Electronic Crossmatch

From Clinfowiki
Jump to: navigation, search

Despite advance in technology, ABO incompatibility remain the top 5 causes of transfusion fatality in the US for the past 5 years. (1) To ensure ABO compatibility, the U.S. Food and Drug Administration (FDA) and AABB required blood bank typing both the donor and recipient blood type, and the unit be crossmatch. Crossmatch can be done through serological method which involves testing of recipient's serum and donor red cells to detect ABO incompatibility and clinically significant antibody or through the use of electronic crossmatch which involve the use computer algorithm to prevent ABO incompatible unit from being released. For patients with a negative antibody screen and no history of unexpected antibody, both immediate spin serological and electronic crossmatch can be used to meet the FDA and AABB crossmatch requirement.

Electronic crossmatch

Electronic crossmatch had been used since the early 80, Sweden had implemented electronic crossmatch at the national level since 1983. (2) The first US hospital to utilize electronic crossmatch is the University of Michigan in 1992, articles and studies were published by the group in University of Michigan after implementation which lead to increase use of electronic crossmatch. (3) Electronic crossmatch can reduce sample volume, lab supplies cost, labor cost and allow for remote issuing of blood products, since testing can be done at a central blood bank with unit stored at a remote location electronically crossmatch. Despite those advantages, the use of electronic crossmatch is not widespread in US, according a survey done by the College of American Pathologists (CAP) in 2007, only 400 of the 3000 blood banks survey used electronic crossmatch. (4) Some of the barriers in electronic crossmatch including:

  • Time required for validation, since compatibility testing is regulated by both FDA and AABB. Blood banks validation must meet both agencies requirements.
  • Training, most blood bank technologists are familiar with the use of serological crossmatch, but electronic crossmatch will require additional time in training technologist on the use of blood bank information system.
  • Software, not all laboratories have blood bank information system that can perform electronic crossmatch.
  • Reimbursement, serological crossmatch is coded as CPT 86920 which reimbursed at $20.44 under Medicare, but electronic crossmatch is coded as CPT 86923 reimbursed only at $13.07 under Medicare. Therefore blood bank can lose almost 40% in reimbursement if switching to electronic crossmatch. Due to DRG, unless a blood bank had a significant volume of outpatient transfusion the impact on the actual amount of reimbursement receive is minimal.

Despite those barriers the use of electronic crossmatch will likely increase in the near future, as blood bank is under pressure to cut cost and reduce turnaround time. At the same time, laboratories across US are facing staffing shortage due to both lack of graduates and baby boomers start to retire. Implementation of electronic crossmatch can help blood bank reduce cost and improve quality of service.

Reference

FDA Center for Biologics Evaluation & Research. (2010, March 22). Annual Summary for Fiscal Year 2009. In Fatalities Reported to FDA Following Blood Collection and Transfusion. Retrieved February 25, 2011, from http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/ucm204763.htm

Judd, J. (2005). Electronic Crossmatching - A Global Perspective. Ortho Worldwide Immunohematology Resource for Education.

Önder, Arslan. Electronic Crossmatching. Transfusion medicine reviews 1 January 2006 (volume 20 issue 1 Pages 75-79)

College of American Pathologists (2009). The Electronic Crossmatch: Past and Present. College of American Pathologists, educational challenge survey J-C(2009)

Judd, J. (1998). The Electronic Crossmatch. Advance for Medical Laboratory Professionals (July, 1998 issue)

Submitted by (Michael Yu)