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North American pretransfusion testing practices, 2001-2004: results from the College of American Pathologists
Ira A Shulman1, Lieta M Maffei, Katharine A Downes
1Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles County-USC Medical Center, Los Angeles, California, USA. lshulman@usc.edu
Insights
Most North American labs use tube methods for pretransfusion testing, including ABO grouping and Rh typing. However, gel-based methods are increasingly used for antibody detection and crossmatching.
Area of Science:
- Transfusion Medicine
- Clinical Laboratory Science
- Hematology
Background:
- Pretransfusion testing is federally regulated under the Clinical Laboratory Improvement Amendments of 1988.
- Key regulated tests include ABO group, Rh D type, antibody detection, identification, and crossmatching.
- Various methods and reagents are available for these essential tests.
Purpose of the Study:
- To assess current pretransfusion testing practices in North American laboratories.
- Analyze trends in ABO grouping, Rh D typing, antibody detection, and crossmatching.
Main Methods:
- Analysis of data from the College of American Pathologists (CAP) Interlaboratory Comparison Program (Proficiency Testing) J-Survey (2001-2004).
- Data grouped by peer group (testing method) for ABO grouping, Rh D typing, antibody detection, and crossmatching.
- Evaluation of testing schemes used by over 4000 participating laboratories.
Main Results:
- Tube testing remains the predominant method for ABO grouping (91.1% in 2004) and Rh D typing (91.1% in 2004).
- Tube testing is also common for antibody detection (55% in 2004) and crossmatching (47.6% for alloimmunized, 40.4% for nonalloimmunized patients in 2004).
- A notable increase in the use of gel-based methods for antibody detection (42% in 2004) and crossmatching was observed.
Conclusions:
- North American laboratories predominantly favor tube methods for pretransfusion compatibility testing.
- There is a significant upward trend in the adoption of gel-based methods, particularly for antibody detection and crossmatching.
- CAP Survey data provide valuable insights into current practices and laboratory proficiency in transfusion medicine.
Context:
Pretransfusion testing of whole blood and red blood cell recipients is regulated by the federal government under the authority of the Clinical Laboratory Improvement Amendments of 1988. Regulated tests include determination of ABO group, Rh D type, antibody detection, antibody identification, and crossmatching. A wide variety of methods and reagents are available for these regulated tests. During 2001-2004, the College of American Pathologists (CAP) Interlaboratory Comparison Program (Proficiency Testing) J-Survey collected data from more than 4000 laboratories regarding their pretransfusion testing practices. Those data are presented in this report.
Objective:
To assess current testing practices for ABO grouping, Rh D typing, antibody detection, and crossmatching in North America.
Design:
Data collected for the CAP Interlaboratory Comparison Program (Proficiency Testing) J-Survey were analyzed for trends in laboratory testing practice during 2001- 2004. The data were grouped for analysis by peer group (testing method used) for ABO grouping, Rh D typing, antibody detection, and crossmatching and then analyzed. SETTING, PATIENTS, OR OTHER PARTICIPANTS: Subscribers to the CAP Interlaboratory Comparison Program Transfusion Medicine J-Series.
Results:
The most common testing schemes used in North America during 2001-2004 are as follows: ABO grouping (most laboratories perform tube testing: 97.6% in 2000 and 91.1% in 2004); Rh D typing (most laboratories perform tube testing: 97.7% in 2001 and 91.1% in 2004); antibody detection (most laboratories perform tube testing: 69.7% in 2001 and 55% in 2004, most frequently with the low ionic strength solution anti-human globulin [AHG] method, 48.3% in 2001 and 39.9% in 2004; as of 2004 slightly more laboratories use the gel AHG method [42%] than the low ionic strength solution AHG tube method); crossmatching for alloimmunized patients (most laboratories perform tube testing using a low ionic strength solution AHG method; 55.8% in 2001 and 47.6% in 2004); and crossmatching for nonalloimmunized patients (tube testing using an immediate spin method; 42% in 2001 and 40.4% in 2004).
Conclusions:
Most North American laboratories currently favor tube methods when performing ABO grouping, Rh typing, antibody screening, and crossmatching. However, there has been a significant increase in the use of gel-based methods in recent years, especially for antibody detection and crossmatching. Data collection and data analysis of CAP Interlaboratory Comparison Program Survey results allow for assessment of laboratory proficiency and provide insights into current North American practice trends in pretransfusion compatibility testing.
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