In-vivo Crossmatch

[Malcolm Needs]

No one wants to work with a tired, cranky pathologist!

Donna

Oh, but Donna, so many of us do!!!!!!!!!!!!!!!

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[L106]

Sorry, Malcolm! (Into every life, a little rain must fall....)

Donna

[Malcolm Needs]

Sorry, Malcolm! (Into every life, a little rain must fall....)

Donna

True, true, but until now I never realised that England was a monsoon area!

Must be the Global Warming!!!!!!!!!!!!!!!!!

[Liz]

The hospital system I work for here in the states use this procedure regularly. We use it primarily for patients with Warm Auto's where the xm was performed with phenotypically matche units that were serologically incompatible with neat plasma and least incompatilbe with adsorbed plasma. We draw a pre-transfusion plasma hemoglobin, give a test dose of washed prbc's and draw a post plasma hemoglobin 10 min later. If there is no significant change in plasma hgb levels, the entire washed unit is transfused.

From the stone ages,
James

This is good to know, thank you James from the stone ages!
I like your humor too!!
This is Liz from the Dark ages

[Liz]

Hey, fellows....I didn't mean to imply that anyone who uses the "in vivo" crossmatch was from the stone ages.....I just personally haven't talked to anyone who has used it for many years.

The procedure may seem "barbaric" to some of you, but as I said, it's usually a "last-ditch effort". It's not that the "in vivo" crossmatch is taking the place of other testing. Rather, (as far as I know) it is used as an additional procedure after all available testing has been done and there is nothing more that can be done to procure compatible.

(If it helps your pathologist sleep better at night, so be it. No one wants to work with a tired, cranky pathologist!)

Donna

Hi Donna,

It was just some comic relief. I did appreciate and I do believe that it is a last ditch effort that we do to make sure that no immediate TR will occur; when I request it, I am very sure that I have done the maximum and in 14 years I only had one immediate reaction and the unit was stopped. It may have been cytokines there was no hemolysis. Frankly I feel safer and I sleep better J

Liz

[L106]

See......besides pathologists, we also enjoy working with Blood Bankers who are well-resting and not cranky!

By the way, Liz, I thoroughly enjoyed your post in a different thread when you described your facility (and some of the challenges that are involved.) It was very interesting. Thanks!

Donna

[rravkin@aol.com]

Oh my goodness, I do feel awfully embarrassed. However quoting the AABB Technical Manual:

Copyright © 2008 by the AABB. All rights reserved.

CHAPTER 20

Hemotherapy Decisions and Their Outcomes 579

"Other situations in which all units appear
incompatible include the presence of alloanti-
bodies to high-prevalence antigens, to multi-
ple antibody specificities, or both. If serologic
testing fails to resolve the problem or if the
problem is identified but time is not sufficient
for acquisition of compatible units, consulta-
tion between the transfusion service medical
director and the patient’s clinician is advised
to weigh the risks and benefits of transfusion
and to consider what alternative therapies are
suitable. If the need is sufficiently urgent,
ABO-compatible but crossmatch-incompati-
ble red cells may have to be given. Depending
on the alloantibody’s specificity (or the possi-
ble specificities that have not been ruled out),
incompatible transfusion does not always
result in immediate hemolysis, and the in-
compatible cells may remain in the patient’s
circulation long enough to provide therapeu-
tic benefit.
If time permits and if equipment is avail-
able, the survival of a radiolabeled aliquot of
the incompatible cells can be determined, but
that determination is beyond the capability of
most laboratories and is rarely needed. An
“in-vivo crossmatch” can be performed by
cautiously transfusing 25 to 50 mL of the
incompatible cells, by watching the patient’s

clinical response, and by checking a 30-
minute posttransfusion specimen for hemo-
globin-tinged serum. Such assessment does
not guarantee normal survival but can indi-
cate whether an acute reaction will occur. If
no adverse symptoms or hemolysis are ob-
served, the remainder of the unit can be
transfused slowly with careful clinical moni-
toring. If the transfusion need is life-threaten-
ing, RBC units may sometimes be given
without special testing, but the clinical staff
should be prepared to treat any reaction that

may result."

So since it is the AABB and recent I may add, what are your opinions on this???
Blush Blush !!!
Liz :-D

Thank you Liz for this info. I always learn something new here and I greatly appreciate it. This procedure is probably used in extreme rare cases do to the litigation potential.

[Liz]

See......besides pathologists, we also enjoy working with Blood Bankers who are well-resting and not cranky!

By the way, Liz, I thoroughly enjoyed your post in a different thread when you described your facility (and some of the challenges that are involved.) It was very interesting. Thanks!

Donna

Hi Donna,

I really appreciate what you wrote. Life here becomes routine and a habit, and I never once thought about the challenges that we overcome daily. Thank you!!! That was nice to know, I feel good about our work now..

Cheers
Liz

[Liz]

Thank you Liz for this info. I always learn something new here and I greatly appreciate it. This procedure is probably used in extreme rare cases do to the litigation potential.

Absolutely, only in extreme cases, as rarely will I and any attending physician agree to this.
Thank you for your kind words

Liz

[jeanne.wall]

Liz

The technique has been around forever and I'd say a fair number of folks still have the procedure in their procedure manual. I think it has more to do with providing comfort to the pathologists and physicians. Those folks want to make sure you can say "compatible" to something. My approach would be to not bother with the "in vivo" crossmatch if I can say compatible to something. I use to just note compatible with absorbed plasma, or whatever. As you have seen from the comments most folks don't think the technique is going to offer much benefit, but if it is needed to assist in comfort levels because you can't use the word "compatible" with something, I'd use it and be done with it.

Jeanne