Major and minor cross matching are two types of blood cross matching tests. Cross matching is an essential procedure performed before administering blood or blood products, like packed red blood cells, in transfusion medicine.
The key difference between major cross matching and minor cross matching is their function. Major cross matching checks if the blood recipient has any antibodies that might resist the blood cells of the donor, while minor cross matching detects antibodies in the donor serum to the recipient’s red blood cells.
CONTENTS
1. Overview and Key Difference
2. What is Major Cross Matching
3. What is Minor Cross Matching
4. Similarities – Major and Minor Cross Matching
5. Major vs Minor Cross Matching in Tabular Form
6. Summary – Major vs Minor Cross Matching
7. FAQ – Major and Minor Cross Matching
What is Major Cross Matching?
Major cross matching is the most important cross matching in transfusion medicine. This compares donor erythrocytes to recipient serum. This method determines if the recipient has preformed antibodies against any antigens on the cells of the donor. Major cross matching is mandatory prior to the release of a unit of packed cells from the blood bank.

Figure 01: Compatibility Testing Concerning RBCs
To perform major cross matching, the health care professional needs red blood cells (whole blood from a donor or packed red blood cells) from the donor in EDTA or citrate and serum from the recipient in a non-anticoagulant tube.
What is Minor Cross Matching?
Minor cross matching is a procedure in which the recipient’s red cells are tested against the donor’s serum. This determines whether the donor has antibodies directed against the recipient’s antigens. It is generally assumed that the small amount of donor serum and antibodies in a unit of packed cells will be diluted in the recipient, so this type of cross matching is considered less important. In fact, this procedure is no longer required in routine testing.

Figure 02: Cross Matching Blood Types
For this procedure, healthcare professionals need serum from the donor and red blood cells from the recipient. Furthermore, in minor cross matching, donor serum is incubated with washed recipient erythrocytes.
Similarities Between Major and Minor Cross Matching
- Major and minor cross matching are two types of cross matching procedures performed in blood transfusion and transfusion medicine.
- Both cross matching procedures test for compatibility between donor and recipients.
- They are performed by qualified healthcare professionals.
- Both can reduce post-transfusion complications.
Difference Between Major and Minor Cross Matching
Definition
- Major cross matching is a type of cross matching where the recipient serum is tested against donor packed cells.
- Minor cross matching is a type of cross matching where recipient red cells are tested against donor serum.
Determines
- Major cross matching determines if the recipient has preformed antibodies against any antigens on the donor’s cells.
- Minor cross matching determines if the donor has antibodies directed against the recipient’s antigens.
Mandatory or Not
- Major cross matching is mandatory in routine testing and for blood transfusion.
- Minor cross matching is not mandatory in routine testing and for blood transfusion.
Requirement
- Healthcare professionals need red blood cells from the donor and serum from the recipient for major cross matching.
- Healthcare professionals need serum from the donor and red blood cells from the recipient for minor cross matching.
Procedure
- For major cross matching, donor erythrocytes are washed and incubated with recipient serum.
- For minor cross matching, donor serum is incubated with washed recipient erythrocytes.
The following table summarizes the difference between major and minor cross matching.
Summary – Major vs Minor Cross Matching
Cross matching will detect incompatibilities between the donor and recipient that will not be evident on blood typing before blood transfusion. Cross matching is very important to minimize post transfusion complications too. Major and minor cross matching are two types of cross matching procedures in blood transfusion. Major cross matching is the most important cross matching, comparing donor erythrocytes to recipient serum to determine if the recipient has preformed antibodies against any antigens on the donor’s cells while minor cross matching is a less important cross matching, comparing donor serum to recipient erythrocytes to determine whether donor antibodies are directed against a patient’s antigens. This is the main difference between major and minor cross matching.
FAQ: Major and Minor Cross Matching
1. What is the function of transfusion medicine?
- Transfusion medicine is the branch of medicine that involves the process of collecting, testing, processing, storing, and transfusing blood and its components. It is one of the most important components in emergency and surgical medicine.
2. Why is major cross matching more important?
- Major cross matching is important because it protects transfused red blood cells from hemolysis and is of the highest importance in routine testing before blood transfusion.
3. Why was the minor cross matching discontinued?
- The minor cross matching was discontinued universally due to enhanced human blood donor screening and the increasing use of blood component therapy versus whole blood transfusions.
4. What is the most common complication of blood transfusion?
- The most common symptoms of blood transfusion reactions are chills, rigor, fever, dyspnea, light-headedness, urticaria, itching, and flank pain. Some rare complications include allergic reactions, immune sensitization, allergic reactions to proteins, circulatory overload, etc.
5. What is graft vs host disease?
- Graft vs host disease occurs in allogeneic transplants. In this condition, the donated stem cells view the recipient’s cells as an unfamiliar threat. As a result, donated cells attack the recipient’s cells.
Reference:
1. “Cross-Matching.” eClinpath.
2. Giri, Dhurba. “Cross Matching : Types, Principle, Procedure and Interpretation.” LaboratoryTests.Org.
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