Optimising the workflow for infant ABO blood typing: The role of automated analyser and a manual reflex protocol

We aimed to optimise the infant ABO typing workflow by evaluating the performance of the ORTHO VISION analyser (VISION; QuidelOrtho, San Diego, CA, USA) and establishing a targeted manual reflex protocol.

The application of automated analysers in infants poses challenges due to weak antigen and antibody expression.

We reviewed ABO blood typing results from 1178 infants who underwent routine dual testing using both the VISION and the manual tube method at our centre. Samples were grouped by age: Group 1 (under 4 months, N = 898, forward typing only) and Group 2 (4 months to under 1 year, N = 280, both forward and reverse typing).

The VISION showed almost perfect agreement with the manual method (weighted kappa >0.94). In Group 1, the manual method showed a higher conclusive rate (100% vs. 98.7%; p < 0.001), resolving 12 technical flags. In Group 2, the VISION demonstrated a higher conclusive rate (71.4% vs. 66.4%, p = 0.006) due to superior sensitivity in detecting early anti-A antibodies (p < 0.001). Inconclusive results in Group 2 correlated significantly with younger age (p < 0.001) but not sex or diagnosis. The proposed algorithm is estimated to reduce the manual workload by 92.2% compared to the previous dual-protocol.

The VISION is a reliable alternative to manual testing for infant ABO blood typing. Our proposed targeted reflex algorithm can minimise operational fragmentation and systemic human error, thereby optimising laboratory efficiency while maintaining patient safety.