Algorithm to Manage Inconclusive RBC Antibodies by Reflex Manual Testing

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.