Blood banking unit:

A. Blood transfusion
Blood typing:
Test Description
The foundation of blood typing is the detection of ABO and Rh antigens on the red blood
cells of an individuals blood. Each person has one blood type (A, B, AB, or O) which is genetically
determined. These blood type designations specify the antigen present on the persons red blood
cells. For example, a person with type B blood has the B antigen on the red blood cells, and someone
with type O blood has no antigens. Another important aspect of blood typing is understanding the
presence of antibodies in the blood and what they mean to blood transfusion therapy. In order for
someone to receive blood from a donor with a minimum of risk for a transfusion reaction, the donors
blood must have no antibodies against the recipients red blood cells, and the recipients blood must
have no antibodies against the donors red blood cells. For example, a person with type AB blood has
no antibodies present and can therefore theoretically receive blood of any of the four blood types (A,
B, AB, or O). Thus a person with type AB blood is often called the universal recipient. A person
with type O blood, on the other hand, has both anti-A and anti-B antibodies and can therefore
receive only type O blood, the only type with no antigen on its red blood cells. Individuals with type O
blood are referred as universal donors, because their blood, which has no antigens present on the red
blood cells, will theoretically cause no reaction when administered to any of the four blood types. The
blood types with their associated antigens and antibodies, and a synopsis of donor and recipient blood
types is summarized in Table B-1. Please note that although several blood types may be listed as
being appropriate for use in a transfusion for a particular blood type, this applies to small volumes of
blood being received. However, when large volumes of whole blood are transfused, ABO matching is
essential.

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Another component of blood typing is that of Rh-typing. Rh factor, also known as D factor,
was so named because the rhesus monkey was used in the initial investigations into this factor. An
individual is either Rh-positive or Rh-negative. The Rh-positive individual has the Rh antigen present
on the red blood cells and no antibodies against the Rh factor. The Rh-negative individual has no
antigens present on the red blood cells and has anti-Rh antibodies if previously sensitized by Rhpositive blood. In Rh-negative males, this sensitization would have occurred through transfusion with
Rh-positive blood. In Rh-negative females, the sensitization could have occurred either through
transfusion with Rh-positive blood, or through pregnancy in which the fetus was Rh-positive.
Determination of the Rh-factor is crucial for pregnant women. If the woman is Rh-negative and
her partners blood is Rh-positive, the fetus is Rh-positive. If the woman is Rh-negative, an indirect
Coombs test, which screens for Rh antibodies, is ordered. If the test is positive, Rh antibodies are
present and Rh antibody titers are then obtained. If the antibody test is negative both initially and
again late in the pregnancy, there is no risk to the fetus. If, however, the test is positive, the Rh negative
mother is producing antibodies against the red blood cells of the Rh positive fetus. These antibodies
may cross the placenta and cause destruction of fetal red blood cells before or during birth. This
results in a hemolytic disease known as hemolytic disease of the newborn or erythroblastosis fetalis.
This disease can be prevented by administering an anti-Rh antibody preparation (RhoGAM) in the
third trimester of pregnancy to women at risk. RhoGAM acts to suppress the mothers production of
antibodies in response to receiving the Rh-positive antigen. RhoGAM should be given to all Rhnegative women whenever there is a possibility of fetal-maternal transplacental hemorrhage, no matter
how minor. Such hemorrhage may occur as a result of chorionic villus sampling, amniocentesis,
spontaneous or therapeutic abortion, or delivery. When a person receives an incompatible type of
blood, that persons antibodies attack the antigens present on the red blood cells of the donor blood.
For example, a person with Type A blood has anti-B antibodies present in the blood. If this person is
given type B blood, which has B antigens on the red blood cells, the recipients anti-B antibodies will
attack the donors B antigens, resulting in a hemolytic, or transfusion reaction. Such a reaction can
result in renal failure and death of the recipient. To avoid the occurrence of transfusion reactions,
testing of both the recipients blood and the donors blood is done in order to ensure compatibility.
Two tests which are conducted are the type and crossmatch and the type and screen. The type
and crossmatch testing includes several components which take approximately an hour to complete.
First, the ABO group and Rh-type of the recipient are determined. Next, from the donated blood
supply available, donor blood of the same ABO group and Rh-type is chosen for compatibility

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testing. Indirect Coombs testing, which is a general screening for antibodies, is performed on both the
recipient and donor blood. More specific antibody testing may be required to identify unusual
antibodies. Once these tests are completed, samples of the recipients blood and the donors blood
are combined (crossmatched). If no antigen-antibody reaction occurs, the donor blood is considered to
be compatible, and thus acceptable for transfusion into the recipient.
Type and screen testing includes only testing to determine the ABO group and Rh-type
and the indirect Coombs test. Actual crossmatching with donor blood is not performed. Type and
screen testing is conducted in situations in which there is only a slight chance of the person requiring
blood, or in emergency situations.
Normal Values
Compatible (no antigen-antibody reactions between donor and recipient blood samples)
Contributing Factors to Abnormal Values

Hemolysis of the blood sample may alter test results.

Administration of Dextran or IV contrast media prior to the test may alter test results.

Interventions/Implications
Pretest

Explain to the patient the purpose of the test and the need for a blood sample to be drawn.

No fasting is required prior to the test.

The blood sample should be drawn before administration of Dextran, a plasma volume
expander.

Procedure

A 10-mL blood sample is drawn in a lavender-top (EDTA) collection tube.

Gloves are worn throughout the procedure.

Posttest

Apply pressure at venipuncture site. Apply dressing, periodically assessing for continued
bleeding.

Label the specimen and transport it to the laboratory.

Report ABO group and Rh type to the primary care provider.

Direct Coombs Test

Test Description

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In some types of diseases, such as infectious mononucleosis and systemic lupus

erythematosus, and in sensitizations such as to the Rh factor, the red blood cells become coated with
antibodies. The direct Coombs test serves as a screening test to determine whether such antibodies
are attached to the patients red blood cells. In this test a sample of the patients blood is mixed with
Coombs antihuman globulin serum. This serum is actually a rabbit serum which contains antibodies
against human globulins. When the patients blood is mixed with the rabbit serum, clumping or
agglutination occurs if antibodies are present on the patients red blood cells. A common cause of a
positive direct Coombs test is autoimmune hemolytic anemia in which the person has antibodies
against his own red blood cells. The test has multiple purposes. It is used to screen blood during type
and crossmatch procedures. It can also be used to detect red blood cell sensitization to drugs or blood
transfusions, as in the testing for the occurrence of a hemolytic transfusion reaction. In cases of
suspected erythroblastosis fetalis, the test can be used to determine the presence of antibodies to the
newborns red blood cells.
Normal Values: Negative

Contributing Factors to Abnormal Values

Hemolysis of the blood sample may alter test results.

Drugs which may cause a positive direct Coombs test: ampicillin, captopril, cephalosporins,
chlorpromazine, chlorpropamide, ethosuximide, hydralazine, indomethacin, insulin, isoniazid,
levodopa, mefenamic acid, melphalan, methyldopa, para-aminosalicylic acid, penicillin,

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phenylbutazone, phenytoin, procainamide, quinidine, quinine sulfate, rifampin, streptomycin,

sulfonamides, tetracyclines.
Interventions/Implications
Pretest

Explain to the patient the purpose of the test and the need for a blood sample to be drawn.

No fasting is required before the test.

Procedure

A 7-mL blood sample is drawn in a lavender-top (EDTA) collection tube.

For newborns, a 5-mL umbilical cord blood sample is sufficient.

Gloves are worn throughout the procedure.

Posttest

Apply pressure at venipuncture site. Apply dressing, periodically assessing for continued
bleeding.

Label the specimen and transport it to the laboratory.

Report abnormal findings to the primary care provider.

Indirect Coombs Test

Test Description
The indirect Coombs test is used to detect unexpected circulating antibodies in the patients
serum which may react against transfused red blood cells. These antibodies are ones other than those
of the A, B, and O blood groups. This is different from the direct Coombs test, which detects
antibodies already attached to the red blood cells.
In this test, the patients serum is considered the antibody and the donor red blood cells as the
antigen. The serum and antigenic red blood cells are brought together to allow any antibodies to
attach to the red blood cells. Antihuman globulin is then added. If the patients serum contains an
antibody that reacted with and attached to the donor red blood cells, agglutination will occur and the
test is considered positive. If no agglutination occurs, no antigen-antibody reaction has taken place.
The serum may contain an antibody, but the donor red blood cells do not have the antigen against
which the antibody would respond. Positive tests are followed with additional testing to identify the
specific antibody present.
Normal Values: Negative
Possible Meanings of Abnormal Values:
Positive

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 Erythroblastosis fetalis
Hemolytic anemia (drug-induced)
Incompatible crossmatch
Maternal-fetal Rh incompatibility
Prior transfusion reaction
Contributing Factors to Abnormal Values

Hemolysis of the blood sample may alter test results.

Administration of dextran or IV contrast media prior to the test may alter test results.

Drugs which may cause a positive indirect Coombs test: cephalosporins, chlorpromazine,
insulin, isoniazid, levodopa, mefenamic acid, methyldopa, penicillin, phenytoin, procainamide,
quinidine, sulfonamides, tetracyclines.

Interventions/Implications
Pretest

Explain to the patient the purpose of the test and the need for a blood sample to be drawn.

No fasting is required before the test.

Procedure

A 7-mL blood sample is drawn in a red-top collection tube.

Gloves are worn throughout the procedure.

Posttest

Apply pressure at venipuncture site. Apply dressing, periodically assessing for continued
bleeding.

Label the specimen and transport it to the laboratory.

Report abnormal findings to the primary care provider.

B. Crossmatching

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