Routine donor red cell antibody screening: Considering the alternate strategy

Area of Science:

• Transfusion Medicine
• Immunohaematology
• Blood Safety

Background:

• Australian Red Cross Lifeblood screens all whole blood donations for red blood cell (RBC) antibodies.
• An alternative strategy proposes screening only on the first donation, with repeats only after specific events like pregnancy or transfusion.
• This study assesses the blood safety implications of reducing routine antibody screening.

Purpose of the Study:

• To evaluate the blood safety risks of an alternate RBC antibody screening strategy.
• To quantify undetected antibodies under the proposed alternate strategy.
• To determine the acceptability of increased residual risk in blood transfusion.

Main Methods:

• Retrospective analysis of whole blood donations from May 2018 to April 2019.
• Quantification of antibodies that would have been missed by the alternate strategy.
• Assessment using the Alliance of Blood Operators Risk-Based Decision-Making framework.

Main Results:

• 171 routine donors developed new antibodies without a reported sensitizing event.
• 47 of these had clinically significant antibodies with potential to cause haemolytic transfusion reactions (HTRs).
• The calculated risk of transfusing incompatible blood due to undetected antibodies is 1 in 82,200.

Conclusions:

• The alternate strategy increases the risk of HTRs.
• Despite being cost-effective, the additional residual risk was considered unacceptable.
• Blood services must weigh the tolerability of increased residual risk against potential cost savings.