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Updated: Feb 16, 2026
Methods for Quantitative Detection of Antibody-induced Complement Activation on Red Blood Cells
Published on: January 29, 2014
Algorithm to Manage Inconclusive RBC Antibodies by Reflex Manual Testing
Jennifer J O'Brien1, Rhonda K Cooke1, Ali A Ebrahim-Nejad2
1Department of Pathology and Laboratory Medicine, University of Maryland School of Medicine, Baltimore.
Insights
Implementing a new algorithm for red blood cell (RBC) antibody identification (ABID) significantly reduced inconclusive results. This improved RBC crossmatch efficiency without adverse events in transfusion medicine.
Area of Science:
- Transfusion Medicine
- Immunology
- Clinical Pathology
Background:
- Inconclusive red blood cell (RBC) antibody identification (ABID) can impede timely RBC crossmatching.
- An increasing trend of inconclusive ABID results necessitated a review of existing workflows.
Purpose of the Study:
- To develop and implement an algorithm aimed at enhancing the efficiency of RBC antibody identification (ABID).
- To reduce the number of inconclusive ABID results and streamline the crossmatching process.
Main Methods:
- A retrospective analysis compared RBC antibody screen (AS) and ABID results before and after algorithm implementation.
- Initial testing utilized solid-phase RBC adherence assay (SPRCA) and manual tube methods.
- The algorithm refined the workflow, establishing SPRCA as the primary AS method and manual tube as the gold standard for ABID.
Main Results:
- The number of inconclusive ABID results decreased substantially, from 26 to six per month post-implementation.
- SPRCA facilitated the identification of 30 specific RBC antibodies under secondary review.
- No patients experienced signs or symptoms of hemolytic transfusion reactions following the implementation.
Conclusions:
- The revised RBC reference workflow, integrating SPRCA and manual tube methods for AS and ABID, effectively minimizes inconclusive results.
- This optimized workflow enhances transfusion safety and efficiency without compromising patient outcomes.
Objectives:
Inconclusive RBC antibody identification (ABID) may delay RBC crossmatch. An increased number of inconclusive ABID was observed, and an algorithm was developed to improve ABID efficiency.
Methods:
RBC antibody screen (AS) and ABID were initially performed using solid-phase RBC adherence assay (SPRCA) and manual tube method. A retrospective analysis of AS and ABID results was performed pre- and postalgorithm implementation.
Results:
The number of inconclusive ABID results decreased from 26 to six per month pre- and postimplementation, respectively. SPRCA became the primary AS method, and manual tube became the gold standard for ABID. SPRCA was used for ABID upon reference specialist secondary review and allowed identification of 30 specific RBC antibodies, for which no patients developed signs or symptoms of a hemolytic transfusion reaction.
Conclusions:
RBC reference workflow using SPRCA and manual tube methods for AS and ABID decreases "inconclusive" ABID without adverse events.
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