Pretransfusion Testing

Part 1
Introduction
 Purpose to select for each recipient blood components which
when transfused will survive and not cause destruction of
recipients rbcs.
 Must prevent transfusion of incompatible donor cells which
may cause HTR.
 US federal government regulates by giving authority to CLIA
to oversee testing:
 ABO/D
 Antibody detection
 Antibody identification
 Compatibility testing
Pretransfusion Testing Requirements
 Positive identification of recipient and recipient’s sample.
 Review of transfusion records for previous results.
 Tests on donor blood.
 ABO/D recipient
 Antibody detection using serum or plasma
 Select ABO/D appropriate components
 Test serum/plasma with donor RBCs, i.e., crossmatch
 Labeling.
Pretransfusion Testing
 Transfusion usually safe and beneficial.
 Donor or recipient RBCs may undergo accelerated
destruction.
 Most HEMOLYTIC transfusion reactions caused by errors in
patient or sample identity.
 Antibody may be below level of detectability.
 Even when all done correctly cannot guarantee survival of
transfused RBCs.
Pretransfusion Testing
 If performed PROPERLY testing WILL:
 Ensure patient receives correct components.
 Verify in most cases components are ABO compatible.
 Detect most clinically significant unexpected antibodies.
Modern Blood Banking Practices
 Many changes over last 20 years.
 In 1980’s time for eliminating unnecessary tests.
 Ongoing reevaluation led to streamlining procedures for cost
effectiveness AND patient safety.
 Intelligent approach, requires rigid adherence to guidelines
and standards.
 Changes based on:
 Patient safety
 Elimination of unwanted reactions
 Increase speed of testing procedures performed.
Transfusion Request Form
 Can be oral, electronic or written and must include
information sufficient to positively ID patient.
 Two identifiers required:
 Patient full name
 Unique ID number
 Other identifier
 DOB
 Driver’s license number
 Photographic ID

 Blood is a drug and requires physician prescription.

Transfusion Request Form
 Additional helpful information
 Sex
 Age
 Diagnosis
 Transfusion and pregnancy history
 Special needs: CMV negative, irradiated, etc.
 Reject requisition if
 Information is incomplete or lacking.
 Inaccurate
 Illegible
Specimen Requirements
 Testing performed only as good as sample submitted.
 Properly collected sample from CORRECT patient is
CRITICAL to safe blood transfusion.
 Patient must be identified with TWO identifiers, best to
allow properly trained individuals to collect.
 Labeling
 Minimum patient full name
 Patient unique ID number.
 Date and time, although some institutions require date only.
 Phlebotomist identification
Specimen Requirements
 Patient does not have armband physically attached.
 DO NOT DRAW
 Have qualified healthcare provider band patient.
 Emergency protocol must be followed in STAT situations
 Emergency room patient identity unknown use temporary
ID.
 Preadmission testing must stress to patient importance of
returning with ID band or will start over.
 Sample must be labeled in physical presence of patient.
Specimen Requirements
 Commercial armbands may be
utilized in addition to institution
armbands.
 Top right: Typenex
 Bottom right: Bio-logics.
Specimen Requirements
 Sample
 Draw into stoppered tube
 May use serum or EDTA plasma
 Can draw from IV line as long as proper protocol followed
 Hemolyzed samples should not b used
 Samples cannot exceed 3 days if transfused or pregnant last 3
months.
 Collection day is day 1, can be used until 11:59pm on day 3.
 Sample must represent current immunological status.
 No pregnancy or transfusion last 3 months the institution will
set requirement for use.
Specimen Requirements
 Infants less than 4 months old.
 No unexpected antibodies detected and infants receive no
components containing clinically significant antibodies no
additional testing required during neonatal period.
 After initial ABO/D type determined this test can be omitted
during neonatal period as long as infant receives ABO specific
or group O cells with compatible D type.
Specimen Requirements
 Sample must be verified by qualified laboratory personnel.
 Any doubt as to identity of patient or labeling of sample new
sample must be obtained.
 UNACCEPTABLE and EXTREMELY RISKY to correct
incorrectly labeled sample.
 Each lab will have policies for accepting mislabeled samples.
 Must be able to defend in court reason.
 If sample can easily be recollected there should be zero
tolerance.
 Study found mislabeled samples 40 times more likely to have
blood grouping discrepancy.
Specimen Requirements - Storage
 Sample and sample from donor RBCs (if crossmatch) MUST
be stored at 1-6C for SEVEN days AFTER transfusion.
 Donor RBCs may be actual segment used for testing.
 Donor segment removed upon issuing unit may be saved.
 Must have sample for repeat testing if patient has transfusion
reaction either immediate or delayed.
 Storage capacity will many times determine amount of time
sample may be used.
 Three day sample plus 7 days = 10 days
 For non-pregnant/transfused for last 3 months may elect to use
for 14 days + 7 = 21 day storage
Previous Records
 Compatibility testing MUST include checking previous records for
patient’s serological history.
 If patient has history must compare current with previous testing.
 If discrepancy present MUST resolve.
 NOTE: Becoming standard practice to collect SECOND sample after
first for patients with no history.
 Most significant information is history of clinically significant antibodies
 Specificity compared to current antibodies detected.
 Regardless of result, may be negative, antigen negative blood MUST be
provided.
Serological Testing – ABO Grouping
 Test unknown RBCs with reagent anti-A and anti-B.
 Testing unknown serum with reagent A1 and B cells
 Discrepancies MUST be resolved prior to issuing blood.
 In an emergency provide
 Group O negative RBCs
 AB plasma products
Serological Testing – D Typing
 Test patient and donor RBCs with anti-D.
 Tests with anti-D must be controlled to avoid incorrect interpretation.
 If problem arises transfuse D negative blood.
 Weak D unnecessary for recipients
 Donors
 No weak D test required at transfusion service.
 D typing of D positive donors not required by transfusion service.
 Weak D test must be performed by blood collection facility for donors.
 If positive labeled “D positive”.
Antibody Detection Tests
 Serum or plasma tested against single-donor suspension of
cells selected to carry blood group antigens necessary for
detection of most important CLINICALLY SIGNIFICANT
unexpected antibodies.
 Unexpected antibodies are those OTHER than anti-A and –B
 Clinically significant antibody is/has:
 Caused hemolytic disease of the fetus and newborn.
 Caused a hemolytic transfusion reaction
 Caused unacceptable survival of transfused RBCs
 Is reactive at 37C or AHG.
Antibody Detection Tests
 IgG coated RBCs (check cells) MUST be used to detect false
negative antiglobulin tests due to inactivation of Coomb’s
serum.
 Commercially available screen cells, 2-3 vials, Group O
 Following antigens MUST be present: D, C, E, c, e, M, N, S, s,
P1, Lea, Leb, K, k, Fya, Fyb, Jka and Jkb.
 No requirement for low incidence antigens (Lua, V or Cw)
 No requirements for homozygous cells to be present.
 May not be used beyond expiration, some antigens deteriorate.
Type and Screen
 Safe alternative to full crossmatch.
 Perform ABO, D and antibody screen.
 When done correctly will detect 99.9% of unexpected
antibodies.
 If antibody screen positive MUST identify antibody and
crossmatch antigen negative donors.
 If antibody screen negative no crossmatch performed.
 Extremely safe and effective.
 Most frequently done for obstetrical and pre-operative
patients where risk of bleeding is minimal.
Type and Screen
 If complications arise patient can receive ABO, D type
specific immediate-spin crossmatch compatible within 10
minutes.
 Transfusion service must have adequate stock of blood.
Type and Screen - Limitations
 CANNOT detect ALL antibodies
 Antibody may be directed against low incident antigen absent
from screen cells.
 Antibody may have fallen below level of detectability.
 Antibody may be exhibiting “dosage” affect, react more
strongly with homozygous and weakly or negative with
heterozygous.
Type and Screen - Limitations
 Dosage
 RBC which is positive for Jka and Jkb is a heterozygous cell.
 Half of the antigens on the RBC will be Jka positive and half will be Jkb
positive.
 RBC which is positive for Jka and negative for Jkb is assumed to be
homozygous for Jka , 100% of the antigens will be Jka .
 Example of patient with Jka showing dosage reaction at AHG:

Jka Jkb Patient 1 Patient 2

+ 0 4+ 1+
0 + 0 0
+ + 2+ 0
Pretransfusion Testing
Part 2
Compatibility Testing - History
 Early 1980’s started to question utility of:
 Routine use of anti-A,B and A2 cells in ABO grouping
 Repeat D typing of D positive donor units
 Weak D testing
 Repeat antibody screen on donor units
 DAT testing
 Performance of elutions
 Significance of antibodies reactive at RT or below.
 Usefulness of albumin in antibody detection tests
 Use of AHG in both antibody screen AND crossmatch
Compatibility Testing - History
 During 1984-85 FDA and AABB allowed the AHG phase of
the CROSSMATCH to be deleted if the patient’s antibody
screen was negative.
 In 1984 Judd recommended deleting the autocontrol as part
of routine pretransfusion testing.
 By 1986 the minor crossmatch was of historic interest only.
Compatibility Testing – Coomb’s
Crossmatch
 Who needs a crossmatch? Patients who are:
 experiencing clinical signs and symptoms of anemia.
 actively bleeding.
 having a surgical procedure where possibility of excessive
bleeding is high.
 What is the “major” crossmatch
 Patient serum/plasma added to donor cells
 Read at three phases: IS, 37C and AHG.
 Set up and read as part of antibody screen procedure
 Agglutination and/or hemolysis are positive.
 Donor cells reacting with patient sample at 37C, AHG or
causing hemolysis are “incompatible” CANNOT be transfused.
Compatibility Testing - IS
 When NO CLINICALLY SIGNIFICANT antibodies are
detected in the antibody screen AND there is no history of
antibodies, the AHG phase of testing is NOT required.
 Rarely are AHG incompatible crossmatches obtained when
antibody screen is negative.
 MUST demonstrate ABO incompatibility by performing IS
crossmatch.
 Policy change requires medical director approval.
Compatibility Testing - IS
 Decision to omit AHG phase based on the following:
 Incidence of incompatible crossmatches when antibody screen is
negative and the reason.
 Sensitivity of antibody detection procedure used.
 Benefits of omitting AHG phase in the laboratory.
 Expertise of individuals working in the transfusion service.
 If clinically significant antibodies are present the
AHG phase of the crossmatch is required.
Compatibility Testing - Computer
 Antibody screen negative and computer validated on site to prevent
release of ABO-incompatible blood it may be used to detect ABO
compatibility instead of serologic testing.
 Following conditions MUST be met:
 TWO determinations of patients ABO group by: second type on same
sample OR second current sample, or comparing to previous records.
 Donor ABO/D type, unit number, component name and confirmatory type.
 Patient ABO/D type, antibody screen result and two unique patient
identifiers.
 Method to ensure correct data entry.
 Computer logic to alert to ABO/D discrepancies on unit label and testing
and ABO incompatibility between recipient and donor.
Optional Pretransfusion Testing
 ABO Grouping
 Testing RBCs with anti-A,B
 Serum/plasma tested against A2 cells
 D typing
 Weak D test
 Rh control with chemically modified reagents unless AB pos
 Antibody Screen (IAT)
 RT incubation
 Additives such as albumin or LISS
 Enzymes
 Polyspecific AHG in IAT
Optional Pretransfusion Testing
 Autocontrol or DAT
 Published data indicate performance is of limited value even in recently
transfused patients.
 Standards does not require autocontrol or DAT
 Microscopic reading of tests, magnifier viewing lamp adequate.
 Crossmatch
 37C and AHG when antibody screen and history is negative.
 RT incubation
 Enzyme tests
 Polyspecific AHG
 Minor crossmatch
Selection of Donor Group
 When possible ABO identical.
 D positive should be selected for D pos, although D neg is acceptable
but should be reserved for D neg except:
 D neg short date unit can be given to D pos “sure give”.
 Multiple antibodies present and D neg more likely to lack.
 D negative should be selected for D neg to avoid immunization to D
antigen.
 Consult with medical director and patient’s physician if need is urgent.
 Use D negative first.
 Weigh risk of patient death versus immunization to D.
 May be appropriate to administer Rh immune globulin especially after
platelet transfusion.
 Selection of Donor Group

Recipient ABO Compatible Donor ABO In Order of Selection

O O
B B, O
A A, O
AB AB, A, O, B – why O before B??
Blood Administered after Non-Type
Specific Transfusion
 Determine presence of anti-A and/or anti-B in patient.
 When serum from freshly drawn sample is compatible at
AHG with recipient’s own blood group may return to group
specific.
 If AHG incompatible must continue with alternative ABO
group.
 If change involved D only return to D type specific.
Other Blood Groups
 Unnecessary to select units based on other blood groups
UNLESS patient has clinically significant unexpected
antibody.
 If antibody strongly reactive use patient serum to screen then
confirm with specific typing sera.
 Weakly reactive screen units with specific typing sera.
 If commercially prepared typing sera is not available use
patient sample or plasma from donor with antibody.
Antibody Detection Techniques
 Use 2 to 3 commercially prepared group O cells.
 Relatively short shelf life, two weeks.
 Antigen profile (antigram) provided with analysis of antigens
present on each cell.
 MAKE SURE lot number of screen cell matches antigram.
 Add patient serum/plasma to screen cells and observe at:
 RT/IS
 After incubation at 37C with enhancement media.
 After washing and addition of AHG reagent.
 Agglutination and/or hemolysis is POSITIVE.
 Phase of reactivity of positive reaction extremely helpful.
Antibody Detection Techniques
 Antibody detection procedure used determined by what is
considered “significant” antibody.
 Carefully considered if AHG crossmatch not performed.
 Once adopted method written in SOP and must be followed
exactly by all staff members.
 Detection method chosen should:
 Detect as many clinically significant antibodies as possible.
 NOT detect clinically insignificant antibodies.
 Allow prompt delivery of blood to the patient.
Antibody Detection Techniques
 Method should be sufficiently sensitive to detect low level of
antibody in patient serum or plasma.
 Undetected low levels of patient antibody may result in rapid
production of antibody if antigen positive cells transfused.
 Antibody present in donor plasma will not harm recipient.
 Methods for antibody screen and crossmatch may be the
same or different.
 RT tests such as IS crossmatch required to detect ABO
incompatibilities, may not be required for antibody screen.
 Antibody screen MUST include AHG to detect clinically
significant antibodies, crossmatch may be IS only.
Antibody Detection Techniques
 Lab personnel should use same interpretations, notations and
consistency in grading reactions.
 Consistency in grading reactions crucial.
 Hemolysis and/or agglutination constitutes visible endpoint of
antigen-antibody reaction and must be observed accurately and
consistently.
 Use light source or optical aid to enhance sensitivity and
consistency.
 Microscopic observation is not required but is useful to
 Distinguish rouleaux from true agglutination
 Detect mixed field agglutination seen in anti-Sda.
Antibody Detection Techniques
 Reactions must be observed for hemolysis then agglutination
IMMEDIATELY after centrifugation.
 Manner in which RBCs are dislodged is crucial.
 Hold tube at angle so fluid cuts across cell button as tube is
tilted.
 Reaction is not interpreted until ALL cells resuspended.
 Over shaking will result in weak or negative reactions.
 Reactions are recorded IMMEDIATELY with tube held in
hand in front of column to record in.
General Considerations
 Labeling tubes
 Each tube labeled properly BEFORE use.
 Recipient’s initials (or other identifying information) and donor
unit number or reagent RBC identification.
 System must allow for accurate, rapid labeling.
 NEVER rely on the position of a tube in a rack or centrifuge
head to identify the contents of the tube.
 ALWAYS place tubes in the serofuge head in the order they will
be read.
 Use the SAME organizational techniques when labeling and
arranging tubes in rack to improve organization and speed.
General Considerations
 Volume of serum or plasma.
 Most procedures call for 2 drops.
 Research has shown 2 drops provide optimal antibody to
antigen ratio.
 Some alloantibodies detected only when 3 to 4 drops used.
 High variability in delivery in transfer pipettes.
 Standardize volumes based on equipment used in your lab.
 Low ionic reagents require ration of 2 drops serum/plasma to 2
drops LISS, cannot vary.
General Considerations
 Cell suspension
 RBCs used for crossmatching obtained from sealed segment of
original tubing attached to blood container.
 Wash once and prepare 2-4% suspension, some workers prefer
2% as it increases sensitivity of the test system.
 Best to use weakest suspension that can be observed for
agglutination.
 Too heavy of a cell suspension can cause weak antibodies to be
missed.
Testing Techniques – Saline Tube
 Simplest to perform.
 Mix serum or plasma with saline suspended RBCs, centrifuge
and read, incubate at RT or 37C.
 Used in crossmatching to detect ABO incompatibility.
 In antibody tests used to detect IgM antibodies which react
preferentially at RT: anti-M, -N, -P1, -Le and –I.
 Rare examples of antibodies of other specificities may be
observed at RT but more often will be reactive at 37C
and/or AHG as well.
Testing Techniques – Bovine Albumin
Tube
 Utilized to enhance agglutination of IgG antibodies since
1945.
 Decreases amount of time required for incubation.
 Controversy: Decrease zeta potential (affects second stage of
agglutination) or due to function of ionic strength of albumin
diluent does it increase uptake of antibody onto cells?
 Many antibodies have enhanced reactivity when albumin is
added to test system.
Testing Techniques – LISS Tube
 Low Ionic Strength Saline shortens incubation time.
 Increases antibody uptake onto cell, enhancing agglutination.
 Several important factors to consider:
 Incubation time and sensitivity subsequent to AHG depends
upon desired ionic conditions.
 Adding additional serum will increase ionic strength, must not
be done.
 MUST adhere to manufacturer’s instructions.
Testing Techniques – PEG Tube
 Polyethylene Glycol (PEG) is a water soluble, neutral
polymer which is an effective potentiator of antigen-antibody
reactions.
 Advantages over albumin include:
 Increases rate of detection of clinically significant antibodies.
 Decreases detection of clinically insignificant antibodies.
 May decrease need for other enhancement techniques.
 Procedure
 Serum or plasma added to RBCs, perform IS.
 Add PEG and incubate at 37C – IS NOT READ AFTER 37C
 Wash and add AHG.
Testing Techniques – Enzymes
Tube
 More appropriate for antibody ID than routine testing.
 GREATLY enhance reactivity of Rh antibodies.
 CANNOT be only method used as M, N, S, Fy and other
antigens are destroyed, those antibody specificities would not
be detected.
 Enzymes used include
 Papain
 Bromelain
 Trypsin
 Ficin – MOST POPULAR
Pretransfusion Testing
Part 3
Negative screen, Compatible XM
 Vast majority will have this outcome.
 DOES NOT guarantee the absence of antibody in patient
sample directed against donor antigens OR the donor cells
will survive normally.
 Negative screen simply means there are no DETECTABLE
antibodies in patient sample directed against antigens present
on these particular screen cells.
 Compatible crossmatch viewed in same manner.
Negative screen, Compatible XM
IS 37C AHG CHECK INTERP
Screen 1 0 0 0 2+ Negative
Screen 2 0 0 0 2+
Screen 3 0 0 0 2+
Donor 1 0 0 0 2+ Compatible
Positive screen, Incompatible XM
 May be due to alloantibodies or autoantibodies
 If ALL tubes positive could be problems with reagents or, at
IS or 37C, rouleaux
 MUST IDENTIFY PROBLEM PRIOR TO TRANSFUSION.
 Need for blood urgent consult with medical director and
patient’s physician.
 Risk of death transfusing incompatible may be less than
depriving patient of oxygen carrying capacity.
Positive screen, Incompatible XM
 The following table would indicate the presence of an
alloantibody directed against screen 1 and donor 1.

IS 37C AHG CHECK INTERP

Screen 1 0 0 2+ Positive
Screen 2 0 0 0 2+
Screen 3 0 0 0 2+
Donor 1 0 0 2+ Incompatible
Positive screen, Incompatible XM
 Positive usually indicates alloantibody present.
 Perform panel study identify antibody specificity.
 Estimate liklihood of finding antigen negative blood in
inventory.
 Use appropriate antiserum to verify units are antigen negative.
 NOT necessary to confirm antigen negative for M, N, P1 or Le antigens.
 Must perform if required at your facility.
 If multiple antibody specificities present must identify all, may
have to send to reference lab.
 Antibody to high incidence antigen most promising source will
be siblings or AABB rare donor blood file.
Positive screen, Incompatible XM
 If autocontrol positive (required for antibody identification
studies) obtain patient history.
 Transfused within last 3 months alloantibody may be present
reacting with transfused donor cells.
 MF agglutination is usually noted as only donor cells are positive
for antigen and coated with antibody.
 Perform elution procedure to remove bound antibody from
cells and identify specificity.
Positive screen, Incompatible XM
 Potent cold reactive antibodies may cause problem with
ABO, D typing as well as antibody detection and crossmatch.
 Most common specificity is anti-I which may show high
thermal amplitude, reacts with adult but NOT cord cells.
 Important to determine if cold is masking warm antibody.
 AFTER IDENTIFICATION perform prewarm technique
 Prewarm serum/plasma and add to prewarmed screen cells.
 After incubation wash with WARM saline.
 Add AHG and evaluate for positive and negative reactions.
 Cold auto-absorption may be necessary – covered later.
Positive screen, Incompatible XM
 Rouleaux is property of serum that causes ALL cells tested to
appear agglutinated at RT and 37C, DOES NOT affect AHG
test as serum is removed.
 Stacked coin appearance of RBCs.
 To confirm perform saline replacement.
 Spin tubes down, remove serum.
 Add 1-3 drops saline, mix, respin.
 Rouleaux formation will disperse, TRUE agglutination will
NOT.
 Spin, remove saline, add serum and proceed to 37C incubation.
Positive screen, Incompatible XM
 Reagent Related Problems
 May be due to a variety of drugs or additives present in reagents
which cause false POSITIVE results.
 If reagent RBCs positive but XMs appear compatible suspect
patient reacting with additive in reagent RBCs, wash reagent
RBCs and retest.
 If ALL screen and XM tubes positive, suspect patient antibody
reacting with substance in enhancement media, repeat with
different enhancement or do saline test.
Positive Screen, Compatible XM
 Patient has antibody directed against antigen on screen cell
which absent on donor cell.
 Patient has a weak antibody reacting with homozygous screen
cell, donor is either heterozygous or negative for antigen.
 Perform antibody identification (panel study) and test donors
for antigen.
 Crossmatch units negative for antigen.
Positive screen, Compatible XM
 The following table would indicate the presence of an
alloantibody directed against screen 1 which is not present in
donor 1 OR
 Antibody reacting with homozygous screen cell, donor 1 is
heterozygous or negatve.
IS 37C AHG CHECK INTERP
Screen 1 0 0 2+ Positive
Screen 2 0 0 0 2+
Screen 3 0 0 0 2+
Donor 1 0 0 0 2+ Compatible
Negative Screen, Incompatible XM
 MOST COMMON CAUSE IS DONOR UNIT HAS
POSITIVE DAT.
 Perform DAT on DONOR UNIT.
 If positive return to blood provider
 RARELY, patient may have antibody to low incidence antigen
present on donor cells but absent from screen cells.
 Perform DAT on donor unit.
 If negative perform antibody ID
 Repeat ABO grouping on DONOR sample.
Negative screen, Incompatible XM
 The following table would indicate the presence of an
alloantibody directed against donor 1 OR donor has positive
DAT.
 Perform DAT FIRST, if negative, panel study.

IS 37C AHG CHECK INTERP

Screen 1 0 0 0 Negative
Screen 2 0 0 0 2+
Screen 3 0 0 0 2+
Donor 1 0 0 2+ Incompatible
Negative Screen, Incompatible XM
 If at RT only this may be due to:
 Donor RBCs are incompatible with patient, retype donor.
 Anti-A1 in serum of A2 or A2B patients.
 Other alloantibodies reactive at RT, perform antibody ID
 Crossmatch incompatible at AHG phase ONLY.
 Donor RBCs have positive DAT.
 Antibody reactive only with cells homozygous for a particular
antigen, screen cells may not have homozygous cell – perform
antibody identification (panel) study.
 Antibody reactive with low frequency antigen present on donor
RBCs, absent on screen cells – perform panel study.
Labeling and Release of Blood
 A tag or label must be attached to blood container indicating
 Recipient’s two independent identifiers
 Donor unit number
 Interpretation of compatibility testing
 Two independent identifiers, of which is the patient’s name.
 Recipient’s ABO/D types.
 Donor unit or pool ID number.
 Donors ABO group and, if required, D type.
 Interpretation of the crossmatch if performed.
 The date and time of issue.
 Special transfusion requirements (CMV reduced risk, irradiated
or antigen negative.
Labeling and Release of Blood
 Prior to issuing a unit of blood, blood bank personnel must:
 Check the expiration date of the blood to avoid issuing an
outdated component.
 Inspect the unit for abnormal appearance.
 Document:
 Name of the individual issuing the blood.
 Date and time of issue.
 Name of person to whom blood was issued or destination.
Labeling and Release of Blood
 A process must exist to confirm that all of the following are
in agreement:
 Identifying information
 Request
 Records
 Blood or components
 All discrepancies must be resolved before issue.
Labeling and Release of Blood
 Final identification of the recipient prior to transfusion
rests with the transfusionist, who must identify the
patient and donor unit and certify that identifying forms,
tags and labels are in agreement.
References
 AABB Technical Manual, 16th edition, 2008
 CAP Today http://tinyurl.com/4cd4qgd
 Basic & Applied Concepts in Immunohematology,
2nd edition, 2009
 Ortho WIRE, http://www.ortho-wire.com