Is It Time to Switch from Conventional Coombs Crossmatching to the Type and Screen Protocol?

ABO grouping, Rh typing and crossmatching are routinely done as part of pre-transfusion testing. The Type and Screen (T&S) protocol has been used in developed countries to ensure the survival of transfused red cells. In this study, we compared the safety, costs and turnaround times (TATs) of the T&S protocol and the conventional pre-transfusion testing protocol for patients who had been scheduled for elective obstetrical or gynaecological procedures.

This observational study was conducted in three phases at the Department of Transfusion Medicine, Jubilee Mission Medical College and Research Institute, Kerala, India and involved 1,800 patients from the Department of Obstetrics and Gynaecology, Jubilee Mission Medical College & Research Institute, Kerala, India over the course of 2 years. Phase I involved the traditional pre-transfusion testing and crossmatching of 150 patients. Phase II involved the use of the T&S protocol on 150 patients. Phase III involved the use of both the traditional and T&S protocols on 1,500 patients without considering the results of each protocol. The safety, costs and TATs of both protocols were compared.

In this study, the T&S protocol provided a safety 100% level when compared to the traditional protocol. The T&S protocol detected unexpected antibodies in 0.4% of cases, which would have gone unnoticed otherwise, demonstrating its usefulness. There was no significant difference in cost between the traditional crossmatching and T&S protocols. We discovered that using only the T&S protocol can save technologists 30% of their time.

Implementing the T&S protocol as a pre-transfusion testing procedure can help improve hospital transfusion practices by supplying blood quickly and safely. Coombs crossmatching remains more of a tradition than a necessity.