In an emergency, therefore, it is possible to use
however, one can get into difficulty by transfusing blood
which shows a minor incompatibility as given below.
High titer of donor antibodies: If the titer (amount)
of antibodies in the donor blood is very high, then even
if there is dilution of the donor’s plasma in the patient’s
plasma, the antibodies may still be present in significant
numbers to cause agglutination, hemolysis and result in a
reaction. O donors with high titer are said to be dangerous
Method of Cross-matching Universal Donor Blood
1. Do major cross-match as described (Fig. 11.7).
2. Make a 1:100 dilution of donor serum in saline.
3. Use this diluted serum for a minor cross-match.
4. If there is no agglutination on minor side using the
1:100 diluted serum, then this a low titer (< 1:100)
plasma and can safely be transfused as long as too
many bottles of such blood are not needed.
5. If there is agglutination on the minor side, it means that
this is high titer (> 1:100) plasma and should better not
be used especially if more than one unit is required (for
AB patient, it is possible to use A, B, or O donor blood.
Whichever is given, it should be cross matched in this
Factors Leading to False Results
If Still an Unexpected Incompatibility is Obtained
1. Test for autoagglutination.
3. Regroup the patient and donor cells.
4. Back-type (serum type) the patient and donor serum.
5. Repeat the cross-match by tube technique.
6. Check the records to see if patient’s present grouping
7. Ask for a fresh patient specimen, if necessary.
Choice of Material for Transfusion
1. Shock due to hemorrhage or decreased blood volume:
Whole blood fresh, stored or preserved.
2. Shock resulting from trauma, burns, or infection:
Plasma liquid, frozen or dried; plasma substitutes.
3. Chronic anemia: Whole blood or resuspended red
4. Leukopenia: Large amounts of fresh whole blood.
5. Prothrombin factor deficiency not corrected by
6. Hemophilia: Factor VIII (AHF) cryoprecipitate
concentrate. Factor IX complex concentrate. Whole
blood or plasma administered within 6 hours of
7. Thrombocytopenia: Platelet transfusion with fresh
Whole blood: In most instances whole blood is
requisitioned by the concerned physician/surgeon, except
in certain circumstances when a special preparation may
Stored bank blood contains nearly all of the substances
required in a usual transfusion therapy. A few labile
1. Platelets: These stick to the rubber and glass surfaces
and also die soon or become non-functional. If
platelets are needed, fresh blood is necessary.
2. WBC’s: These die fairly rapidly. On occasions, where
the patient is suffering from severe leukopenia with
infection, a transfusion of fresh blood provides viable
leukocytes which help to fight the infection but which
3. Factor VIII: Anti-hemophilic globulin. Patients with
hemophilia should be transfused with fresh blood if
they need transfusion to help stop bleeding, since AHG
disappears rapidly from stored blood.
4. Other labile factors: Can be provided by giving frozen
Sedimented cells: The bottle kept in the refrigerator shows
at bottom settled cells and above it the plasma. In chronic
anemia one may want to transfuse just the packed cells.
This can be prepared by aspirating the plasma into a
separate sterile bottle, leaving the cells in original bottle.
FIG. 11.7: Method of cross-matching universal donor blood
Blood Banking (Immunohematology) 371
Label the plasma bottle with the date, the bottle number
and the group and type of the blood from which it is
obtained, aspirate a small amount of plasma into a ‘pilot’
The packed cells should be transfused within 4 hours.
Aspirate plasma only when someone comes to collect
it, this ensures that the packed cells would be used
The ACD plasma aspirated from the sedimented cells may
be stored for months at 4–6°C and is safe for transfusion.
If the plasma becomes cloudy or shows floating granules
(bacterial colonies)__suck little bit of it from the top, do a
hanging drop and Gram stain of the same—discard if it
is found contaminated. Minor cross-matching should be
done with the patient’s red cells and the donor’s plasma.
1. Liquid plasma: It should contain 5% dextrose to
prevent precipitation of fibrin at room temperature.
The prothrombin titer diminishes rapidly after 72
hours. Liquid plasma may be kept at room temperature
for 3 years. Hepatitis virus is attenuated or destroyed
in plasma that has remained at room temperature for
2. Frozen plasma: Plasma frozen within 72 hours after
blood is drawn may be stored indefinitely at –20oC
(–4oF). Reliquefy at 37oC (98.6oF) in a water bath and
use promptly. Frozen plasma retains its full content
of labile constituents (prothrombin, complement,
antibodies). Hepatitis virus is also preserved, frozen
plasma should therefore not be used unless no other
substitute for blood is available.
3. Dried plasma: Plasma dried after freezing within
72 hours after blood is drawn is stable at room
temperature for 5 years if kept in an airtight container.
Reliquefy with 0.1% solution of citric acid and
administer within 1 hour. Dried plasma retains its
full content of labile constituents. Hepatitis virus is
Blood Transfusion Complications
2. Reactions due to infected blood.
3. Allergic reactions to white cells, platelets or proteins.
4. Pyrogenic reactions (febrile reactions)
• Pyrogens may come from the bottle, tubing,
or the blood itself. Precaution should be taken
that equipment, solutions, etc. used should be
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