University of Alabama at Birmingham Birmingham, Alabama, United States
Background/Case Studies: Hospital X is a smaller hospital part of the University of Alabama at Birmingham (UAB) and is physically separate from the main UAB hospital. Hospital X operates with a limited-capacity blood bank, which has not undergone significant upgrades in staffing, storage, or processing capabilities. Even though the volume and complexity of surgical cases performed at Hospital X have increased, the infrastructure of the blood bank has remained relatively static. After multiple multidisciplinary meetings with surgery, anesthesia, transfusion medicine, risk management and leadership, the conclusion was to: increase the inventory of the Hospital X’s blood bank, add a new leadership role with more well-trained technicians, and implementing a consultation system with the main hospital blood bank regarding patients with clinically significant alloantibodies. In this abstract, we will review the consultation process and how it improved the outcome and workflow of Hospital X.
Study
Design/Methods: The preoperative team sends a surgical case list to the Hospital X blood bank the day before surgery to initiate antibody screening. If significant antibodies are identified, the on-call pathology resident is notified. The resident reviews each case based on surgical complexity and transfusion history, referencing the institution’s Maximum Surgical Blood Ordering Schedule (MSBOS) to guide crossmatching. Two or more additional units are typically crossmatched for antibody-positive patients beyond MSBOS recommendations to mitigate delays in securing compatible units. The resident consults with the transfusion medicine attending as needed and may coordinate with anesthesia and surgical teams for complex cases. We reviewed 20 cases between December 2024 and March 2025 involving antibody-positive patients. Each case was assessed for surgery type, antibody profile, and blood units ordered after consultation, compared to the standard MSBOS guidance.
Results/Findings: Table 1 summarizes the 20 collected cases of patients with a positive antibody profile who are planned for surgery the following day. Before implementing a formal consultation workflow, many of these surgeries may have been postponed or referred to the main hospital due to blood availability concerns. The new process demonstrated improved preparedness, with appropriate unit allocation and minimal disruptions to surgical scheduling.
Conclusions: Involving pathology residents in preoperative planning for patients with positive antibody screens proved effective in optimizing transfusion readiness at Hospital X. This collaborative model improved patient safety and allowed continued execution of complex surgeries at a satellite hospital with limited blood bank capacity, serving as a scalable model for other UAB-affiliated sites.
