クロスマッチ

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/02 03:48:18」(JST)

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Compatibility testing concerning RBCs

Cross-matching (or crossmatching) blood, in transfusion medicine, refers to the testing that is performed prior to a blood transfusion in order to determine if the donor's blood is compatible with the blood of an intended recipient, or to identify matches for organ transplants. Cross-matching is usually performed only after other, less complex tests have not confirmed compatibility. Blood compatibility has many aspects, and is determined not only by the blood types (O, A, B, AB), but also by blood factors, (Rh, Kell, etc.).

Cross-matching is done by a certified laboratory technologist, in a laboratory. It can be done electronically, with a computer database, or serologically. Simpler tests may be used to determine blood type (only), or to screen for antibodies (only). (indirect Coombs test).

Types of cross-matching

Full cross-matching

This is the most comprehensive form of cross-matching, making it the safest form, but it is also the most expensive and time-consuming. It involves serological body-temperature tests and can take around an hour.

Abbreviated cross-matching

Immediate-spin cross-matching

Immediate-spin cross-matching (ISCM) is an abbreviated (faster, less expensive, less sensitive) form of cross-matching that is conditionally appropriate as either preliminary to, or in place of, full cross-matching. It is an immediate, room-temperature serological test, taking only several minutes.

Electronic cross-matching

Electronic cross-matching is essentially a computer-assisted analysis of the data entered from testing done on the donor unit and blood samples drawn from intended recipient. This includes ABO/Rh typing of the unit and of the recipient, and an antibody screen of the recipient. Electronic cross-matching can only be used if a patient has a negative antibody screen, which means that they do not have any active red blood cell atypical antibodies, or they are below the detectable level of current testing methods. If all of the data entered is compatible, the computer will print a compatibility label stating that the unit is safe to transfuse.

Cross-matching falls into two categories:

Major cross-match: Recipient serum is tested against donor packed cells to determine if the recipient has preformed antibodies against any antigens on the donor's cells. This is the required cross-match prior to release of a unit of packed cells.
Minor cross-match: Recipient red cells are tested against donor serum to detect donor antibodies directed against a patient's antigens. This is no longer required. It is assumed that the small amount of donor serum and antibodies left in a unit of packed cells will be diluted in a recipient.

Emergencies

As the complete cross-matching process requires approximately 1 hour to be done, it's not always used in emergencies.

In the case of an emergency, a type-specific blood ("uncross-matched blood") can be requested. It is thought that this lifesaving measure is of more benefit than any risk of an antibody-mediated transfusion reaction. This type of blood has less risk of a serious transfusion reaction because it is both ABO-compatible and Rhesus (Rh)-compatible.

Type O and Rh negative blood can be given if the recipient's blood group is not known, as may happen in an emergency.

In an emergency, blood grouping can be done easily and quickly in 2 or 3 minutes in the laboratory on glass slides with appropriate reagents, by trained technical staff. This method depends on the presence or absence of agglutination, which can usually be visualized directly, although occasionally a light microscope may be needed. If laboratory services are not available, another system of deciding which type of blood to use in an emergency is the bedside card method of blood grouping, where a drop of the intended recipients' blood is added to dried reagents on a prepared card. This method may not be as reliable as laboratory methods, which are preferable.

External links

Nobelprize.org Interactive online game for blood typing and transfusion (Flash Player 5 required)

wikipedia.org/wiki/Serological explaines the word used in the Full cross-matching tab under the Types of cross-matching tab

UpToDate Contents

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1. 適合性試験 compatibility testing
2. 交差適合試験での不適合 the incompatible crossmatch
3. 腎移植におけるHLAとABOの感作および脱感作 hla and abo sensitization and desensitization in renal transplantation
4. 腎臓移植における移植片機能不全の危険因子 risk factors for graft failure in kidney transplantation
5. 腎臓移植における臓器共有（organ sharing） organ sharing in kidney transplantation

English Journal

Transplantation of High Panel-Reactive Antibody Left Ventricular Assist Device Patients Without Crossmatch Using On-Bypass Pheresis and Alemtuzumab.

Lick SD, Beckles DL, Piovesana G, Vaidya S, Indrikovs A, Barbagelata NA, Valentine V.SourceDepartment of Surgery, University of Texas Medical Branch, Galveston, Texas.
The Annals of thoracic surgery.Ann Thorac Surg.2011 Aug 18. [Epub ahead of print]
BACKGROUND: Highly sensitized (HS) left ventricular assist device (LVAD) patients with high panel-reactive antibody (PRA) levels present a challenge. Alemtuzumab, a potent depleting agent for T and B lymphocytes (months to years), and plasmapheresis, offer an opportunity for heart transplantation to
PMID 21855854

Prevention and treatment of alloantibody-mediated kidney transplant rejection.

Bartel G, Schwaiger E, Bohmig GA.SourceDepartment of Medicine III, Medical University Vienna, Vienna, Austria.
Transplant international : official journal of the European Society for Organ Transplantation.Transpl Int.2011 Aug 10. doi: 10.1111/j.1432-2277.2011.01309.x. [Epub ahead of print]
Summary Antibody-mediated rejection (AMR), which is commonly caused by preformed and/or de novo HLA alloantibodies, has evolved as a leading cause of early and late kidney allograft injury. In recent years, effective treatment strategies have been established to counteract the deleterious effects of
PMID 21831227

Japanese Journal

輸血部門における危機的出血への対応に関するアンケート調査結果

紀野修一,半田誠,稲田英一,稲葉頌一,入田和男,吉村速,蕨謙吾,津崎晃一,益子邦洋,矢野哲,亀井良政,厚生労働科学研究費補助金「危機的出血に対する輸血ガイドラインに導入による救命率変化および輸血ネットワークシステム構築に関する研究」研究班
日本輸血細胞治療学会誌 = Japanese journal of transfusion and cell therapy 55(5), 624-632, 2009-11-16
雑誌掲載版背景・目的:病院輸血部門は血液センターと輸血使用現場を中継する位置にあり、危機的出血発生時には迅速な対応が要求される。今回、病院輸血部門の体制をアンケート調査し、危機的出血発生時の対応における問題点を明らかにした。対象・方法:病床数500床以上の麻酔科認定病院385施設を対象とし、2007年11月に調査を実施した。成績:輸血管理体制はほぼ整備されていたが、緊急輸血や大量輸血時への対応マニ …
NAID 10026334251