General

Core Lab Study



Synonym/Acronym:
ABO group and Rh typing, blood group antibodies, crossmatch (XM), type and screen (T&S), type and crossmatch.

Rationale
To identify ABO blood group and Rh type, typically for prenatal screen and transfusion purposes. These tests are also used to help establish compatibility for cellular therapy and solid organ transplantation (in addition to human leukocyte antigen [HLA] and HLA antibody typing).

A small group of studies in this manual have been identified as Core Lab Studies. The designation is meant to assist the reader in sorting the basic “always need to know” laboratory studies from the hundreds of other valuable studies found in the manual—a way to begin putting it all together.

Normal, abnormal, or various combinations of core lab study results can indicate that all is well, reveal a problem that requires further investigation with additional testing, signal a positive response to treatment, or suggest that the health status is as expected for the associated situation and time frame.

Blood product transfusion carries significant risks for patients, up to and including death. It’s crucial for nurses to understand the ABO/Rh systems and to follow their facility’s transfusion policies and procedures for the administration of different types of blood products. Blood typing and other core lab tests such as TBil, H&H, platelet count, and WBC count are valuable tools used to evaluate and monitor patients before, during, and after transfusion. Blood typing is included in the obstetric panel.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings
(Method: FDA-approved reagents with glass slides, glass tubes, gel, or automated systems) Compatibility (no clumping or hemolysis).

Critical Findings and Potential Interventions
Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.

Signs and symptoms of blood product transfusion reactions range from mildly febrile to anaphylactic and may include chills, dyspnea, fever, headache, nausea, vomiting, palpitations and tachycardia, chest or back pain, apprehension, flushing, hives, angioedema, diarrhea, hypotension, oliguria, hemoglobinuria, acute kidney injury, sepsis, shock, and jaundice. Complications from disseminated intravascular coagulation (DIC) may also occur.

An IgA deficiency mediated transfusion reaction is a relatively rare type of anaphylaxis. It has been observed when an IgA deficient blood product recipient is transfused with a blood product containing anti-IgA antibodies. The reaction usually occurs within 1 hr of transfusion. A reaction does not occur in all patients with an IgA deficiency and the reaction can occur along a spectrum ranging from no symptoms or adverse reaction to full-blown, life-threatening anaphylaxis. Commonly transfused blood products (FFP, RBCs, platelets) contain small amounts of plasma.

Possible interventions in mildly febrile reactions include slowing the rate of infusion, then verifying and comparing patient identification, transfusion requisition, and blood bag label. The patient should be monitored closely for further development of signs and symptoms. Administration of epinephrine may be ordered.

Possible interventions in a more severe transfusion reaction may include immediate cessation of infusion, notification of the HCP, keeping the IV line open with saline or lactated Ringer solution, collection of red- and lavender-top tubes for post-transfusion work-up, collection of urine, monitoring vital signs every 5 min, ordering additional testing if DIC is suspected, maintaining patent airway and blood pressure, and administering mannitol.