After blood is donated, it goes through a series of rigorous tests to ensure that it is safe to transfuse in a patient. New findings from a recent graduate of BloodCenter of Wisconsin’s Specialist in Blood Banking Program will add efficiency to the testing process when antibodies are present, helping labs all over the world match donations to patients in need.
BloodCenter of Wisconsin’s Specialist in Blood Banking (SBB) Program was established in 1965 and is one of the longest-running programs of its kind in the country. Program participants earn a certificate on top of a master’s degree from Marquette University, and the program provides its students with a broad education in all aspects of blood banking, including donor testing, patient testing, phlebotomy and more.
One such patient test is an antibody screen, which detects any antibodies a patient may have made from previous blood transfusions or pregnancies. Antibodies identify foreign antigens like bacteria and viruses, disable those antigens and signal the body’s immune system to kick in.
Red blood cell antibody testing is important to ensure that patients do not experience negative reactions to blood transfusions. In standard test tube antibody testing, laboratory professionals take whole red cells and mix them with a patient’s plasma to see if there is a reaction. However, many labs are moving toward solid-phase antibody testing, an automated testing platform in which holes are punched in red cells and the liquid is cleared away, so that the membrane of the cell is all that’s left. The patient’s plasma can then be tested against it.
Many hospitals, including Froedtert, have moved toward solid-phase testing because it can be automated, and because it decreases the amount of time between a donor giving blood and that blood being transfused into a patient. Most times, when an antibody screen comes up positive, it’s easy to identify the antibody. However, in some patients, it’s much more difficult to figure out what the antibody screen picked up and why it came back positive. This can delay the process of matching patients with needed blood transfusions.
As part of her Specialist in Blood Banking student project, Nichole Miller sought to understand why some solid-phase antibody testing resulted in false positives, and if they would come up positive via the standard test tube method. For the article “Patient factors associated with unidentified reactivity in solid-phase and polyethylene glycol antibody detection methods,” Miller took a look at patients whose antibody screens came back positive to determine if something specific about each patient resulted in a positive test. She found that positive antibody screens were more closely tied to females (likely because of past pregnancies), patients with autoimmune diseases (who make more antibodies in the first place), and patients with chronic diseases.
Solid-phase antibody testing is more sensitive compared to test tube methods, and it is not uncommon for false positives to arise. What Miller wanted to know was whether the positives found through solid-phase testing were early indicators of an antibody developing, or if they were junk results. Solid-phase testing increases throughput, but false positives tend to require rework for lab technicians, thus lengthening the amount of time between blood being drawn from a donor and transfused in a patient. Miller determined that, while there were some false positives linked to a patient’s sex and underlying clinical diagnosis, the incidence of new, unidentified reactivity in solid-phase antibody testing does occur. The data pointed to some false positives on the solid-phase that were early signs of antibody development.
These research findings will help make the blood testing process more efficient and could eliminate the need for re-work by laboratory technicians. Not only will patients receive matched blood, but it will be available to them much sooner.
Miller has since graduated from the Specialist in Blood Banking Program and continues her work with BloodCenter of Wisconsin as Specialized Production Manager, managing platelet production and quality control testing of blood products. Having her student project published “was a feeling of accomplishment, not only for me, but for the program overall,” she said.
“I was able to take my Specialist in Blood Banking education and put it to use to help advance the knowledge of patient care on a newly advancing technology.”
About the expert: Nichole Miller is a Specialized Production Manager at BloodCenter of Wisconsin. She recently graduated from the Specialist in Blood Banking Program and earned a master’s degree from Marquette University.