Document Type : Original Article


1 Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India

2 Department of Transfusion Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, India

3 Department of Immunohaematology & Blood Transfusion Medicine, Government Medical College & Hospital (GMCH) Jammu, Jammu & Kashmir, India

4 Department of Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi


Objective: Type and crossmatch (TC) policy is the most common approach for pretransfusion compatibility testing prior to issue of blood for transfusion. As it involves
reserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can lead
to excessive blood cross matching, inventory management problems, undue workload,
blood outdating and reagent wastage. Type and screen (TS) policy is an alternative
approach without the need to cross match and reserve blood units prior to issue. The aim
of the current study was to retrospectively assess the impact of the implementation of TS
policy for pre-transfusion compatibility testing on blood transfusion services at an urban
level Ι trauma center.
Methods: The study was done in two phases in the Department of Transfusion Medicine
at Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data was
collected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policy
and second phase (Apr 2017-Sept 2017) of TS policy.
Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusion
probability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stock
index (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentage
of issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reduction
in expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytic
transfusion reaction was reported during the study.
Conclusion: TS policy was found to be a safe and an efficient alternative approach to TC
policy for pre-transfusion compatibility at our center. We recommend the implementation
of TS policy, but each center should first assess its feasibility based on patient population,
blood bank resources and staff knowledge


Main Subjects

1. Ramakrishnan VT, Cattamanchi S. Transfusion practices in trauma. Indian J Anaesth 2014; 58(5): 609-15. doi:
2. Shaz BH, Dente CJ, Harris RS, MacLeod JB, Hillyer CD. Transfusion management of trauma patients. Anesth Analg
2009; 108(6): 1760-8. doi: 10.1213/ane.0b013e3181a0b6c6.
3. Evanovitch D. A primer in pretransfusion testing. Transfus Apher Sci 2012; 46(3): 281-6. doi: 10.1016/j. transci.2012.03.017.
4. Milkins C, Berryman J, Cantwell C, Elliott C, Haggas R, Jones J, et al. Guidelines for pre-transfusion compatibility
procedures in blood transfusion laboratories. British Committee for Standards in Haematology. Transfus Med
2013; 23(1): 3-35. doi: 10.1111/j.1365-3148.2012.01199.x.
5. Shulman IA, Downes KA, Sazama K, Maffei LM. Pretransfusion compatibility testing for red blood cell administration. Curr Opin Hematol 2001; 8(6): 397-404. doi: 10.1097/00062752-200111000-00014.
6. Oberman HA. The present and future crossmatch.Transfusion 1992; 32(9): 794-6.
7. White J. Pre-transfusion testing. ISBT Sci Ser 2009; 4(1): 37-44. doi: 10.1111/j.1751-2824.2009.01211.x.
8. Beck ML, Tilzer LL. Red cell compatibility testing: a perspective for the future. Transfus Med Rev 1996; 10(2):
118-30. doi: 10.1016/s0887-7963(96)80088-5.
9. Schmidt P. Standards for Blood Banks and Transfusion Services. 11th ed. Bethesda: American Association of Blood
Banks; 1984.
10. Food and Drug Administration (FDA). Guidance for Industry “Computer Crossmatch” (Computerized Analysis
of the Compatibility between the Donor’s Cell Type and the Recipient’s Serum or Plasma Type); 2011. Available from:
11. Powers A, Chandrashekar S, Mohammed M, Uhl L. Identification and evaluation of false-negative
antibody screens. Transfusion 2010; 50(3): 617-21. doi:10.1111/j.1537-2995.2009.02464.x.
12. Orlando N, Bianchi M, Valentini CG, Maresca M, Massini G, Putzulu R, et al. Red cell alloantibody screening:
comparative analysis of three different technologies. Transfus Med Hemother 2018; 45(3): 179-83. doi:
13. Garratty G. How concerned should we be about missing antibodies to low incidence antigens? Transfusion 2003;
43(7): 844-7. doi: 10.1046/j.1537-2995.2003.00492.x.
14. Lange J, Selleng K, Heddle NM, Traore A, Greinacher A. Coombs’ crossmatch after negative antibody screening--a
retrospective observational study comparing the tube test and the microcolumn technology. Vox Sang 2010; 98(3 Pt
1): e269-75. doi: 10.1111/j.1423-0410.2009.01278.x.
15. Narvios AB, Rozner M, Lichtiger B. Thirty-day typing and screening for patients undergoing elective surgery:
experience at a large cancer center. Transfusion 2006; 46(3):348-51. doi: 10.1111/j.1537-2995.2006.00728.x.
16. Knowles SM, Milkins CE, Chapman JF, Scott M. The United Kingdom National External Quality Assessment
Scheme (blood transfusion laboratory practice): trends in proficiency and practice between 1985 and 2000.
Transfus Med 2002; 12(1): 11-23. doi: 10.1046/j.1365-3148.2002.00353.x.
17. Downes KA, Shulman IA. Pretransfusion testing practices in North America, 2005-2010: an analysis of the College
of American Pathologists Interlaboratory Comparison Program J-survey data, 2005-2010. Arch Pathol Lab Med
2012; 136(3): 294-300. doi: 10.5858/2011-0127-cpr.1.
18. Devbhandari MP, Farid S, Goatman C, Moussa Y, Rammohan KS, Krysiak P, et al. Is type and screen only policy safe for patients undergoing elective lobectomy? Eur J Cardiothorac Surg 2013; 44(6): 1113-6. doi: 10.1093/ejcts/
19. Pei Z, Szallasi A. Prevention of surgical delays by preadmission type and screen in patients with scheduled surgical procedures: improved efficiency. Blood Transfus
2015; 13(2): 310-2. doi: 10.2450/2014.0172-14.
20. Kuriyan M, Fox E. Pretransfusion testing without serologic crossmatch: approaches to ensure patient safety. Vox Sang 2000; 78(2): 113-8. doi: 10.1159/000031160.
21. Tiwari AK, Aggarwal G, Dara RC, Arora D, Gupta GK,Raina V. First Indian study to establish safety of immediatespin crossmatch for red blood cell transfusion in antibody screen-negative recipients. Asian J Transfus Sci 2017; 11(1):
40-4. doi: 10.4103/0973-6247.200774.
22. Setia R, Sachdeva P, Arora S, Handoo A, Kapoor M. Making type and screen policy an essential component
of pretransfusion testing: need of the hour in India. Glob J Transfus Med 2017; 2(1): 34-7. doi: 10.4103/gjtm.gjtm_2_17.
23. Chaudhary R, Agarwal N. Safety of type and screen method compared to conventional antiglobulin crossmatch
procedures for compatibility testing in Indian setting. Asian J Transfus Sci 2011; 5(2): 157-9. doi: 10.4103/0973-
24. Agrawal A. Type and screen policy: is there any compromise on blood safety? Transfus Apher Sci 2014; 50(2): 271-3. doi:10.1016/j.transci.2014.01.003.
25. Pathak S, Chandrashekhar M, Wankhede GR. Type and screen policy in the blood bank: is AHG cross-match still
required? a study at a multispecialty corporate hospital in India. Asian J Transfus Sci 2011; 5(2): 153-6. doi:
26. Hasan O, Khan EK, Ali M, Sheikh S, Fatima A, Rashid HU. “It’s a precious gift, not to waste”: is routine cross matching
necessary in orthopedics surgery? retrospective study of 699 patients in 9 different procedures. BMC Health Serv
Res 2018; 18(1): 804. doi: 10.1186/s12913-018-3613-9.
27. Zewdie K, Genetu A, Mekonnen Y, Worku T, Sahlu A, Gulilalt D. Efficiency of blood utilization in elective surgical
patients. BMC Health Serv Res 2019; 19(1): 804. doi:10.1186/s12913-019-4584-1.
28. Hall TC, Pattenden C, Hollobone C, Pollard C, Dennison AR. Blood transfusion policies in elective general surgery:
how to optimise cross-match-to-transfusion ratios. Transfus Med Hemother 2013; 40(1): 27-31. doi: 10.1159/000345660.
29. Alavi-Moghaddam M, Bardeh M, Alimohammadi H, Emami H, Hosseini-Zijoud SM. Blood transfusion practice
before and after implementation of type and screen protocol in emergency department of a university affiliated
hospital in Iran. Emerg Med Int 2014; 2014: 316463. doi:10.1155/2014/316463.
30. Shulman IA, Nelson JM, Kent DR, Jacobs VL, Nakayama RK, Malone SA. Experience with a cost-effective crossmatch
protocol. JAMA 1985; 254(1): 93-5.
31. Aggarwal G, Tiwari AK, Arora D, Dara RC, Acharya DP, Bhardwaj G, et al. Advantages of type and screen policy:
perspective from a developing country! Asian J Transfus Sci 2018; 12(1): 42-5. doi: 10.4103/ajts.AJTS_31_17.
32. Alghamdi S, Gonzalez B, Howard L, Zeichner S, LaPietra A, Rosen G, et al. Reducing blood utilization by
implementation of a type-and-screen transfusion policy a single-institution experience. Am J Clin Pathol 2014;
141(6): 892-5. doi: 10.1309/ajcpx69venskotyw.
33. Patten E, Alperin JB. Type and screen: a safe and effective preoperative blood ordering policy with emphasis on its use in obstetrics and gynecology. Am J Obstet Gynecol 1982;142(5): 563-7. doi: 10.1016/0002-9378(82)90762-1.