I Have given outline about the screening test and investigation done before the blood transfusion.

1. LABORATORY
INVESTIGATION OF
TRANSFUSION REACTION
PRESENTED BY,
S.SHRUTHI VASAN
III BSc.CLT
Dr.NGPARTS & SCIENCE COLLEGE

2. TRANSFUSION:
 The process of transferring donated blood, blood
products, or other fluids into the circulatory system
of a person or animal.

3. TRANSFUSION REACTION:
 Reaction of the body to a transfusion of blood that
is not compatible with its own blood.
 It is an adverse reaction that can range from fever
and hives, to renal failure, shock and death.

4. NEED FOR BLOOD TRANSFUSION:
 Blood transfusion is needed when if the person is
too much of blood loss, such as the following:
 Injury or major surgery
 An illness that causes bleeding such as a Bleeding
ulcer.
 An illness that destroys blood cells, such as Haemolytic
Anemia or Thrombocytopenia.
 If there is an illness in which bone marrow doesn’t make
enough blood, such as Aplastic anemia, you may
needed transfusion.

5. INITIAL MEASURE BEFORE THE INVESTIGATION
TEST:
 An intravenous line with normal saline should be maintained.
 The patient should be assessed and supported as necessary
while the patient’s physician and the transfusion service are
notified.
 A responsible physician will need to evaluated the patient and
determine appropriate clinical care.
 The unit and all tubing should be returned to the blood bank
along, along with post-infusion blood and urine sample as
clinically indicated.
 The reaction should be documented in the patient’s chart.

6. SAMPLE CRITERIA:
MINIMUM SAMPLE REQUIREMENT:
 Verify the patient’s identify using at least two unique
identifiers.
 Date and time of sample collection.
 Ensure all section in the form are completed in a legible
and detailed manner.
 Completed all the information in the ‘specimen
collection’ information.
 Ensure both the nursing and facility of blood bank
clerical checks have been completed and this
documented on the form. This will prevent delays in
testing.

7. SAMPLE REJECTION:
 Specimen receives unlabeled/improperly labeled or
overloaded with more than one name.
 Key identifiers information is missing, incorrect or
discrepant on the sample and / or requisition.
 Specimen not received the laboratory within 8 hours of
collection.
 Unacceptable tube received.
 Specimens which are haemolysed.
 Insufficient of sample.

8. LABORATORY INVESTIGATION:
 After initial measures, there are three basic
preliminary test are done. They are:
 Clerical check
 Visual check
 Serology check

9. PURPOSE:
 To determine the likelihood the occurrence of haemolytic
transfusion reaction.
 It is a serious complications that can occur after a blood
transfusion. The reaction occurs when the red blood cells that
were give during the transfusion are destroyed by the persons
immune system.
 If there is evidence of haemolysis or if the clinical situation
something severe and unusual, the addition test such as
TRALI and TACO must be performed.
 TRALI – Transfusion Belated Acute Lung Injury. it is an acute lung
injury that is temporally related to a blood transfusion, specially it
occurs within the first six hours following a transfusion.
 TACO – Transfusion Associated Circulatory Overloaded. It occurs
due to the rapid transfusion of a large volume of blood

10. Transfusion reaction
Lab investigation
Preliminary test
Clerical check visual check serology

11. CLERICAL CHECK:
 To identify the possibilities of ABO blood compatibility.
 Compare the component bag, label, paper work with
patient sample and look for errors.
 If an error is found, the physician must be notified.
 Most common errors:
 Misidentifications of patient when pre transfusion sample
drawn.
 Mix up of sample in the lab.
 Not enough incubation time.

12. VISUAL CHECK:
 Plasma or serum reaction and compare with pre-transfusion.
 This step is done to examine the presence.
 This destruction of red cells and releasing haemoglobin will
resulting a pink to red.
 The pink colour or red colour serum indicates into haemolysis.
 Thus the ABO testing must be repeated of post transfusion
specimen.
 An urine examination of a post reaction helps in diagnosis of
acute haemolysis.
 The free haemoglobin in the urine indicates the intravascular.

13. SEROLOGY CHECK:
 On post transfusion sample redo the ABO test and
perform the direct antiglobulin test (DAT).
 The sample post transfusion must be preserved in
a EDTA preservation.
 If the DAT is positive on the post transfusion sample
then one should be performed on the pre
transfusion sample.
 If the result for the pre transfusion DAT is negative
but the result for post transfusion is positive.

14.  If any of these three test above have positive and
suspicious results, REDO test done before blood
transfusion which are:
 ABO &Rhesus grouping.
 Antibody screening.
 Repeat crossmatch.