A transfusion service supervisor in California reports that her hospital's current practice is NOT to crossmatch autologous RBC units which have been collected on site at her hospital. She thought this practice also applied to autologous units collected elsewhere, but recently discovered that some of her technologists are crossmatching autologous units that have been collected at other facilities. When looking at their written procedures to see why some technologists are crossmatching autologous units that were collected at other facilities, she was surprised to find that they have no current written policy about this, one way or the other. She acknowledges that they need to write one.

She would like input as to what other facilities do regarding crossmatching autologous RBC units. She comments that she sees no difference in their own collected units versus those collected at other facilities, so that whatever policy they come up with, it will probably be standardized to all autologous RBC units. She concludes stating that they use an immediate spin crossmatch for non-alloimmunized patients, and she thinks that they should do the same for all of the autologous RBC units. She welcomes comments.

The following comments have been received.

ADDENDA Sept. 28, 2004

1. A colleague at a hospital in Alaska reports that they handle pretransfusion testing for autologous red cell units in a manner identical to that for allogeneic red cell units. They perform an immediate spin crossmatch on autologous RBC units for patients with no current or history of an alloantibody and an AHG crossmatch for those patients who currently or historically have an alloantibody. The reasons for this are standardization and simplification. The technologists treat all red blood cell units identically. They do not collect any autologous units at their facility, so that all of their autologous units are shipped to them by their supplier.

ADDENDA Sept. 30, 2004

2. A colleague at a VA hospital in the Pacific Northwest reports that they do exactly as the responder from Alaska. At her institution, autologous units are treated as homologous red cell units and undergo crossmatching accordingly.

ADDENDA Oct. 3, 2004

3. A colleague in Texas reports that at her institution they handle pretransfusion testing on these patients in the same manner as that for patients who will receive allogeneic units. They perform an antibody screen on the patient and if an autologous unit is requested they do an immediate spin crossmatch on the autologous RBCs. If the patient has a history of an alloantibody they perform an AHG crossmatch. They do not collect autologous units at their facility. It seems to her that regardless of where the unit is collected the procedure for crossmatching RBCs should be the same, whether the blood is allogeneic or autologous.

ADDENDA Oct. 5, 2004

4. A colleague in New Jersey states their policy is to do a clerical check only, not a serologic test. If the patient's name, SS#, date of birth and blood type all match the information associated with the RBC unit, they issue the unit based on a 'CLERICAL CROSSMATCH' in their computer.

ADDENDA Oct. 20, 2004

5. A colleague in Wisconsin reports that they do NOT crossmatch autologous RBC units, whether or not the patient has a history of an unexpected red cell antibody. What they do instead is to re-confirm the blood type of the autologous blood, as well as perform a 'Type and Screen" on a current blood specimen for each patient who is scheduled to go to surgery and possibly receive their autologous blood. The reason that they do the type and screen testing is to be prepared, in the event the patient requires more blood than their autologous unit(s). STAT blood requests would be difficult to honor if they were not already prepared, having done an antibody screen. In addition, his laboratory does NOT do computer crossmatches yet, but their computer is designed to flag the situation when non-autologous blood products are selected for a patient who has autologous blood available, as well as to flag when ABO-incompatible RBCs have been inadvertently selected.

ADDENDA Oct. 31, 2004

6. A colleague in Northern California reports that they do not crossmatch autologous blood. Rather, they obtain a fresh blood sample from the patient and test that sample for ABO/Rh and an antibody screen. They also confirm the blood type of the autologous unit, and perform an 'antigen-type' of the unit if the patient has an unexpected alloantibody.

ADDENDA Feb. 16, 2006

7. A colleague in California reports that her hospital system wants to standardize their practice regarding the crossmatching of autologous units throughout their region. Currently, some of their hospitals crossmatch autologous units and some hospitals do not. Those hospitals that do crossmatch autologous units perform this test because they feel it is an added safety feature. All of their system facilities currently perform an ABO/Rh double check (second sample drawn) on all non-group O patients who have no historical record, except in the case of an autologous patient where the autologous donation is considered the "second sample". The autologous unit is typed at the donor center and confirmed by the transfusion service. Their physician group is questioning the justification to continue crossmatching autologous units, citing that this one test has not prevented any "mis-transfusion". They believe that errors are more likely to occur at the time of transfusion, or at the time of sample collection. The sample collection issue is addressed (at least for non-group O patients) with the confirmation of ABO/Rh at the time of checking against historic records or by using a double check system. The physician group would like to know what practice others are following, with regards to crossmatching autologous units, and if an autologous unit crossmatch is performed, has it been shown to improve patient safety or to detect any ABO/Rh incompatibility that would not have been detected otherwise?

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator