(P-IN-1) Are Equivocal Results Significant with an Automated Analyzer?

Blood bank analyzers help streamline processes and improve patient care. However, they can also present their own set of challenges along with managing difficult patients, multiple antibodies, monoclonal drug therapies, and host of other complications. Antibody reactivity may rise and fall. Therefore, weak reactions cannot be ignored as they may develop into a clinically significant antibody.  This is a retrospective study to determine if specimens that initially resulted with equivocal (?) results developed a clinically significant antibody on subsequent testing.

Study

Design/Methods:

In 2023, antibody detection (AD) and antibody identification (ABID) assays were performed on two Echo Lumena instruments (Werfen, Norcross, GA). In this study, all ABID panels over a 9-month period were reviewed to determine if a (?) result coincided with an antibody being identified on a subsequent visit. For results that were positive in the second visit, was there an antibody identified that previously reacted (?). 

Results/Findings:

Samples (27) met our criteria with (?) reactions. Out of the 27 samples, the ABID panel gave a range from 1-5 (?) cells, demonstrating equivocal results during initial testing.  

Patients returned for repeat testing on average 62 days later. Of the 27 patients, 4 patients tested negative for AD (17%) and 23 (83%) patients tested positive for AD on subsequent testing resulting in identifying a clinically significant antibody. The most common antibodies identified: anti-E (43%), anti-Jka (17%) and anti- Fya (13%).

Conclusions:

When technologists are busy and pulled in various directions it takes additional time and resources to investigate (?) results. Often these results may show a pattern or if no pattern is clear, they are reported out as inconclusive. Our retrospective study over a 9-month period documented that 83% of the time a clinically significant antibody could be identified in a subsequent sample. This proved that a questionable result is significant and could have been forming an antibody in the initial sample. Due to these finding we are considering patient crossmatching with the same technology as ABID, to ensure the same sensitivity for the best patient outcome. Facilities might consider performing their own study to determine if initial equivocal results have developed into a clinically significant antibody.