(P-IN-3) Times are Changing: A Process Review for Antibody Identification

Less staff and increased testing, Transfusion Services are struggling to keep up.  Decades ago, technologists would spend time trying various techniques to uncover the specificity of each antibody. They often employed multiple potentiators and enzyme panels to resolve every antibody that came into their department. These facilities typically had dedicated blood bank staff to work up challenging samples. Not all antibodies were considered clinically significant, but most all were identified. Now, with more generalists in the blood bank and cutting costs, Transfusion Services focus on administering a safe blood product while monitoring turnaround time (TAT) and reduction in send out cost especially for clinically insignificant antibodies. This is a retrospective study comparing the impact of process improvements for ABID from 2009 to 2023.

Study

Design/Methods:

We reviewed historical data for the past 15 years, including procedures, staff expertise, TAT, Antibody Identification (ABID) volumes, and ABID specificity.

Results/Findings:

In the past 15 years antibody detection assays increased 51% and our ABID increased 67%. In 2009, our rate of positive ABID was 5.28% which often included clinically insignificant antibodies. In 2023, our ABID positive rate dropped to 4.07% even as the patient complexity, such as oncology and monoclonal therapy drugs increased. This was a reduction of 1.21% or ~285 annual antibody workup’s that resulted in a reagent & labor savings (~$14,000).  In 2009, we employed hemagglutination testing with LISS. Historically, our ABID processes included performing ficin, mini-cold and multiple antibody panels to assist with ABID. These tests were very manual and labor intensive which resulted in requiring a dedicated blood bank staff. With the implementation of automation over the years, including two Echo Lumena's (Werfen, Norcross, GA), we reduced our detection of clinically insignificant antibodies and our send out cost.  Automation improved our TAT and allowed us the ability to employ more generalists.

Conclusions:

There is a need to perform antibody identifications, especially in a tertiary care hospital, but trying to juggle staffing constraints, less experienced technologists, hospital cost saving initiatives and reduced send out costs makes managing an active transfusion service very challenging.  Implementing automation helped with staffing and allowed us to integrate more generalists. In addition, it gave us an added technology benefit that reduced the detection of clinically insignificant antibodies, freed up staff, reduced our send out cost, TAT and allowed us to improve patient care.