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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 138-146

Prevalence of clinically significant antibodies in patients undergoing elective surgery in a Nigerian teaching hospital: A case for the type and screen method


1 Department of Haematology and Blood Transfusion, Federal Medical Centre, Yenogoa, Nigeria
2 Department of Haematology and Immunology, College of Health Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
3 Department of Haematology, Immunology and Blood Transfusion, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria

Date of Submission14-Dec-2017
Date of Acceptance16-Sep-2019
Date of Web Publication7-Feb-2020

Correspondence Address:
Dr. E I Obi
Department of Haematology and Blood Transfusion, Federal Medical Centre, Yenogoa, Bayelsa State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_344_17

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   Abstract 


Background: Provision of safe and adequate blood is challenging in our environment due to paucity of voluntary donors as well as inappropriate blood ordering and utilization. The type and screen (TS) method (typing of blood group and screening for antibodies) reduces the demand for blood reservation in hospital blood banks. Aims: The aim of this study is to determine the safety (detection clinically significant antibodies) and cost effectiveness of the TS method compared to the conventional antiglobulin crossmatch (ACM). Settings and Design and Methods: This was a cross-sectional prospective study carried out at the University of Port Harcourt Teaching Hospital (UPTH). 124 participants booked for elective surgeries with no history of blood transfusion or pregnancy were investigated. ACM was performed on all participants' serum against 159 donor red cells. TS was also performed blindly on the same participants' sera, antibody screening was done with three-screen-cells using the gel method. An 11-cell panel was used for antibody identification. Blood utilization was calculated using the crossmatch: transfusion ratio (CTR), probability of transfusion (%T) and transfusion index (TI). Results: Out of the 159 units crossmatched for 124 study participants, only 19 were actually transfused (88.1% not utilized). The prevalence of compatible ACM was 100%, however the TS detected one antibody (0.81%) in a male participant identified as anti-M. The overall CTR, %T and TI were 8.4, 15.6% and 0.16 respectively, with N384,750 ($963.1) wastage in terms of cost. The TS method would have saved N266,000{$665.9} (N1900{4.78} per un-transfused patient). Conclusions: There was improper utilization of blood in elective surgeries. The TS method identified an antibody not detected by ACM. This would have saved N266,000 {$665.9}, and reduced the demand for blood reservation in the bank. Although The TS method was found not to be significantly different in outcome compared to the ACM, it was found to be cost effective.

Keywords: Antoglobiulin crossmatch, clinically significant antibodies, cost-effectiveness, elective surgeries, type and screen


How to cite this article:
Obi E I, Pughikumo O C, Korubo K I, Ejele A O. Prevalence of clinically significant antibodies in patients undergoing elective surgery in a Nigerian teaching hospital: A case for the type and screen method. Niger J Clin Pract 2020;23:138-46

How to cite this URL:
Obi E I, Pughikumo O C, Korubo K I, Ejele A O. Prevalence of clinically significant antibodies in patients undergoing elective surgery in a Nigerian teaching hospital: A case for the type and screen method. Niger J Clin Pract [serial online] 2020 [cited 2020 Nov 25];23:138-46. Available from: https://www.njcponline.com/text.asp?2020/23/2/138/277863




   Introduction Top


Blood shortage is a major problem for most blood banks and centers in our environment because of a great demand and a poor donation culture. Studies in Nigeria, show a high crossmatch: transfusion ratio (>2.5) in elective surgeries, thus contributing to shortage of blood.[1],[2],[3] Patient blood management strategies focus on preventive measures to reduce or obviate the need for transfusions and ultimately to improve the clinical outcomes. The strategies employed pre and periperatively include optimizing haematopoeisis with haematinic agents, autotransfusion, minimizing bleeding and blood loss with haemostatic agents like antifibrinolytics and surgical techniques. Additionally, changes in practice of surgeons by the adherence to restrictive strategy of blood transfusion (target haematocrit ≥24%) as opposed to liberal blood transfusion (target haematocrit ≥30%) may play a role in patient blood management.[4] Optimum blood use may also be achieved by the use of a maximum surgical blood ordering schedule (MSBOS), which determines the maximum number of units to be crossmatched for each surgical procedure, and which would require a type and screen method.

The Type and screen (TS) method is the testing of a patient for ABO, Rh 'D' blood groups and the presence of clinically significant antibodies (antibody screening test). If the antibody screen is negative, blood is neither crossmatched nor reserved. In the case of a positive antibody screen, the causative antibody is identified and an antiglobulin crossmatch using a blood unit free of the relevant antigen is done.[5]

Pre-transfusion compatibility testing (PCT) is a series of procedures done to prevent the transfusion of incompatible donor red cells that might result in an immune-mediated hemolytic transfusion reaction in the recipient.[1] The major cross-match, which is sometimes used as a synonym for compatibility testing, is just one of the components of the PCT. The procedures that constitute PCT are: Positive identification of patient and patients' blood sample; Review of patients' past blood bank history and records; ABO and Rh D typing of both patient and donor; Screening of the patients' serum or plasma for irregular antibodies; Major serologic crossmatch between the donor red cells and the patients' serum or a computer crossmatch; and Labeling of the compatible unit with the patients' information.[2]

In our environment, pretransfusion compatibility testing includes a major crossmatch without an antibody screen test and the compatible donor unit is reserved. These units may not be utilized eventually leading to wastage of blood bank resources, overburdening of blood bank personnel, incurring extra cost on the patient and ultimately the unavailability of blood units to other patients in need. The implementation of the TS policy has been shown to reduce the crossmatch: transfusion ratio (CTR) without compromising safety.[6],[7],[8]

The study aims to determine if the type and screen method is a safe (detection of clinically significant antibodies) and cost-effective method for pretransfusion compatibility testing compared to the conventional antiglobulin crossmatch in elective surgical patients.

Specific objectives

  1. To compare the cost-effectiveness of the antiglobulin crossmatch procedure to the type and screen test at the UPTH, Port Harcourt.
  2. To determine the prevalence of incompatible crossmatchat the UPTH, Port Harcourt.
  3. To determine the prevalence of clinically significant antibodies in patients undergoing elective surgeries at the UPTH, Port Harcourt.
  4. To determine the crossmatch transfusion ratio in these patients.


There is thus a need to validate these findings and substantiate the efficacy of the TS method in our environment with the view of recommending the implementation of the TS test policy.


   Methods Top


This was a hospital-based cross-sectional study conducted at the University of Port Harcourt Teaching Hospital, (UPTH), Port Harcourt. Ethical approval was obtained from the UPTH ethics committee, informed consent was also received from the patients recruited for the study. The study participants were patients scheduled for elective surgeries from the different surgical departments including Obstetrics and Gynaecology. Participants were given a questionnaire to obtain transfusion history.

Inclusion criteria

All patients booked for elective surgical procedures for which blood was ordered and without a history of previous blood transfusion or pregnancy.

Specimen collection and analysis

Five milliliters (5 ml) of venous blood was collected from each subject, 3 ml of which was dispensed into an EDTA Vacutainer® sample bottle for ABO and RhD blood grouping and; 2 ml into a plain Vacutainer® sample bottle for ABO blood grouping (reverse), a major cross-match, detection of irregular antibodies and antibody identification (if required). The clotted blood samples were centrifuged at 1500 rpm for two minutes and 1 ml was dispensed into a test tube for the major crossmatch and reverse blood grouping while the remaining was stored at -30°C and analyzed weekly.

ABO and RhD blood group phenotype

5% red cell suspension were made and anti-sera of the corresponding antigens were added (Anti-A, Anti-B, Anti-D) using the standard tube method.[5] Reverse grouping was done using A1 and B cells. The results were read macroscopically and microscopically.

Antibody detection

The sera were tested against 3 individual group O reagent screening cells using the gel technology by Diamed®. This is based on the principle of differential passage of agglutinated and free red cells through a gel microtube column. This procedure was done blindly, without knowing the result of the pretransfusion compatibility test. The patient's serum was mixed with the reagent red cells, incubated on top of a dextran gel containing antiglobulin/LISS reagent and then centrifuged. In a negative reaction, all cells collect at the bottom of the tube, whereas in a positive reaction, the red cells are trapped in the gel as shown in [Figure 1].[9]
Figure 1: Antibody screening using the gel card. Source: adapted from ID gel testing. http://us-pdfdownload.rhcloud.com/read-document/ id-gel-antibody-screening/; [cited 2015 5th January]

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Red cell antibody identification

One of the samples that tested positive during the antibody screening was tested using an 11-cell antibody identification panel to determine the specific antibody using the gel technology by Diamed®.[10]

Major cross-match

The sera were tested against each donor red cells using the tube method.[9]

Blood utilization indices were computed using the following equation.[11]

a.



A ratio of 2.5 and below is considered indicative of optimum blood usage.

b.



A value of 30% and above was considered indicative of significant blood usage.

c.



Value of 0.5 or more was considered indicative of significant blood usage.

d. Maximal surgical blood order schedule (MSBOS) =1.5 × TI

Statistical analysis

The statistical package, Statistical Package for Social Sciences software (SPSS) version 20 was used for data entry. Consistent and logical checks were introduced to the entry module of the package to ensure reliability of the data entry. All discordant entries were checked against the original data collection instrument and corrected. Initial data exploration was done by producing the frequency distribution of all the variables entered.

Appropriate statistical tools were summarized by using mean, median, standard deviation, frequencies and proportion. A P value of <0.05 was taken as statistically significant.


   Results Top


A total of 124 patients, 65 (52.4%) males and 59 (47.6%) females, participated in the study. Their ages ranged between 2 weeks and 48 years and with a mean of 24 ± 15 years. The participants underwent 15 different elective surgical procedures in various departments. Out of the 124 subjects, there were 43 (34.50%) in obstetrics and gynaecology (O and G), 31 (25.10%) in general surgery, 28 (22.60%) in orthopedics and 22 (17.80%) in Ear nose and throat (ENT). the distribution of patients across departments is shown in [Figure 2].
Figure 2: Distribution of elective surgical patients

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The most frequently performed procedures were myomectomy in Obstetrics and Gynaecology, open reduction and internal fixation (ORIF) in Orthopaedics, and tonsillectomy in Ear, Nose and Throat (ENT) department as shown in [Table 1].
Table 1: Blood utilization indices for the various units of surgery in this study

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Blood group O Rh D positive has the highest frequency among the study population while blood group O Rh D negative has the lowest frequency as shown in [Figure 3].
Figure 3: Blood group distribution among study population

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[Table 2] shows the rate of utilization of blood. A total of 159 units of blood were cross-matched and reserved for these patients, but only 19 units were eventually transfused to 19 patients i.e. only 11.9% of the blood was utilized leaving 88.1% un-utilized and this value was statistically significant (P < 0.005). The surgeons requested a total of 159 blood units preoperatively for 124 study participants. Majority of the surgical teams requested for one unit of blood per patient as shown in [Figure 4]. [Figure 5] shows that antiglobulin crossmatch was done on all 159 units of blood as requested by the Surgeons. It was observed that 69.8% were group specific compared to 30.2% that were group compatible as shown in [Figure 5]. Cross-matching was done mostly for one unit of blood as requested. All the 124 patients' sera were compatible with the donor units provided. However, the type and screen method done blindly for all 124 samples showed the presence of clinically significant antibodies in one of the patients, giving a prevalence of 0.81% and the antibody was identified as anti-M. [Table 3] shows the total cost of routine antiglobulin test per unit of blood was N2850 ($7.13) compared to N3850 ($9.63) for the TS method.
Table 2: Distribution blood group of study participants versus their crossmatched units

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Figure 4: Blood unit request

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Figure 5: Pattern of crossmatch in study subjects

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Table 3: Comparison of the cost of procuring a unit of blood using the type and screen method and the conventional antiglobulin crossmatch procedure

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The cost of cross-matching all 159 units was N438,900 ($1098.01) while the cost for cross-matching 19 units of blood that were actually transfused was N54,150 ($135.38) as shown in [Table 4].
Table 4: Total cost of both transfused and non-transfused crossmatched blood units for study participants

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All 159 units of blood were cross-matched and reserved for these patients. Only 19 units were actually transfused to 19 patients i.e. only 11.9% of the blood was transfused leaving 88.1% un-utilized and this value was statistically significant (P = 0.005). The overall crossmatch: transfusion ratio (CTR) was 8.4, but there was a considerable variation in the CTR depending on the type of surgery performed ranging from 2.5 to 17. The departments of Obstetrics and Gynaecology and Orthopaedic surgery ordered for and transfused the highest number of blood units. No blood was transfused in Paediatric surgery and Neurosurgery. The transfusion probability and transfusion index were 15.3% and 0.16 respectively for the total study population. Urology had a transfusion probability of 80%.


   Discussion Top


Blood is a precious commodity and its proper utilization is the key for efficient management of blood bank resources. A careful assessment of the risks and benefits of allogeneic transfusion is essential for a better patient management.

The prevalence of clinical alloantibodies in our study was 0.81%, which is in agreement with a study by Gharehbaghian et al.[12] that reported a prevalence of 0.97%. This finding is also similar to a study in India,[7] 0.76%, and Iran[13] 1%.

The TS method identified a circulating antibody that was undetected by routine crossmatch. This anti-M antibody was identified in a male participant. This is similar to the finding of Mathur et al.[14] Anti M is usually a naturally occurring antibody but may occur as an immune antibody, and only rarely has been implicated as a cause of immediate and delayed hemolytic transfusion reactions or hemolytic disease of the newborn.[15],[16] Immune antibodies usually occur after stimulation from pregnancy, transfusion or organ transplant,[12] and patients with these exposures were excluded from this study.

The positive antibody screen in this patient could be due to a high titer of anti M that reacts strongly at room temperature and causes haemagglutination to carry through 37°C in the antiglobulin test phase. It may also represent a small percentage of anti M that are of the immunizing type and this stimulation would probably be as a result of exposure to drugs or infections.[17] Though compatible blood was provided for this patient using the antiglobulin crossmatch technique, it may be because of the low expression of the M antigen in the West African populace. It has been reported that only 2% of West Africans express the M antigen.[18]

The essence of the crossmatch is to confirm the ABO blood grouping and identify unexpected antibodies. In this study, there was 100% compatible crossmatch. This may be due to the high percentage of group specific blood, compared to group compatible blood. Some authors have reported the sensitivity of the crossmatch to be between 91.6% and 99.9%.[18],[19],[20]

Comparatively, Boral et al.[21] showed that the TS was also 91.6-99.9% effective in preventing the transfusion of serologically incompatible blood in selected surgical patients. Other reports have shown that the antiglobulin phase of the crossmatch could be omitted from the pretransfusion testing without putting patients at risk.[19],[20],[21],[22]

The 12th edition of the American Association of Blood Banks (AABB) standards advocates the use of the TS procedure especially for preoperative patients, when blood transfusion is unlikely and expanded the use of “immediate spin” crossmatch in patients who do not have a current or past history of clinically significant antibody.[23]

The type and screen method (TS) was found not to be significantly different in outcome compared to the conventional antiglobulin crossmatch technique; however, the TS method was able to detect a circulating antibody in one of the study participants which would have been missed otherwise with the conventional antiglobulin cross-match. The prevalence of alloantibodies in these study participants who underwent elective surgeries was found to be 0.81% which was in concordance with a study done by Gharehbaghian that showed a prevalence of 0.97.[12] This finding is also similar to a study done in India which showed a prevalence of 0.75,[7] but slightly lower than a study done in Iran which showed a prevalence of 1%.[13] This might be due to a difference in selection criteria of study participants.

The sensitivity of the crossmatch could not be assessed in this study as there were no incompatible crossmatch observed. However, some authors have reported a sensitivity of 91.6-99.9%.[7],[8],[22]

The essence of the crossmatch is to confirm the ABO blood grouping and identify any unexpected antibody. In this study, there was 100% compatible crossmatch. This may be due to the high percentage of group specific blood, compared to group compatible. Also it is in concordance with findings in the literature that says that the presence of immune antibodies are usually after stimulation from pregnancy, transfusion or organ transplant, and patients with these exposure were excluded from this study.[12] It was observed that group specificity was largely due to the high frequency of blood group O in both the donor and recipient and this is similar to other studies that have reported that the distribution of blood group amongst a particular population can have an influence on blood donation.[12],[15],[24]

In this study, the TS method identified a circulating antibody. This anti-M antibody was identified in a male participant. This is similar to the finding of Mathur A et al.[14] Anti M is a naturally occurring antibody but may occur as an immune antibody, and only rarely has been implicated as a cause of immediate and delayed hemolytic transfusion reactions or hemolytic disease of the newborn.[15],[16] The positive antibody screen in this patient could be due to the high titer of anti M that reacts strongly at room temperature and causes haemagglutination to carry through 37°C and the antiglobulin test phase. It might also be that this represents a small percentage of anti M that are of the immunizing type and this stimulation would probably be as a result of exposure to drugs or infections.[17] Though compatible blood was provided for the study participant with ease, using the antiglobulin crossmatch technique, it may be because of the low expression of the M antigen in the West African populace. It has been reported that only 2% of West Africans express the said antigen.[18]

Our study revealed that 88.1% of the blood units ordered and crossmatched were not transfused. This is similar to a report from Nepal where 86.4% of blood units ordered and crossmatched were not transfused.[9] A study in Ilorin, North Central, Nigeria reported less wastage as 69.4% of blood units were not transfused.[2] The difference may be due to better blood ordering practice. The blood utilization indices also confirmed a practice of blood wastage. Our study revealed an overall crossmatch-transfusion ratio (CTR) of 8.4, but for individual surgeries, the CTR ranged from 2.5 to17. The high CTR observed in almost all the elective surgical procedures in this study [Table 1] was comparable to existing literature.[25],[26],[27],[28],[29] This suggests that for most surgeons, blood ordering is simply a culture in preparation for any unexpected eventuality.[12] The department of Obstetrics and Gynaecology had the highest number of cross-match, which is similar to what was reported by Beylayneh et al. in Ethiopia.[12] Subramanian et al.[12] observed a crossmatch transfusion ratio >2.5 in most orthopaedic surgeries that require internal fixation as observed in the present study. Surgical procedures in ENT showed an overall ratio of 7.3 which also indicates the culture of over-ordering blood. This was reported by Olawummi et al. in Ilorin,[2] who found that none of the blood units requested were transfused. Similarly, another study in Lagos, South West, Nigeria showed an overall CTR of 10 in cleft palate surgery.[25]

The other indices of transfusion calculated in this study [Table 5] were also indicative of inefficient blood usage as the transfusion index (TI) was 0.16 (target is 0.5) and the probability of transfusion (%T) was less than 30% (target ≥30%). This is similar to the findings in an Indian Tertiary care hospital[21] where %T ranged from 11% to 25%. In our study, Paediatric surgery and Neurosurgery departments did not transfuse any of their patients. This is suggestive of a very low probability of blood transfusion. This was also observed by Linsler et al.[14]
Table 5: Blood Utilization indices for the various units of surgery in this study

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These observations show that ordering blood is a routine for most surgeons. Estimating the MSBOS for some of the surgical procedures in this study [Table 6] showed that if the hospital were using the MSBOS, only urological surgical procedure would have required grouping and crossmatching of blood.
Table 6: Maximum surgical blood ordering schedule (MSBOS) for the most elective surgical procedures

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The impact of cost containment is of paramount importance in our environment where individual patients are fully responsible for any blood crossmatched and there is no refund for any unit not transfused. All patients paid the sum of N2850 for each unit of blood crossmatched and only 11.9% was utilized leading to N384,750 ($963.1) wastage within the study period (however, the cost of TS method would have been N1900{4.78). In terms of cost, this further shows the high degree of wastage as is widely reported in other studies.[30],[31] Conversely, if the type and screen method was used a total of N266,000{$665.9} would have been saved, because even though blood grouping and antibody screening will be done for all 124 study participants, only 19 of the study participants would have paid for the cost of procuring a unit of blood (at N3850 when typed, screened and crossmatched). Many studies have shown that the implementation of MSBOS and the introduction of TS procedure have led to a safe, effective and economic solution to ordering blood.[11],[32] A study in Iran showed a decrease in the CTR after the implementation of TS method and an increase in transfusion index after the implementation of the type and screen policy.[33]

The TS offers several advantages over the conventional antiglobulin crossmatch as it allows optimal use of donor blood, because it is not tied up by being crossmatched and held for patients who probably will not need it in the majority of cases, as seen in this study (88.1%). It also has potential for a more economic transfusion service due to blood inventory requirements, decreased reagents used for carrying out unnecessary crossmatch or re-crossmatch, and more efficient use of the blood bank staff time. The type and screen method shortens the turnaround time for providing blood unit as patients' antibody status is already known before they go in for surgery, therefore in the event of blood transfusion requirement for those that have antibody negative screen, an immediate spin crossmatch to check for ABO incompatibility is done and this takes about 10-15 minutes as opposed to the conventional crossmatch that takes at least 30 minutes to one hour.[34] In cases where the antibody screen is positive, the offending antibody is identified and blood unit free of the corresponding red cell antigen is provided.[5]

Only 4 (5.1%) of the adult study participants had a haematocrit less than 30%, of which only one received blood transfusion, and this might be because of the surgical technique employed by the surgeons to limit blood loss. This further shows that if other blood conservation methods are put in use, the need for blood transfusion may be reduced.


   Conclusions Top


There was improper utilization of blood in elective surgeries. The type and screen method identified an antibody not detected by the antiglobulin crossmatch method. This would have saved N266,000 {$665.9}, and reduced the demand for blood reservation in the bank. Although The TS method was found not to be significantly different in outcome compared to the ACM, it was found to be cost effective.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Downes KA, Shulman IA. Pretransfusion testing. In: Roback JD, Combs MR, Grossman BJ, Hillyer CD, editors. Technical Manual. 16th ed. United States: American Association of Blood Banks; 2008. p. 437-60.  Back to cited text no. 1
    
2.
Rowley M, Cantwell C, Milkins C. Laboratory aspects of blood transfusion. In: Bain BJ, Bates I, Laffan MA, Lewis SM, (editors). Dacie and Lewis Practical Haematology. Eleventh ed. UK:Elsevier; 2011. p. 522-45.  Back to cited text no. 2
    
3.
Malhotra S, Kaur G, Singh L, Basu S, Lehl SS. Delayed haemolytic reaction due to anti Jka alloimmunization. IJBTI 2011;1:16-9.  Back to cited text no. 3
    
4.
Shander A, Javidroozi M, Perelman S, Puzio T, Lobel G. From bloodless surgery to patient blood management. Mt Sinai J Med 2012;79:56-65.  Back to cited text no. 4
    
5.
Sandler SG, Abedallthagafi MM. Immunohematology. J Blood Group Serol Educ 2009;25:147-51.  Back to cited text no. 5
    
6.
Contreras M, Daniels G. Red cell immunohaematology: introduction. In: Hoffbrand AV, Catovsky D, Tuddenham EGD, Green AR, (editors). Postgraduate Haematology. sixth ed. UK: Wiley- Blackwell; 2011. p. 230-42.  Back to cited text no. 6
    
7.
Transfusion-Related-Activities. Standards for Blood Banks and Transfusion Services. 28th ed. Bethseda, Maryland, United States of America: AABB; 2012. p. 32-55.  Back to cited text no. 7
    
8.
Chapman JF, Elliot C, Knowles SM, Milkins CE, Poole GD. Guidelines for compatibility procedures in blood transfusion laboratories. Transfus Med 2004;14:59-73.  Back to cited text no. 8
    
9.
Klein HG, Anstee DJ. Blood Grouping techniques. Mollison's Blood Transfusion in Clinical Medicine. 11th ed. UK: Blackwell; 2005. p. 299-342.  Back to cited text no. 9
    
10.
Roxby D. Current concepts in pre-transfusion serological compatibility testing. ISBT Sci Ser 2011;6:265-9.  Back to cited text no. 10
    
11.
Belayneh T, Messele G, Abdissa Z, Tegene B. Blood requisition and utilization practice in surgical patients at University of Gondar ospital, Northwest Ethiopia. Journal of Blood Transfusion 2013. Available from: http://dx.doi.org/10.1155/2013/758910. [Last cited on 2017 Jan 04].  Back to cited text no. 11
    
12.
Gharehbaghian A, Ghezelbash B, Aghazade S, Hojjati MT. Evaluation of alloimmunization rate and neccessity of blood type and screening test among patients candidate for elective surgeries. Int J Hematol Oncol Stem Cell Res 2014;8:1-4.  Back to cited text no. 12
    
13.
Reyhaneh K, Gharehbaghian A, Gharib K, Vida V, Raheleh K, Mehdi TN. Frequency and specificity of RBC alloantibodies in patients due for surgery in Iran. Indian J Med Res 2013;138:252-6.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Mathur A, Dontula S, Jagannathan L. An unusual case of a potentially clinically significant anti-M antibody in a healthy blood donor without any history of blood transfusion. Blood Transfus 2011;9:339.  Back to cited text no. 14
    
15.
Sancho JM, Pujol M, Fenandez F, Soler M, Manzano P, Felio E. Delayed haemolytic transfusion reaction due to anti-M antibody. Br J Haematol 1998:103:268-9.  Back to cited text no. 15
    
16.
Duguid JK, Bromilow IM, Entwistle GD, Wilkinson R. Haemolytic disease of the newborn due to anti-M. Vox Sanguinis 1995;68:195-6.  Back to cited text no. 16
    
17.
Tondon R, Kataria Rahul, Chaudhary R. Anti-M: Report of two cases. Asian J Transfus Sci 2008;2:81-3.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Contreras M, Daniels G. Antigens in human blood. In: Hoffbrand AV, Catovsky D, Tuddenham EGD, Green AR, editors. Postgraduate Haematology. 6th ed. UK: Wiley-Blackwell; 2011. p. 244-67.  Back to cited text no. 18
    
19.
Chaudhary R, Agarwal N. Safety of type and screen method compared to conventional antiglobulin crossmatch for compatibility testing in Indian setting. Asian J Transfus Sci 2011;5:157-9.  Back to cited text no. 19
[PUBMED]  [Full text]  
20.
Pathak S, Chandrashekhar M, Wankhede GR. Type and screen policy in the blood bank: Is AHG cross-match still required? A study at a multispecialty corporate hospital in India. Asian J Transfus Sci 2011;5:153-6.  Back to cited text no. 20
[PUBMED]  [Full text]  
21.
Boral H, Haines A, Sullivan M. The Type and screen: A safe alternative and supplement in selected surgical procedures. Transfusion 1977;17:163-8.  Back to cited text no. 21
    
22.
Chow EYD. The impact of the type and screen test policy on hospital transfusion practice. HKMJ 1999;5:275-9.  Back to cited text no. 22
    
23.
Butch SH, Oberman HA. The computer or Electronic crossmatch. Transfus Med Rev 1997;11:256-64.  Back to cited text no. 23
    
24.
Nwauche CA, Eneh AU, Pughikumo CO. ABO and Rhesus blood groups and their newborns in Port Harcourt. Port Harcourt medical journal. 2012;6:455-9.  Back to cited text no. 24
    
25.
Adeyemo WL, Ogunlewe MO, Desalu I, Ladeinde AL, Adeyemo TA, Mofikoya BO. Frequency of homologous blood transfusion in patients undergoing cleft lip and palate surgery. Indian journal of plastic surgery 2010;43:54-9.  Back to cited text no. 25
    
26.
Akinola IO, Fabamwo AO, Tayo AO, Rabiu KA, Oshodi YA, Onyekwere CA. Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria. BMC Pregnancy Childbirth 2010;10:57.  Back to cited text no. 26
    
27.
Mann K. SI, Ali T, Chong P, Leopold P, Hatrick A et al. Removing the need for crossmatched blood in elective EVAR. Eur J Vasc Endovasc Surg. 2012;43:282-5. Epub 2011 Dec 17.  Back to cited text no. 27
    
28.
Balayneh T, Messele G, Abdissa Z, Tegene B. Blood requisition and utilization practice in surgical patients at university of Gondar hospital, Northwest Ethiopia. Jounal of blood transfusion. 2013. doi:10.1155/2013/758910.  Back to cited text no. 28
    
29.
Enosolease ME, Imarengiaye CO. Blood shortage situation: An audit of red blood cells order and pattern of utilization. African Journal of Biotechnology. 2009;8:5922-5.  Back to cited text no. 29
    
30.
Ayatunde AA, Ng MY, Pal SL, Welch NT, Parsons SL. Analysis of blood transfusion predictors in patients undergoing elective oesophagiectomy for cancer. BMC surg. 2008;8:3.  Back to cited text no. 30
    
31.
Muizuiddin M, Jawaid M, Alam SM, Soomro S, Manzar S. Utilisation of blood in elective surgeries. Pak J Med Sci. 2007;23:331-3.  Back to cited text no. 31
    
32.
Mujeeb SA. An audit of blood crossmatch ordering practices at the Aga Khan University Hospital: first step towards a maimum surgical blood ordering schedule (MSBOS). Jounal of the Pakistan Medical Association. 2001;51:379-80.  Back to cited text no. 32
    
33.
Moghaddam MA, Bardeh M, Alimhammadi H, Emami H, Zijoud SMH. Blood transfusion practice before and after implementation of Type and Screen protocol in emergency department of a University affiliated hospital Emergency medicine international. 2014. doi:10.1155/2014/316463.  Back to cited text no. 33
    
34.
Oberman HA. The present and future crossmatch. Transfusion. 1992;32:794-6.  Back to cited text no. 34
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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