blood group and blood transfusion

1. Lab Investigation in Transfusion
reaction and mismatch blood
transfusion
Dr sandeep singh

2. SLO
 At the end of session students must be able to:
 Define transfusion reaction
 Describe initial measures after transfusion reaction
occurs
 Preliminary tests for investigation
 Other additional tests

3. NEED FOR BLOOD transfusion
 Blood transfusion is needed:
 when if the person is too much of blood loss, such as
the following :Injury or major surgery
 An illness that causes bleeding such as a Bleeding ulcer,
piles, hemetemesis
 An illness that destroys blood cells, such as Haemolytic
Anemia or Thrombocytopenia.
 If there is an illness in which bone marrow doesn't make
enough blood, such as Aplastic anemia, you may needed
transfusion.

4. Transfusion reaction
 Reaction of the body to a transfusion of blood that is
not compatible with its own blood.
 An adverse reaction can range from fever and hives, to
renal failure, shock and death

6. Initial measures
 Stop the transfusion and disconnect the entire
infusion set from the needle/catheter.
 Using a new infusion set, keep the IV line open with a
drip of normal saline.
 Check the
 label on blood bag,
 cross matching report,
 and identify the patient to confirm that the patient
received the correct unit of blood or component.

7. Initial measures
 The patient's physician should be informed
immediately for evaluation of the patient and to
determine appropriate clinical care.
 Notify the blood bank and fill the form of transfusion
reaction report.

9. Initial measures
 Return all transfused packs to Blood Bank full or
empty
 Return giving set and attached solutions.
 Send post transfusion blood samples(opposite arm)-
10 ml in plain and 2 ml in EDTA
 First voided urine should be sent for the laboratory for
the analysis of free hemoglobin.
 Return transfusion sheet with full details of suspected
reaction and transfusion reaction report.

10. Sample criteria
 Verify the patient's identity using at least two unique
identifiers.
 Date and time of sample collection.
 Ensure all section in the form are completed in a
legible and detailed manner.
 Completed all the information in the 'specimen
collection' information.
 Ensure both the nursing and facility of blood bank
clerical checks have been completed and this
documented on the form. This will prevent delays in
testing.

11. Sample rejection
 Specimen receives unlabeled/improperly labeled or
overloaded with more than one name.
 Key identifiers information is missing, incorrect or
discrepant on the sample and/or requisition.
 Specimen not received in the laboratory within 8
hours of collection.
 Unacceptable tube received.
 Specimens which are haemolysed.
 Insufficient of sample.

12.  After initial measures, there are three basic
preliminary test are done. They are:
 Clerical check
 Visual check
 Serology check

13. Clerical error
 Check identity of patient, label on donor blood bag
and all relevant paper to ensure that there was no
clerical error.
 Most common errors:
 Misidentification of patient
 Mixup of samples in the lab

14. Visual check
 Compare the color of plasma of patient’s pre and post-
transfusion blood sample.
 Pink red discoloration of Post transfusion sample- free
hemoglobin d/t hemolysis
 Yellow or brown discoloration in patient's sample drawn
4-10 hrs after the transfusion – presence of bilirubin

16. Visual check
 Check the color of transfused bag:
 Purple colored and presence of clot in blood bag but no
change in color of blood in tubing - Bacterial
contamination
 Change in color both in tubing and bag – hemolysed
blood
 Check the color of post voided urine:
 Redish color – acute hemolysis

17. Serology check
 Repeat ABO , Rh (D) testing in the
 patient’s pre-and post-transfusion blood samples
 blood from bag and segment of tubing ( attached to the
bag)
 Perform DAT/DCT on patient’s post transfusion
sample
 DCT Negative – No incompatibility
 DCT positive – do test on pre-transfusion sample
 If negative indicates incompatibility

18.  Repeat the cross match with pre and post transfusion sample of the patient
against the sample of blood bag by a saline , albumin and IAT techniques.
 Antibody screening in patients’s pre-and post transfusion samples and in
the blood from the bag or segment of the tube

22. Interpretation of forward grouping

24. Interpretation of Reverse grouping

26. Forward blood grouping

27. Reverse blood grouping

47. Thanks