AM25-MN-33-L - Crossmatch Incompatible Transfusions: How Collaboration Between Transfusion Services and Immunohematology Reference Laboratories Enhance Patient Safety

Proposed Session Description: The crossmatch, perhaps the most critical component of pretransfusion testing, serves as the final check of compatibility between a blood donor and recipient. What do you do when you encounter an incompatible crossmatch? Are you always confident to approve an incompatible red cell transfusion? Are your clinical colleagues comfortable transfusing incompatible units? In this session, illustrative cases of incompatible crossmatch red cell transfusions will be presented. The cases will highlight the critical collaboration needed between hospital transfusion services and immunohematology reference laboratories, as well as between the transfusion service and clinical providers in making shared decisions to approve and monitor incompatible transfusions. Etiologies of crossmatch incompatible transfusions and at-risk patient populations (i.e. patients with sickle cell disease) will be reviewed, including monoclonal antibody biotherapies, warm and cold autoantibodies, alloantibodies, and multifactorial causes. Different crossmatch methodologies and techniques (i.e. prewarming, autocontrol) will be presented. The role of partial (i.e., Rh and Kell) and more extensive blood group system matching will also be discussed, including challenges associated with matching for allogeneic bone marrow transplant recipients. Lastly, strategies for explaining incompatible transfusions to clinicians will be described.