CROSS MATCHING

The terms compatibility test and cross matching are some time used interchangeably, however they should be clearly differentiated. A cross matching is only part of compatibility test. Compatibility testing consists of following: Review of patients past blood bank history and records. ABO and Rh typing of recipient and donor. Antibody screening of recipients and donors serum. Cross matching.

The cross match test is carried out to ensure that there are no antibodies present in patients serum that will react with donor cells when transfused. The two main function of cross match are test are: It is the final check of ABO-compatibility between the donor and patient.
It may detect the presence of an antibody in the patients serum that will react

with an antigen on donor red cells which was not detected in antibody screening because of the absence of corresponding antigen in screening cells. Cross match testing Procedures have been divided into two parts: Major cross match test. Minor cross match test.

Major cross match consist of mixing donors red cells with recipients (Patients) serum while Minor cross match consists of mixing patients cells with donors plasma. Minor cross match has now been given up in most blood bank laboratories because donor samples are screened before hand for common irregular type of antibodies. Major cross match technique:

Immediate spin technique. Saline room temperature technique. Albumin addition technique at 37oC. Indirect antiglobulin technique.

Cross match-Major (Method): (i) Put two drops of patients serum in a prelabelled glass test tube. (ii) Add one drop of 24% of suspension of donor red cells.

(iii) Mix the contents and incubate for (5-10 min) for immediate spin method or for (45-60 min) for saline room temperature technique.
(iv)

Centrifuge the tube at 1000 rpm for one minute (immediate spin method) while in case of saline room temperature technique centrifugation is optional.

(v) Examination the tube for haemolysis or agglutination. (vi) If haemolysis or agglutination is present at this stage the cross match is incompatible. (vii)If negative, i.e. there is no haemolysis or agglutination, wash the cell four times with saline and decant the last wash completely. Add one drop of AHG reagent. (viii)Centrifuge the tube at 1000 rpm for one min and look for haemolysis or agglutination with optical aid. (ix) Record the result. (x) If the test is negative, add one drop of control IgG coated red cells. Centrifuge again at 1000 rpm for 1min. (xi) Look for haemolysis or agglutination. If no agglutination, the test is invalid. Repeat the procedure. Interpretation Haemolysis or agglutination at any stage of the test procedure except after adding control IgG coated red cells indicates incompatibility.