Analysis of the current status of difficult crossmatching and the causes of blood mismatch from 2017-2021.

Blood transfusion is a critical medical intervention, and accurate cross-matching is essential to prevent adverse reactions. However, difficult cross-matching (DCM), often caused by irregular antibodies, poses significant challenges, particularly in patients with prior transfusions, pregnancies, or certain medical conditions. To analyze the incidence and causes of DCM from 2017 to 2021 and propose strategies to improve transfusion safety and compatibility. A total of 363 patients who underwent difficult cross-matching due to incompatible blood matching between January 2017 and December 2021 were selected as the study population. Pre-transfusion testing was conducted for all patients to observe patterns in difficult cross-matching, assess the causes of blood mismatch, and analyze irregular antibody detection results. Based on these findings, specific treatment measures were proposed to address the causes of incompatibility. Most DCM cases occurred in females (81.27%), especially under 45 years of age, with obstetrics and gynecology being the most affected departments. Positive irregular antibodies were identified in 86.50% of cases, mainly from the Rh blood group system (42.99%), followed by autoantibodies (19.43%) and other blood group antibodies. Effective strategies included selecting antigen-negative blood, warming transfusions for cold autoantibodies, and using saline for pseudoagglutination. Irregular antibodies are the main cause of DCM. Accurate identification and tailored transfusion strategies are essential to ensure safety. Greater awareness and improved screening can reduce risks and enhance clinical outcomes.