Department of Pathology and Laboratory Medicine, Diagnostics Institute, Cleveland Clinic, Ohio, United States
Background/Case Studies: Transfusion Medicine employs a variety of testing strategies and includes the use of red blood cell (RBC) phenotyping with reagent antisera. The extent of phenotyping performed on a patient’s RBCs is guided by laboratory policy. “Extended” RBC phenotyping was frequently performed at our blood bank as part of the antibody workup, in alignment with practices modeled after reference laboratories. We evaluated the impact of the newly implemented policy designed to focus phenotyping on clinically indicated scenarios, along with a cost analysis to assess the financial and operational effects of this targeted approach.
Study
Design/Methods: In November 2023, the blood bank implemented a revised policy on RBC antigen phenotyping. Table 1 outlines the key differences between the previous and revised policies. To assess the operational and financial impact of the change, a 14-month analysis was conducted, focusing on cost savings and technologist time utilization under the revised protocol. Cost analysis was based on serologic antigen typing performed using the tube method. This included all components of technologist labor, such as labeling test tubes, preparing cell suspensions, observing agglutination reactions, and completing both paper and electronic documentation. In addition to labor, the analysis incorporated the cost of all consumables used during testing, including saline, antisera, anti-IgG, reagent red cells, test tubes, pipettes, and quality control materials.
Results/Findings: During the 14-month review period, 1,704 patients met the criteria outlined in Table 1, which included individuals with a diagnosis of sickle cell disease and/or thalassemia major (at first presentation), patients receiving daratumumab, and patients with a positive antibody screen (at first presentation or with new findings compared to previous antibody screens). Following implementation of the revised policy, a total of 672 individual antigen typing tests were performed across these 1,704 patients. In contrast, under the former policy, an additional 11,300 antigen typing tests would have been required for the same cohort. This change resulted in an estimated cost savings of $754,182.70 and a reduction of approximately 422.7 hours of technologist hands-on time.
Conclusions: The optimization of RBC antigen typing policy significantly reduced unnecessary antigen typing, leading to measurable improvements. The change resulted in substantial cost savings and reduced technologist workload. In addition to financial and operational benefits, the project aligned our blood bank practices more closely with evidence-based transfusion guidelines, promoting responsible resource utilization without compromising patient care. In an era of increasing healthcare demands and constrained laboratory resources, this work serves as a model for data-driven, patient-centered test utilization in blood bank operations.
