he patient was pregnant, received RBC products by transfusion within the last 3 months, or if these histories are unknown.

7 Patient RBCs can be obtained from either clotted or anticoagulated samples. They can be washed before use to remove plasma or serum, which may interfere with some testing procedures. A 2 to 5 percent saline suspension of RBCs is used for most serologic testing procedures; however, the manufacturers directions should be consulted for the proper cell concentration to use for typing tests performed with licensed reagents. A method for preparing a button of washed RBCs suitable for performing one test is given in Procedural Appendix 1.

Donor Samples
Samples for donor testing must be collected at the same time as the full donor unit. Depending on the method used for testing, clotted and/or anticoagulated pilot samples are obtained. The donor information and medical history card, the pilot samples for processing, and the collection bag must be labeled with the same unique number before starting the phlebotomy, and the numbers must be verified again immediately after collection.8 The donor number is used to identify all records of testing and eventual disposition of all component parts of the unit of blood. More detailed information on donor samples can be found in Chapter 11. RBCs for donor pretransfusion compatibility testing can be prepared from the segmented tubing through which the donor blood was collected. The tubing or segment is attached to the collection bag, and each segment is imprinted with the same number. These numbers are different from the donor unit number but nonetheless are a positive means of sampling a given unit of blood. Donor RBCs can be obtained from the segments in a number of ways that permit several procedures to be performed from the same segment. One technique that works well for sampling is using a lancet to make a tiny hole in the segment through which a single drop of blood can be expressed easily and then disposing the lancet in a biohazard sharps container. The hole is essentially self-sealing, so the rest of the blood in the segment remains uncontaminated. Another technique is to cut the RBC end of the segment tubing with scissors and use an applicator stick to remove cells or express a drop by squeezing the tubing. Commercially manufactured segment cutters eliminate the need for scissors, thus enabling dispensing the RBCs into a test tube in one motion. The segment may be stored with the cut end down in a properly labeled test tube and covered or stoppered to minimize contamination and maintain RBC integrity. The contents of the segment should preferably not be emptied into a test tube for storage because of the increased risk of contamination. Regardless of the method used to harvest cells from a segment, it is important that engineering and/or work practice controls be used to eliminate or minimize aerosol production when the segment is cut or opened. Refer to Chapter 25 for additional information on safety procedures. Both donor and recipient samples must be stored for a minimum of 7 days following transfusion.9 The samples should be stoppered, carefully labeled, and refrigerated at 1_ to 6_C. They should be adequate in volume so they can be

reevaluated if the patient experiences any adverse reaction to the transfusion.

Compatibility Testing Protocols

Testing of the Donor Sample
According to the Code of Federal Regulations10 and the American Association of Blood Banks (AABB) Standards,11 ABO and Rh grouping (including a test for weak D) and tests intended to prevent disease transmission must be performed on a sample of blood taken at the time of collection from the donor. A screening test for unexpected antibodies to RBC antigens is required by AABB Standards on samples from donors who reveal a history of prior transfusion or pregnancy.12 Testing is performed by the facility collecting the donor unit, and results must be clearly indicated on all product labels appearing on the unit. The transfusing facility is required by AABB Standards13 to confirm the ABO cell grouping on all units and Rh typing on units labeled Rh-negative. Repeat weak-D testing is not required. The transfusing facility is not required to repeat any other testing procedure. The sample used for this testing must be obtained from an attached segment on the donor unit. All testing must be performed using in-date licensed reagents according to manufacturers directions and protocol established in the written SOP of the facility. A detailed explanation of the processing of donor blood can be found in Chapter 11.

Testing of the Patient Sample

A record must be maintained of all results obtained in testing patient samples. Some large transfusion services keep this information on a computerized retrieval system for ready access. However, when computer records are not available, these transfusion services must have another system that permits retrieval of patient testing results.14 Ideally, the same unique identification number should be assigned each time a patient is admitted to a health-care facility for treatment. The number can then be used as a method for positive identification by comparing results of previous and current testing. Verification of previous results helps establish that the current samples were collected from