| No. | Error Case (Pre-Transfusion Testing Phase) |
|---|---|
| 1 | Mismatch between the patient's actual blood type and medical records |
| 2 | Unexpected antibody detected during antibody screening test |
| 3 | Transfusion ordered without performing pre-transfusion testing |
| 4 | ABO and Rh test results missing → Blood release denied by the blood bank |
| 5 | Barcode label on specimen does not match patient information |
| 6 | Specimen collected from a different patient with the same name |
| 7 | Using test results older than 72 hours for patients with repeated transfusions |
| 8 | Positive result in crossmatching → Blood product needs to be changed |
| 9 | Emergency transfusion attempted before completing crossmatch test |
| 10 | Pre-transfusion testing performed without checking past adverse transfusion history |
Positive Crossmatch Reaction
A 66-year-old male patient is undergoing chemotherapy after colon cancer surgery.
He experienced postoperative bleeding, and his hemoglobin was (6.5) g/dL this morning.
Doctor ordered 2 units of PRBC (packed red blood cells).
The nurse completed the pre-transfusion tests (ABO/Rh typing, antibody screen) and sent a crossmatch request.
Shortly after, the blood bank reported a positive crossmatch reaction, meaning the designated PRBC could not be used.
The nurse must now request a washed red blood cell product instead.
The situation is not emergent, but the patient is symptomatic with anemia.
Nurse (senior)
(Reviewing EMR)
Mr. Jung has been prescribed PRBC 2 units, and the pre-transfusion testing is done. We’re just waiting on the crossmatch results… Blood bank is calling now.
Blood Bank
The crossmatch result for patient Jung Ki-hoon came back positive.
The currently assigned PRBC cannot be transfused.
Please submit a request for washed red blood cells instead.
It will take approximately 2 hours to prepare the new product.
Nurse (senior)
(To new nurse)
A positive crossmatch means the patient may have antibodies that would react with the donor blood.
In this case, we need to request washed RBCs, which are filtered to remove plasma proteins and other components.
I’ll report this to the doctor and explain the delay to the patient.
Nurse (senior)
(Calling Doctor Kim)
Doctor Kim, the crossmatch result for Mr. Jung was positive.
The current PRBC units cannot be used.
Blood bank recommends switching to washed red blood cells. It will take about 2 hours to prepare.
Doctor Kim
Alright, please proceed with the change. Be sure to inform the patient about the delay.
Nurse (senior)
Mr. Jung, the compatibility test showed a reaction, so we can’t use the blood that was initially prepared.
Instead, we’ll be using washed red blood cells, which are safer in your case.
It may take around 2 hours for the blood to be ready. Would you be okay waiting a bit longer?
Patient
I’m already feeling tired and a little short of breath. Is it safe to wait?
Nurse (senior)
Your vital signs are stable for now. But if you feel more dizzy or breathless, please let me know immediately.
We’ll continue IV fluids in the meantime and monitor you closely.
Nurse (senior)
(EMR documentation)
🗓 2025.04.08 14:20
- Patient Jung Ki-hoon scheduled for PRBC 2 units; crossmatch result returned positive
- Transfusion with current blood is not permitted; Doctor instructed to switch to washed RBCs
- Blood bank estimates 2 hours for preparation; patient informed and consented
- Vital signs stable:
BP (116/70) mmHg, HR (91) bpm, Temp (36.8) degrees Celsius, RR (20) breaths/min, SpO₂ (97) percent - IV fluid: NS (Normal Saline) maintained
Nurse (senior)
(To new nurse)
Crossmatching is the final and most critical safety check before transfusion.
Even if ABO/Rh matches, a positive crossmatch reaction means the blood must not be used.
In such cases, switch to an alternative product like washed RBCs and consult with the blood bank or physician.
Nurse (new)
This is my first time seeing a positive crossmatch. Thank you for walking me through the right process.
Patient
I wasn’t expecting this, but I feel better knowing everything is being double-checked. I’ll wait.
Nurse (senior)
Thank you, Mr. Jung. We’ll make sure you stay safe and comfortable while we prepare the correct blood.
✅ Key Learning Points
| Situation | Positive crossmatch reaction → current PRBC cannot be used → switch to washed RBC required |
| Nursing Actions | ① Verified test result ② Reported to physician ③ Requested blood product change ④ Explained delay to patient ⑤ Continued monitoring |
| Documentation | Included crossmatch result, physician order, patient response, and vital signs |
| Clinical Reminder | Even with ABO/Rh match, crossmatch must be negative → positive result requires product substitution and physician coordination |
Catheter Management Scenarios: Central Venous Catheter (CVC), Peripherally Inserted Central Catheter (PICC), and Implanted Port
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