
Many people have asked me what happens to the blood after it's donated and I even did a blog posting in 2009 called "Follow That Donation"
http://hip2give.blogspot.com/2009/08/follow-that-donation.html which is always interesting to see the path a donation takes.
So we know what happens with donated blood, but what happens prior to the actual transfusion? It's really a screening process to match the blood types.
The terms type and screen are used for the testing that (1) determines the blood group (
ABO compatibility) and (2) screens for
alloantibodies.[20] It takes about 45 minutes to complete (depending on the method used). The blood bank technologist also checks for special requirements of the patient (e.g. need for washed, irradiated or
CMV negative blood) and the history of the patient to see if they have a previously identified antibody.
A positive screen warrants an antibody panel/investigation. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been
phenotyped for commonly encountered and clinically significant
alloantibodies. Donor cells may have homozygous (e.g. K+k-), heterozygous (K+k+) expression or no expression of various antigens (K-k+). The phenotypes of all the donor cells being tested are shown in a chart. The
patient's serum is tested against the various donor cells using an enhancement method, e.g. Gel or
LISS. Based on the reactions of the
patient's serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (i.e. cause transfusion reactions,
HDN, etc.). Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen negative
phenotyped red blood cells to prevent future transfusion reactions. A direct
antiglobulin test (DAT) is also performed as part of the antibody investigation.[21]
Once the type and screen has been completed, potential donor units will be selected based on compatibility with the
patient's blood group, special requirements (e.g.
CMV negative, irradiated or washed) and antigen negative (in the case of an antibody). If there is no antibody present or suspected, the immediate spin or
CAC (computer assisted
crossmatch) method may be used.
In the immediate spin method, two drops of patient serum are tested against a drop of 3-5% suspension of donor cells in a test tube and spun in a
serofuge. Agglutination or
hemolysis in the test tube is a positive reaction and the unit should not be transfused.
If an antibody is suspected, potential donor units must first be screened for the corresponding antigen by
phenotyping them. Antigen negative units are then tested against the patient plasma using an
antiglobulin/indirect
crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read.
If there is no time the blood is called "uncross-matched blood". Uncross-matched blood is O-positive or O-negative. O-negative is usually used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies.
The process to match blood is lengthy but life saving when done right. In the event of emergencies, then hospitals will use O-positive or O-negative. But as always the rarest form of blood is the one NOT on the shelf.
During the past two months our nation has seen an extraordinary amount of inclement weather and recent reports are showing more than 10,000 blood drives have been canceled so supplies are critically low. Between the time it takes to process the blood and the critically low numbers, our nation is in dire need. Please take the time to donate, the need is constant.
(Information provided above from several resources including A.B.C. Facts and Red Cross Facts)