# Compatibility Testing Log

| Form ID | FRM-BB-001 | Revision | 1.0 |
|---------|-------------|----------|-----|

---

## Patient Information

| Field | Entry |
|-------|-------|
| Patient Name | |
| MRN | |
| Date of Birth | |
| Sex | ☐ Male ☐ Female |
| Location/Unit | |
| Ordering Physician | |
| Date of Request | |
| Time of Request | |

---

## Specimen Information

| Field | Entry |
|-------|-------|
| Date Collected | |
| Time Collected | |
| Collected By | |
| Phlebotomist ID | |
| Tube Type | ☐ EDTA ☐ Clot ☐ Both |
| Specimen Acceptable? | ☐ Yes ☐ No (reason: _______) |
| Previous Records Available? | ☐ Yes ☐ No ☐ N/A |

---

## ABO/Rh Typing

### Current Sample

| Test | Result | Interpretation |
|------|--------|----------------|
| Anti-A | ☐ Pos ☐ Neg | |
| Anti-B | ☐ Pos ☐ Neg | |
| Anti-D | ☐ Pos ☐ Neg | |
| A1 Cells | ☐ Pos ☐ Neg | |
| B Cells | ☐ Pos ☐ Neg | |

**ABO Type:** ☐ A ☐ B ☐ AB ☐ O

**Rh Type:** ☐ Positive ☐ Negative

**Weak D Testing (if applicable):**
☐ Not performed ☐ Positive ☐ Negative

### Historical Results (if available)

| Date | ABO | Rh | Source |
|------|-----|----|--------|
| | | | |
| | | | |

**Results Consistent?** ☐ Yes ☐ No (see discrepancy resolution)

---

## Antibody Screening

| Field | Entry |
|-------|-------|
| Method | ☐ Tube ☐ Gel ☐ Solid Phase |
| Enhancement | ☐ LISS ☐ PEG ☐ None |
| Screen Cell Lot # | |
| Expiration Date | |

### Screen Cell Results

| Cell | Immediate Spin | 37°C | AHG | CC |
|------|----------------|------|-----|-----|
| I | | | | |
| II | | | | |
| III | | | | |

**Antibody Screen Result:** ☐ Negative ☐ Positive

**If Positive, Antibody Identified:**

---

## Antibody Identification (if screening positive)

| Field | Entry |
|-------|-------|
| Panel Lot # | |
| Method | |
| Antibody(ies) Identified | |
| Clinical Significance | ☐ Yes ☐ No |
| Phenotyped Units Required? | ☐ Yes ☐ No |
| Phenotype Requirements | |

| Panel Cell | Results | Antigen Correlation |
|------------|---------|---------------------|
| 1 | | |
| 2 | | |
| 3 | | |
| 4 | | |
| 5 | | |
| 6 | | |
| 7 | | |
| 8 | | |
| 9 | | |
| 10 | | |
| 11 | | |

---

## Crossmatch

### Unit 1

| Field | Entry |
|-------|-------|
| Unit Number | |
| ABO/Rh | |
| Expiration Date | |
| Antigen Typed? | ☐ Yes: _______ ☐ No ☐ N/A |

| Phase | Result | Interpretation |
|-------|--------|----------------|
| Immediate Spin | ☐ Compatible ☐ Incompatible | |
| 37°C | ☐ Compatible ☐ Incompatible | |
| AHG | ☐ Compatible ☐ Incompatible | |
| Coombs Control | ☐ Valid ☐ Invalid | |

**Final Result:** ☐ Compatible ☐ Incompatible

### Unit 2

| Field | Entry |
|-------|-------|
| Unit Number | |
| ABO/Rh | |
| Expiration Date | |
| Antigen Typed? | ☐ Yes: _______ ☐ No ☐ N/A |

| Phase | Result | Interpretation |
|-------|--------|----------------|
| Immediate Spin | ☐ Compatible ☐ Incompatible | |
| 37°C | ☐ Compatible ☐ Incompatible | |
| AHG | ☐ Compatible ☐ Incompatible | |
| Coombs Control | ☐ Valid ☐ Invalid | |

**Final Result:** ☐ Compatible ☐ Incompatible

### Unit 3

| Field | Entry |
|-------|-------|
| Unit Number | |
| ABO/Rh | |
| Expiration Date | |
| Antigen Typed? | ☐ Yes: _______ ☐ No ☐ N/A |

| Phase | Result | Interpretation |
|-------|--------|----------------|
| Immediate Spin | ☐ Compatible ☐ Incompatible | |
| 37°C | ☐ Compatible ☐ Incompatible | |
| AHG | ☐ Compatible ☐ Incompatible | |
| Coombs Control | ☐ Valid ☐ Invalid | |

**Final Result:** ☐ Compatible ☐ Incompatible

---

## Electronic Crossmatch (if applicable)

| Field | Entry |
|-------|-------|
| Two ABO/Rh on file? | ☐ Yes ☐ No |
| Results consistent? | ☐ Yes ☐ No |
| Antibody screen negative? | ☐ Yes ☐ No |
| Computer system validated? | ☐ Yes |

---

## Special Requirements

| Requirement | Ordered? | Provided? |
|-------------|----------|-----------|
| CMV Negative | ☐ | ☐ |
| Irradiated | ☐ | ☐ |
| Leukoreduced | ☐ | ☐ |
| Washed | ☐ | ☐ |
| Volume Reduced | ☐ | ☐ |
| HbS Negative | ☐ | ☐ |
| Antigen Negative: _______ | ☐ | ☐ |

---

## Results Summary

| Field | Entry |
|-------|-------|
| ABO/Rh | |
| Antibody Screen | ☐ Negative ☐ Positive |
| Antibodies Identified | |
| Units Crossmatched | |
| Units Compatible | |
| Units Available for Issue | |

---

## Verification

### Performed By

| Field | Entry |
|-------|-------|
| Technologist Name | |
| Tech ID | |
| Date | |
| Time | |
| Signature | |

### Reviewed By (if required)

| Field | Entry |
|-------|-------|
| Reviewer Name | |
| Date | |
| Signature | |

---

## Discrepancy Resolution (if applicable)

| Field | Entry |
|-------|-------|
| Type of Discrepancy | |
| Investigation Performed | |
| Resolution | |
| Resolved By | |
| Date | |
| Supervisor Review | |

---

*Form FRM-BB-001 Rev 1.0 - Compatibility Testing Log*