodies usually show pan reactivity against all routine reagent red cells making exclusion of clinically significant antibodies difficult or impossible.

Auto Immune Haemolytic Anaemia (AIHA)

In patients with AIHA, autoantibodies often cause laboratory problems making determination of the ABO and Rh group problematic and prevent effective antibody screening due to cross reacting antibodies. While transfused cells are present in the circulation, allo antibodies can be made which may be masked by the stron auto antibody.

Anti-CD38 Interference (Daratumumab)

Daratumumab is an anti-CD38 monoclonal antibody which has proven to be highly efficacious for the treatment of those patients with relapsed and refactory Multiple Myeloma (MM). This therapy however interferes with blood transfusion testing by binding to CD38 present on the surface of red cells and causing panagglutination in the antibody screen; thereby making exclusion of clinically significant all antibodies impossible without additional specialised testing.

If for what ever reason the sample is unsuitable for testing, the ward or doctor will be informed.
If atypical antibodies are identified, the ward or doctor will be informed and extra samples will be requested for further investigation.
If there is a requirement for sample referral, the ward or doctor will be informed.
Please ensure that the request form contains a location and contact number (ward extension or bleep number) so that the information above may be conveyed.

General additional information

As per BSH guidance and recommendations from SHOT reports, it is required that a patient’s blood group has been confirmed from two blood samples taken on separate occasions before issuing blood components for transfusion. This measure is intended to reduce the risk of transfusing components of the wrong blood group.

It is important to note that all cellular blood components contain residual red cells and can therefore illicit an immune response. To ensure that the specimen used for compatibility testing is representitive of a patients current immune status, serological studies should be performed using blood collected no more than three days in advance of the actual transfusion when the patient has been transfused, or has been pregnant within the preceeding three months, or when such information is uncertain or unavailable. Where there has been no transfusion or pregnancy within the preceeding three months, the sample will be valid for seven days.

For further information regarding pre transfusion compatability procedures and appropriate use of blood and products, please refer to the BSH Guidelines

Test also known as Group & Screen / Group and Hold