Organizing the Antibody Identification Process

Extract

The focus on patient safety issues in recent years has led to implementation of hospital-wide processes meant to decrease risk of errors that lead to adverse events. The consequences of patient identification errors or testing errors even in as straightforward a procedure as ABO typing have been recognized for years.^1-5 Ongoing concerns about transfusion-transmitted disease have resulted in enhanced testing for viral diseases such as hepatitis C, human immunodeficiency virus, and West Nile virus. Changes in blood donation criteria have been made in response to the emergence of Chagas disease, Lyme disease, and babesiosis. Electronic procedures such as bar-coding for patient identification are additional methods that increase transfusion safety.^6,7 There is a concurrent push for physicians to decrease allogeneic transfusion volume. Some methods for this include re-evaluation of traditional transfusion triggers, review of surgical blood order schedules, and promotion of autologous products and intra-operative blood conservation.^8-11

Despite the alternatives to allogeneic transfusion, there are occasions when a patient must receive a transfusion during surgery or perhaps a series of transfusions due to chronic disease or treatment for malignancy. Despite the relative safety of the blood supply, there is no way to prevent transfusion-triggered alloimmunization. Patients undergoing chemotherapy may require extensive component support. One study of a group of cancer patients showed that approximately 9% formed alloantibodies and that risk of developing alloantibody was 0.5% per unit transfused.¹² Other studies have shown that once patients had developed a single specificity, they had increased probability of developing additional specificities.¹³ Some patients initially…

ABBREVIATIONS: UAB = Universtity of Alabama at Birmingham Hospital; DAT = direct antiglobulin test.