DHA Standard Operating Procedures Template

Standard Operating Procedures Title: Neonatal Compatibility Testing

Ownership: Effective Date: 04/10/2014 Code: DHA/PGD/COM/TS/022
Pathology & Genetics Department. Revision Due Date:04/10/2017 Type:
Revision No: 03 Technical
First Edition Date: 05/10/2008
Applies to:
Rashid Hospital Dubai Hospital Latifa Hospital Hatta Hospital PHC
1.0 Purpose:
To describe the tests to be performed when small volumes of blood (aliquots) is required to be transfused to
newborns and infants under four months of age.

2.0 Principle:
Newborns do not produce their own antibodies until about four months of age; any antibody present is
the circulating maternal antibody. Their immune system is immature and relatively unresponsive to
immune stimulation during the first four months of life, thus the pretransfusion testing is different from
adults. Initial patient testing must include ABO and Rh typing of their red cells and a screen for
unexpected red cell antibodies using either plasma or serum from the infant or mother. The purpose of
creating small-volume aliquots is to limit donor exposures and decrease donor-related risks.

3.0 Special Safety Precautions:

3.1 Refer to Lab Safety Manual & apply the universal safety precautions- as indicated.
3.2 Wear protective lab gown & gloves throughout the procedure.
3.3 All reagents should be treated as potentially infectious.
3.4 Special protective measures, conditions for clinical waste disposal & disinfection should be
followed in accordance to Lab Infection Control Guidelines.

4.0 Specimen:
SOP No Effective Date Revision Due date Revision No First Edition Date
DHA/PGD/COM/TS/022 04/10/2014 04/10/2017 03 05/10/2008

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 DHA Standard Operating Procedures Template
4.1 Aseptically and freshly drawn baby's pretransfusion blood sample – with or without anticoagulant.
Samples drawn into plain tubes (no anticoagulant) may also be used but the serum must be cleared by
centrifugation at 1500 g for 10 minutes before using to avoid fibrin residues
4.2 Mother's blood sample for initial antibody screen if no previous test results are available.
4.3 1-2 mL of baby's blood for initial antibody screen if mother's records or blood is not available.
4.4 Blood specimens exhibiting gross haemolysis or contamination should not be used.
4.5 Separate the plasma or serum from the red cells. If not tested immediately, it should be stored
between 2-8ºC after separation & must be examined within 48 hours.

5.0 Procedure:
5.1 Do an initial ABO and Rh (D) testing on baby's pretransfusion specimen –refer to related ABO/Rh
typing P&P or according to the procedure below;
Using DiaClon ABO/Rh for Newborns DVI+ for patient blood typing and ABD Confirmation for
donor typing
Equipment /Materials.
a. BioRad-ID Centrifuge
b. BioRad-ID Working Table
c. BioRad-ID Pipetor
d. BioRad-ID Dispenser
e. BioRad-ID Suspension Tubes
f. BiaRad-ID Disposable pipettes
5.2 Test Procedures for patient typing
a. Allow all reagents to reach room temperature before use
b. Identify the DiaClon ABO/Rh for newborns with the patient name and health card number or
accession number
c. Prepare 0.8% patient red cell suspension by adding 10 ul of red cell concentrate or 20 ul whole
blood to 1 ml of ID Diluent 2. Mix Well

SOP No Effective Date Revision Due date Revision No First Edition Date
DHA/PGD/COM/TS/022 04/10/2014 04/10/2017 03 05/10/2008

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 DHA Standard Operating Procedures Template
d. Add 50 ul of test red cell suspension to each microtube.
e. Centrifuge the microtyping card for 10 minutes in the ID-Centrifuge
f. Interpret and record the results in Transfusion Services daily register/s – as appropriate and
Sunquest system (laboratory system).
5.3 Test Procedures for donor ABD confirmation
5.3.1 Identify the ABD confirmatory card for donor with the donor unique number.
5.3.2 Remove the aluminium foil from as many as microtubes required by holding the ID Card in the
upright position.
5.3.3 Prepare 5% donor red cell suspension by adding 25 ul packed cells to 0.5 ml ID Diluent 2 in a
clean and properly labeled suspension tube.
5.3.4 Pipette 10 or 12.5 of the donor red cell suspension to appropriately labeled microtubes.
5.3.5 Centrifuge the ID Card for 10 minutes in the ID Centrifuge.
5.3.6 Read and record the results in Transfusion Services daily register/s – as appropriate and Sunquest
system (laboratory system)
5.4 Do an initial antibody screen for unexpected red cell antibodies, using serum or plasma of either the
neonate or mother – refer to related Antibody Screen such as PGD/COM/TS/14 or PGD/COM/TS/15
5.5 Perform compatibility testing as of PGD/COM/TS/13 or PGD/COM/TS/12
5.6 During any one hospitalization episode of the neonate or until the neonate reaches age of four months,
whichever is sooner, crossmatch compatibility testing & repeat of ABO & RH(D) typing may be
omitted as long as the following criteria are met:
5.6.1 The initial Antibody Screen is Negative.
5.6.2 Transfused red cells are group O, ABO-identical, or ABO-compatible.
5.6.3 Transfused red cells are either Rh(D) negative or the same Rh(D) type as the patient.
6 If the initial antibody screen is positive (alloantibody is detected in neonate or mother specimen), units
shall be prepared for transfusion that does not contain the antigen(s) to the identified antibody/ies or
units are compatible by antiglobulin crossmatch. This should continue until maternal antibody is no
longer detected in neonate's specimen. Once a negative antibody screen is obtained, crossmatches and

SOP No Effective Date Revision Due date Revision No First Edition Date
DHA/PGD/COM/TS/022 04/10/2014 04/10/2017 03 05/10/2008

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 DHA Standard Operating Procedures Template
use of antigen-negative blood in no longer required up to 4 months of neonate's age.
7 Testing the neonate's reverse type for anti-A &/or anti-B is not necessary. However, before non-group-O
RBCs can be issued, testing of the neonate's plasma or serum is required to detect passively acquired
maternal Anti-A or Anti-B and crossmatch should include the Antiglobulin phase. If the antibody is
present, ABO-compatible RBCs must be used until the acquired antibody is no longer detected.
8 Of importance, AVOID the transfusion of any components that may passively transfer unexpected
alloantibodies or ABO-incompatible antibodies to the recipient.
9 Upon completion of neonatal pretransfusion testing; enter the result in Transfusion Services daily
register and Sunquest (laboratory system). The crossmatch compatibility forms will be automatically
generated.
10 Using the Blood Component Preparation option in Sunquest, split the unit. The new aliqout number will
be automatically generated by the system as follows;
10.6 Mother bag will be designated as OO division
10.7 The mother bag division will change to AO upon creation of the new aliquout
10.8 The first aliquot will have AO division
10.9 The second aliquot will have BO division
10.10 The third aliquot will have Aa
10.11 The fourth aliquot will have Ab division
11 Prepare the required small aliquot using the attached satellite bag to split the required volume or a
transfer bag connected through the sterile connection device.
12 Label the aliquot unit with the new unit number, component type, ABO/Rh(D) group, volume or weight
in gram, collection date & expiration date- as of the origin unit.

9.0 Calculations: NA

10.0 Expected Values: Refer to P&P: PGD/COM/TS/012.

SOP No Effective Date Revision Due date Revision No First Edition Date
DHA/PGD/COM/TS/022 04/10/2014 04/10/2017 03 05/10/2008

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 DHA Standard Operating Procedures Template
11.0 Interpreting/ Reporting Results:
For DiaClon ABO/Rh Newborn Card for patient
Anti-A Anti-B Anti-AB Blood Group RhD Pos RhD weak positive RhD Negative
1+ to 4+ negative 1+ to 4+ A
Negative 1+ to 4+ 1+ to 4+ B 3+ to 4+ + to ++ Negative
1+ to 4+ 1+ to 4+ 1+ to 4+ AB
Negative Negative Negative O

For DiaClon ABD Confirmatory Card for donor

Anti-A Anti-B Blood Group RhD Pos RhD weak positive RhD Negative
1+ to 4+ negative A
Neative 1+ to 4+ B 3+ to 4+ + to ++ Negative
1+ to 4+ 1+ to 4+ AB
Negative Negative O

For Compatibility interpretation, refer to PGD/COM/TS/012 and PGD/COM/TS/07 (look for grading result)

12.0 Procedure Notes:

12.1 If the neonate has left the hospital and been readmitted, a new specimen must be obtained and the
Type and Screen repeated.

13.0 Method limitations:

13.1 For neonates with renal or hepatic insufficiency, it is advisable to remove the additive solution from
the plasma, particularly if multiple transfusions are expected from same unit.

14.0 Tools/Attachments Form: NA

15.0 References:
15.1 AABB Technical Manual, 16th Edition, 2008.
15.2 Standards for Blood banks & Transfusion Services, 26th edition, 2009.

SOP No Effective Date Revision Due date Revision No First Edition Date
DHA/PGD/COM/TS/022 04/10/2014 04/10/2017 03 05/10/2008

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 DHA Standard Operating Procedures Template

16. Revision History

New issue Part revision Complete revision

Date Status Change Reference Section

05/10/2008 Deleted New
Modified
Added
14/08/2010 Deleted Title: modified.
Modified 3.3: added.
Added 4.1: collection tube type not specified.
AABB Technical Manual,
5.0,6.0,7.0: reference P&P code changed.
2008.
8.1 to 8.8: procedure detailed with additional Standards for Blood banks
steps. & Transfusion Services,
2009.
10.0, 11.0: Reference P&P added.
12.1,13.1: added.
15.0: references changed.

24/09/2012 Deleted Hatta hospital is included

Modified AWH changed to Latifa
Added 1.0 wors is and infant are added
AABB Technical Manual
2.0 sentences 2, 3 and 4 added 16th Edition
4.1 2nd sentence added Manufacturer’s
4.4 and 4.5 added Instructions leaflet

5.1 Using DiaClon ABO/Rh for Newborns and

ABD confirmatory for donors added with their

SOP No Effective Date Revision Due date Revision No First Edition Date
DHA/PGD/COM/TS/022 04/10/2014 04/10/2017 03 05/10/2008

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 DHA Standard Operating Procedures Template
respective test procedures and
material/equipment
5.4 and 5.5 Specified related P&P’s
5.10 TS daily registers and Sunquest added
5.11, 5.11.1 to 5.11.6 added
11.0 grading chart for DiaClon ABO/Rh for
Newborn and ABD confirmatory for donor
added
0410/2014 Deleted 2. Updated
Modified 5.1c. corrected AABB Technical Manual
5.6 sub numbers corrected 16th Edition
Added
6. edited. Manufacturer’s
New template used Instructions leaflet
Search words: Standard Operating Procedures

17. Search words: Standard Operating Procedures

SOP No Effective Date Revision Due date Revision No First Edition Date
DHA/PGD/COM/TS/022 04/10/2014 04/10/2017 03 05/10/2008

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