Banner University Medical Center Tucson, Arizona, United States
Background/Case Studies: Not all antibodies read textbooks and react as expected allowing antibody identification (ABID) with just one panel. Historically, transfusion facilities would rely on a supplemental panel purchased specifically for such a purpose. Using the technologist’s expertise to analyze the panel and select just the right cell(s) to rule in or rule out the antibodies in the most efficient way. Our transfusion medicine department implemented two Echo Lumena instruments (Immucor, Norcross, GA) which do not have the capability to automate selected cells. Instead, we run a full secondary panel on the analyzers. Both selected cells and a full secondary panel are usually sufficient to complete the ABID. The aim of this study is to compare workflow and cost of running selected cells verses a complete secondary panel.
Study
Design/Methods: A time study was performed with two samples: one containing an anti-Jka and a second with both anti-E and anti-K. ABO/Rh and antibody detection testing (ADT) was initially performed on the Lumena. As with any other sample with a positive ADT, a 14-cell automated ABID panel was reflexed. The time study commenced at the end of this initial panel. Two technologists were timed to perform selected cells and then a full automated secondary panel. The average for each then was calculated. Additional data compared labor (LC) and reagent (Rgt) costs.
Results/Findings: The total reagent cost to run selected cells was less than the complete automated secondary panel at $23.12 and $25.02 respectively (Table 1). The average tech time required to perform selected cells was 31 minutes longer than the 8 minutes tech time required to run a 14-cell automated ABID panel, with a reduced turnaround time of 48%. Total reagent and labor costs were 31% more with selected cells compared to a full secondary panel. Conclusions: As staffing limitations have evolved and less dedicated techs are staffed in the blood bank, labs are redesigning how we perform ABID testing. Based on this study, it is more efficient to automate a full additional 14- cell panel then revert to selected cells. For our institution and our entire 13 hospital healthcare system, we have found this to be an ideal ABID process. Even for the most difficult samples, to us it is more beneficial to run a third full panel than opt for selected cells that require more labor, expertise in determining controls and ensuring the correct selected cells were included. This also reduces our potential for increased clerical errors with automate antibody panels.
Importance of research: As staffing limitations have evolved and less dedicated techs are staffed in the blood bank, labs are redesigning how to perform antibody identification testing. The aim of this study is to compare workflow and cost of running selected cells verses a complete secondary automated panel which included labor cost, reagent cost and turnaround time. The comparison included multiple antibodies and technologists in a time study for selected cells and a completed automated secondary panel.
