An Experience of Various Pretransfusion Test Protocols in a Tertiary Referral Hospital / 대한수혈학회지

BACKGROUND: Pretransfusion tests are essential for safe transfusions, but occasionally, part or all can be omitted when a transfusion is needed urgently in an emergency. The purpose of this study was to share the authors' experience of various pretransfusion test protocols in a tertiary referral hospital in Korea. METHODS: From July 2016 to June 2017, all transfusion cases at Samsung Medical Center were analyzed retrospectively. For each pretransfusion test protocol, the parameters regarding issue, return and disposal rate of blood products, occurrence of hemolytic transfusion adverse effect, and prescription frequency of each respective department and ordering site were analyzed. RESULTS: A total of 90,539 units of red blood cells, 24,814 units of fresh frozen plasmas, 24,758 units of single donor platelets, and 23,303 units of platelet concentrates were issued during the study period. Among them, 3.6%, 1.8%, 0.3%, and 0.4% of red blood cells, fresh frozen plasmas, single donor platelets, and platelet concentrates were issued according to the emergency transfusion protocols. When various pretransfusion test protocols were applied to issue blood products, there was no case in which an adverse hemolytic transfusion reaction was suspected. When compared with usual pretransfusion test protocol, all emergency transfusion protocols showed significantly higher return and wastage rates in red blood cells and fresh frozen plasmas. Platelets also had a higher return and wastage rate, but the difference was not significant. CONCLUSION: These results suggests that there is no different risk of adverse hemolytic transfusion reaction regardless the pre-transfusion protocols, but management about of the increased rate of return and wastage of blood products in emergency transfusions should be considered.

Evaluation of an Automated Solid-phase Cell Adherence Assay in the Galileo System (Immucor) for Routine Pretransfusion Tests / 대한수혈학회지

BACKGROUND: In spite of a trend of automation for conducting most clinical laboratory tests, many blood banks are still dependent on manual tests. The aim of this study was to evaluate a full automation system called the Galileo (Immucor, USA) for conducting pretransfusion tests. METHODS: From August to October in 2009, a total of 3,002 cases of ABO-RhD typing and 1698 cases of antibody screening were compared between using manual tests and the Galileo system at Seoul National University Hospital, Seoul, Korea. For the manual tests, we used the slide method for ABO-RhD typing and the anti-human immunoglobulin treated microplate method for antibody screening. The Galileo system used the microplate method for ABO-RhD typing and the solid-phase red cell adherence (SPRCA) method for antibody screening. We calculated the overall concordance rate and the false positive or negative rates regarding the manual method as a standard test and the Galileo system as a comparative test. RESULTS: When comparing 3,002 cases of ABO-RhD typing, 52 cases (1.7%) were retested. A discrepancy between the two tests remained in 17 cases (0.6%) after repetition, which led to a concordance rate of 99.4% (2,985/3,002). On the comparison of 1,698 cases of antibody screening, 54 cases (3.2%) were retested. A discrepancy between the two tests remained for 30 cases (1.8%) and the concordance rate was 98.2% (1,615/1,698). Among the 20 false negative cases (1.2%), nine were thought to be cold antibodies with no cases of confirmed warm antibody. CONCLUSION: The automated Galileo system and the preexisting manual tests showed very good concordance for ABO-RhD typing and antibody screening. The Galileo system can be used with confidence for routine pretransfusion tests.

A Case of anti-Xga in a Patient with Chronic Liver Disease / 대한임상병리학회지

A 49 years old male patient suffering from liver cirrhosis and diabetes mellitus was admitted with complaints of chest pain and hematemesis. Three years ago, the patient received a transfusion of unknown blood components, presumed platelet concentrates. During the pretransfusion testing, we found irregular antibodies with the antibody-screening test and identified the antibody as anti-Xga. An antiglobulin test was done as a part of a cross-match and all compatible units of packed red cells were transfused. No transfusion reaction was observed.