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GXM & GSH Antiglobulin test (Coombs test)
AHG (Antihuman globulin) – produced via animals by injection of human globulin,
Compatibility testing compleme nt, immunoglob ulin
Prevent haemolysis AHG + Human RBC (coated with Ig antibody) or complement
Agglutination – indicate +ve test
Donor’s blood is not compatible/ safe for transfusion
Blood grouping
AHG enhance red cell agglutination (red cells coated by antibodies)
Reagents/ equipments
Anti A, B, AB (direct grouping)
Blood from recipient (cells, serum)
Tile, Test tubes
Centrifuge
Known cells – O, A, B (indirect grouping)
Principle
Antigen-antibody reaction causes RBC agglutination

Cross Matching (GXM) Group Screen Hold (GSH)

To transfuse compatible red cells to patients Group Screen Hold
Principle ABO, Rhesus grouping Red blood cell antibody Keep screened sample
Red cells from donor (same ABO, RhD) tested against recipient (patient) serum of patient’s blood screening until need arise
Agglutination – incompatible donor red cells Patient’s serum tested Will not be cross-
Methods against reagent red matched until needed
Detecting clinically significant IgM antibodies (cold) – saline in room temperature cells (known red cell
Detecting clinically significant IgM, IgG antibodies (warm) – saline 37°C antigens)
Detecting immune antibodies (mainly IgG) – indirect antiglobulin test (AHG test) Using known red cell
at 37°C antigens (red cell panel
Cross matching test I, II, III) – indirect
Coomb’s test
+ve result will show
agglutination
(indicate patient has
specific antibody(s ) to
antigen(s))
Results of antibody screening
Postive (+ve) Negative (-ve)
Identify antibody – type of red cell When blood is required, cross-
antibody matching will be performed
(saline, room temperature)
Compatible blood will be supplied Blood issued as soon as neede d
after full cross-matching & typed Full cross-matched proceed in lab
(negative for antigen to particular Blood is taken even when procedure
antibody) is not finished
Red cell antibodies to
Advantages of GSH
Minor blood groups
↓ Blood stock (for blood cross -matching - n ot needed for blood transfu sion)
• Lewis, Duffy, Kell antigens (on red cell surface) ↓ Blood wastage & Expiry date
Major blood groups
Safe blood is supplied to patients (equal to doing GXM)
• ABO, Rhesus D antigen (very immunogenic) Blood is delivered ASAP when needed
Development of Red cell antibodies by
Indications for GSH
Naturally
Cases of elective surgery (chances of not using is ↑ than using blood)
Immune me chanisms
Blood request is not more than 2 units
Adult cases only
Negative for red cell antibody screening
No history of recent blood transfusion

Gel card method

GXM & GSH
AHG is pre-added in gel card column
Agglutination show as layer of red cells on top of gel column

Red cell agglutination (incompatible donor) – Test tube, Blood film