A Nationwide Study on Pretransfusion Testing for 10 Years in Korea Using Health Insurance Review and Assessment...

Assessing pretransfusion testing utilization at medical institutions on a nationwide scale can be challenging. This study aimed to evaluate the status of pretransfusion testing in Korea by analyzing insurance claims data.

We identified all claims including pretransfusion testing or blood transfusion made between January 2011 and December 2020 from the Korean Health Insurance Review and Assessment Service database. ABO/RhD typing, antibody screening and identification, and crossmatching were analyzed according to the hospital type.

A total of 42,968,177 claims from 20,088,744 patients were analyzed. The median ratios of ABO serum typing to cell typing were 1.000 for tertiary hospitals, 0.998 for secondary hospitals, 0.000 for primary hospitals, and 0.000 for clinics (P < 0.001). Between 2016 and 2020, there was a 10.3-32.3 percentage-point increase in the proportion of automated ABO typing in tertiary hospitals, secondary hospitals, and clinics, while there was only a 1.9 percentage-point increase in primary hospitals. The median ratios of antibody identification to screening were 0.459% for tertiary hospitals, 0.359% for secondary hospitals, 0.198% for primary hospitals, and 0.139% for clinics (P < 0.001). For the first red blood cell (RBC) transfusion for each patient at each hospital, 71.5% of the patients from primary hospitals and 68.3% of the patients from clinics received RBC transfusion after only crossmatching without antibody screening.

The application of pretransfusion testing considerably differs according to the type of hospital in Korea. Primary hospitals and clinics need education and improvement in practice to pursue safe blood transfusion.