Examine the list of blood or plasma products listed in the table below. Indicate in your answer, whether cross match is essential with the use of each of these products.

Product

Need for cross match

Cryo precipitate

 

Fresh frozen plasma

 

Granulocyte concentrate

 

Intravenous immunoglobulin

 

Packed red blood cells

 

Platelets

 

Prothrombin concentrate

 

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College Answer

Product

Need for cross match

Cryo precipitate

No

Fresh frozen plasma

No

Granulocyte concentrate

Yes

Intravenous immunoglobulin

No

Packed red blood cells

Yes

Platelets

No

Prothrombin concentrate

No

Discussion

According to the college answer, only the red cells and granulocytes need crossmatching - the other blood products can apparently be given willy-nilly. This makes some sense in the context of the physiology of transfusion reactions; only RBCs and granulocytes are likely to have the relevant antigens on their surface. This refers to crossmatching specifically, where the compatibility between the patient and the donor product is tested by mixing samples to detect ABO incompatibility. The contrast between this and the "group and screen" is that the group and screen merely tests for blood group and screens for antibodies, whereas the crossmatch mixes samples to confirm compatibility and then the compatible PRBC bags are put aside for that specific patient.

As far as grouping and screening goes, the Australian Red Cross Blood Service also recommend that "where possible, patients should receive ABO-identical blood products". The main reason for this is not a lifethreatening transfusion reaction, but rather the immediate and frustrating destruction of the transfused platelets (for example). Additionally, though uncrossmatched plasma and plasma components are generally held to be safe, the ARCBS also recommends they be ABO group-compatible, because the transfused plasma may occasionally contain some antibodies to the recipient's native RBCs. The amount of antibodies transfused in this way will be very small, and the reaction will be on a smaller scale, but it is still an avoidable source of morbidity.

The ANZBT Guidelines for Pretransfusion Laboratory Practice reflect these issues, suggesting that for plasma transfusion a pretransfusion crossmatch is not required, but that products should ideally be compatible with the ABO group of the recipient's red cells. Additionally, they support the recommendation for the use of ABO-compatible platelets.

Thus, when amended with these recommendations, the college answer would look like this:

Product

Need for cross match

Need for group and antibody screen

Cryo precipitate

No

Yes, ABO ideally

Fresh frozen plasma

No

Yes, ABO ideally

Granulocyte concentrate

Yes

Yes, always - ABO and RhD

Intravenous immunoglobulin

No

No

Packed red blood cells

Yes

Yes, always - ABO and RhD

Platelets

No

Yes, ABO ideally

Prothrombin concentrate

No

No

References

References

Australian Red Cross Blood Service: Blood Group Compatibility

Australian & New Zealand Society of Blood Transfusion Ltd Guidelines for Pretransfusion Laboratory Practice (5th ed, March 2007)