Dear Blood Transfusion Laboratory Information System (LIS) Market Companies (Cerner, Haemonetics, Meditech, SCC Soft Computer, Sunquest, WellSky),

 

To improve patient safety and the operational efficiency of our transfusion care services, I, as a stakeholder, join other leaders, clients, clinicians, advocates, and patients to request your participation in the exchange of red blood cell (RBC) alloantibody information through enhanced vendor collaboration. 

 

The Alloantibody Exchange[1] is one such proposed innovation.

 

Access to antibody data from health systems outside of our own will achieve several essential goals.

 

Firstly, this will promote transfusion safety through shared knowledge of those antibodies which may have evanesced (become undetectable), and yet be capable of causing delayed hemolytic transfusion reactions (DHTRs), ie- destruction of blood transfusions which were not adequately selected to bypass the missed historic antibody.[2-5] Indeed, jurisdictions with better information centralization for blood matching have fewer transfusion matching errors and incompatibility-related outcomes, with DHTRs decreased by 50%.[6]

 

Secondly, this will improve blood bank efficiency by the time saved in acquiring patient alloantibody histories from diagnostic laboratories serving in a patient’s care journey – the range of which may go beyond patient recollection-, clinician handover-, and transfusion staff interrogation- capacities.

   

It follows that re-consolidating compatibility-testing history in such a manner will also permit more secure and accurate transmission of information than phone and fax communication.[7]    

 

I urge you to prioritize the measures required for inter-operability.

 

I am not alone in considering this functionality to be of the utmost importance, and I anticipate that vendors leading in this capability will inform future LIS contract decisions that I or others in my community may make.

 

Moreover, I am cognizant of this being an issue of particular importance in sickle cell disease (SCD) – a condition that tracks with African ancestry, which in turn reflects more immunogenetic diversity[8, 9] and structural disadvantage/discrimination.[10, 11]   Taken together, patients with SCD are at risk of having more antibodies,[12, 13] with more of these being missed in part owing to the more fragmented or dispersed nature of healthcare,[14, 15] and with more severe DHTRs described.[16, 17] 

 

Lives and healthcare system costs are at stake here.[18]

 

Thank you for your consideration and the striving towards critical health information service solutions.

 

1.            Hauser RG, Hendrickson JE. Alloantibody Exchange. Available from: https://www.alloantibody.org/

2.            Unni N, Peddinghaus M, Tormey CA, Stack G. Record fragmentation due to transfusion at multiple health care facilities: a risk factor for delayed hemolytic transfusion reactions. Transfusion. 2014;54(1):98-103. Epub 2013/05/29. doi: 10.1111/trf.12251. PubMed PMID: 23711236.

3.            Delaney M, Dinwiddie S, Nester TN, Aubuchon JA. The immunohematologic and patient safety benefits of a centralized transfusion database. Transfusion. 2013;53(4):771-6. Epub 2012/07/19. doi: 10.1111/j.1537-2995.2012.03789.x. PubMed PMID: 22803792.

4.            Harm SK, Yazer MH, Monis GF, Triulzi DJ, Aubuchon JP, Delaney M. A centralized recipient database enhances the serologic safety of RBC transfusions for patients with sickle cell disease. Am J Clin Pathol. 2014;141(2):256-61. Epub 2014/01/18. doi: 10.1309/AJCP47QAAXTOZEKJ. PubMed PMID: 24436274.

5.            Mathur G, Wilkinson MB, Island ER, Menitove JE, Tilzer L. A case for a national registry of red blood cell antibodies. Vox Sang. 2022;117(5):738-40. Epub 2022/01/14. doi: 10.1111/vox.13250. PubMed PMID: 35023153.

6.            van Gammeren AJ, van den Bos AG, Som N, Veldhoven C, Vossen R, Folman CC. A national Transfusion Register of Irregular Antibodies and Cross (X)-match Problems: TRIX, a 10-year analysis. Transfusion. 2019;59(8):2559-66. Epub 2019/05/24. doi: 10.1111/trf.15351. PubMed PMID: 31121075.

7.            Stephens L, Miller H, Coppola L. Transfusion medicine diagnostic error by facsimile. Transfusion. 2022;62(6):1157-8. Epub 2022/04/09. doi: 10.1111/trf.16875. PubMed PMID: 35394673.

8.            Yu N, Chen FC, Ota S, Jorde LB, Pamilo P, Patthy L, et al. Larger genetic differences within africans than between Africans and Eurasians. Genetics. 2002;161(1):269-74. Epub 2002/05/23. doi: 10.1093/genetics/161.1.269. PubMed PMID: 12019240; PubMed Central PMCID: PMCPMC1462113.

9.            Chou ST, Evans P, Vege S, Coleman SL, Friedman DF, Keller M, et al. RH genotype matching for transfusion support in sickle cell disease. Blood. 2018;132(11):1198-207. Epub 2018/07/22. doi: 10.1182/blood-2018-05-851360. PubMed PMID: 30026182.

10.          Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, et al. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health. 2015;105(12):e60-76. Epub 2015/10/16. doi: 10.2105/AJPH.2015.302903. PubMed PMID: 26469668; PubMed Central PMCID: PMCPMC4638275.

11.          Power-Hays A, McGann PT. When Actions Speak Louder Than Words - Racism and Sickle Cell Disease. N Engl J Med. 2020;383(20):1902-3. Epub 2020/09/02. doi: 10.1056/NEJMp2022125. PubMed PMID: 32871062.

12.          Karafin MS, Westlake M, Hauser RG, Tormey CA, Norris PJ, Roubinian NH, et al. Risk factors for red blood cell alloimmunization in the Recipient Epidemiology and Donor Evaluation Study (REDS-III) database. Br J Haematol. 2018;181(5):672-81. Epub 2018/04/21. doi: 10.1111/bjh.15182. PubMed PMID: 29675950; PubMed Central PMCID: PMCPMC5991618.

13.          Silvy M, Tournamille C, Babinet J, Pakdaman S, Cohen S, Chiaroni J, et al. Red blood cell immunization in sickle cell disease: evidence of a large responder group and a low rate of anti-Rh linked to partial Rh phenotype. Haematologica. 2014;99(7):e115-7. Epub 2014/04/15. doi: 10.3324/haematol.2014.104703. PubMed PMID: 24727821; PubMed Central PMCID: PMCPMC4077098.

14.          Panepinto JA, Owens PL, Mosso AL, Steiner CA, Brousseau DC. Concentration of hospital care for acute sickle cell disease-related visits. Pediatr Blood Cancer. 2012;59(4):685-9. Epub 2011/12/20. doi: 10.1002/pbc.24028. PubMed PMID: 22180290; PubMed Central PMCID: PMCPMC3310931.

15.          Williams LA, 3rd, Lorenz RG, Tahir A, Pham HP, Marques MB. High Percentage of Evanescent Red Cell Antibodies in Patients with Sickle Cell Disease Highlights Need for a National Antibody Database. South Med J. 2016;109(9):588-91. Epub 2016/09/07. doi: 10.14423/SMJ.0000000000000528. PubMed PMID: 27598370.

16.          Vidler JB, Gardner K, Amenyah K, Mijovic A, Thein SL. Delayed haemolytic transfusion reaction in adults with sickle cell disease: a 5-year experience. Br J Haematol. 2015;169(5):746-53. Epub 2015/03/11. doi: 10.1111/bjh.13339. PubMed PMID: 25753472.

17.          Habibi A, Mekontso-Dessap A, Guillaud C, Michel M, Razazi K, Khellaf M, et al. Delayed hemolytic transfusion reaction in adult sickle-cell disease: presentations, outcomes, and treatments of 99 referral center episodes. Am J Hematol. 2016;91(10):989-94. Epub 2016/06/28. doi: 10.1002/ajh.24460. PubMed PMID: 27348613.

18.          Viayna E, Gehrie EA, Blanchette C, Meny GM, Noumsi G, Huber M, et al. Red cell alloimmunization is associated with increased healthcare costs, longer hospitalizations, and higher mortality. Blood Adv. 2022. Epub 2022/08/09. doi: 10.1182/bloodadvances.2022006982. PubMed PMID: 35939787.