Type and screen policy in the blood bank: Is AHG cross-match still required? A study at a multispecialty corporate hospital in India

Background: Antibodies against only about 25-28 blood group antigens are known to cause hemolytic reactions (HTRs), and red cell antibody screening should detect such clinically significant antibodies. An extension of the antibody screening test is the ′type and screen′ done to detect clinically significant antibodies, omiting the anti-human globulin (AHG) cross-match. Aim: The aim of this study was to find out if the type and screen procedure is a safe method for pre-transfusion testing when compared to the AHG cross-match currently in use in India. Materials and Methods: We evaluated data from 45373 patients for whom a total of 61668 units of packed red blood cells (PRBC) were cross-matched in the AHG phase using DiaMed ID cards. An antibody screen was carried out in all the patients using the DiaMed ID-DiaCell I+II+III. The AHG cross-match was also carried out for all recipients, irrespective of the result of the antibody screen. The results were compared to see if there were any cases where the antibody screening was negative but the AHG cross-match showed incompatibility. Results: Not a single case was found where the antibody screen was negative and AHG cross-match showed incompatibility. In 68 cases the antibody screening was positive. Out of the 68 cases, AHG cross-match was incompatible with at least one unit of PRBC in 41 cases. Conclusion: The screening cell panel adequately detected the clinically significant antibodies in the Indian population in our study. The type and screen policy can be safe, efficient, cost-effective, and beneficial to the transfusion service in India.