Performance of 0.8 percent reagent red blood cell panels after extended on-board analyzer utilization

Automated pre-transfusion testing provides significant improvements in efficiency and productivity along with a reduction of the potential for errors. With reflex test capability and bidirectional Laboratory Information System interfacing, enhanced levels of effectiveness can be achieved in delivery of test results. To improve efficiency and productivity in our laboratory related to antibody identification (AbID) on our automated testing analyzer, we conducted a study that would allow for extended on-board utilization of our AbID reagent red blood cells (RRBCs). Our current process requires loading the 0.8 percent AbID RRBC panel onto the analyzer at the time of antibody detection and then removing and returning it to refrigerated storage once the AbID test has been completed. Our study was conducted at two hospital sites with an initial pilot study to determine the feasibility of using the RRBC panel on board with evaporation caps over a 7-day timeframe upon initial use of the panel and at two different timeframes later in the panel shelf life. Once the initial pilot study was completed and the feasibility of use established, a secondary study was initiated to determine if stability of reactivity was maintained using a rotational approach of time on board the analyzer compared with time in standard refrigerated storage. A 12-hour rotation at hospital 1 over a 2-week period and a 24-hour rotation at hospital 2 over a 3-week period were evaluated. Anti-c and anti-Fy^a were used at one site while the other site used anti-E and anti-K. Respective negative controls were tested at both sites. Results of the pilot study demonstrated that the reactivity of the antibodies tested over the 7-day timeframe was maintained along with antibody specificity. The secondary study demonstrated sustained reactivity strength when using the rotational approach but showed occasional yet inconsistent results with respect to specific RRBC deterioration, fibrin in patient's plasma, or indeterminate occurrence. Based on the results of the study, a 7-day on-board utilization protocol was established for routine use. The new extended on-board protocol offers enhanced performance, efficiency, and safety for our transfusion medicine operations.