背景:温暖的自身抗体(WAAs)在使用传统方案(TP)确定合适的产品时会导致延迟和额外费用。2013年,CarterBloodCare免疫血液学参考实验室(IRL)为WAA患者引入了分子方案(MP)。
方法:对2004年11月至2020年9月提交IRL的样本记录进行回顾性审查。推荐人,同种抗体(ies),性别,并记录了年龄。此外,记录MP患者表型匹配红细胞(RBC)所需的常见临床显著抗原的计数.为了进一步分析使用WAA测试患者的费用和时间,选择300名患者。
结果:对转诊医院的平均费用和在IRL中进行测试所花费的时间的分析确定了两次或更多次转诊时的节省。总的来说,研究中300名患者中有219名(73%)达到或超过了转诊人数。进一步的分析表明,尽管WAA患者(n=300)的人口统计学特征相似,在TP(M=264.18,SD=15.06)和MP(M=156.00,SD=90.37)的平均时间测试患者之间存在统计学上的显着差异,t(157)=14.46,p<.001,95%置信区间[CI](93.41-122.97)。此外,假设每个患者每次转诊接受两次红细胞,在TP(M=1222.58,SD=165.69)和MP(M=1269.78,SD=433.52)的患者医院平均费用之间没有统计学上的显着差异,t(192)=-1.25,p=.214,95%CI(-121.95-27.54)。
结论:MP有效节省了WAA患者的测试时间,这有利于转诊医院,病人,和IRLs。预防性表型匹配血液的费用可以忽略不计,MP将减轻当前的一些实验室困难,同时为患者提供安全的产品。
Warm autoantibodies (WAAs) cause delays and additional expenses while determining suitable products when using a traditional protocol (TP). In 2013, Carter BloodCare Immunohematology Reference Laboratory (IRL) introduced a molecular protocol (MP) for patients with WAAs.
Retrospective review of records for samples referred to the IRL from November 2004 to September 2020, was performed. Referrals, alloantibody(ies), gender, and age were recorded. Additionally, the count of common clinically significant antigens needed for phenotypically matched red blood cells (RBCs) were recorded for patients in MP. To further analyze charges and time spent testing patients with WAAs, 300 patients were selected.
Analysis of average charges to the referring hospital and time spent testing in the IRL determined savings at two or more referrals. Overall, 219 of 300 (73%) of patients in the study met or exceeded the number of referrals. Further analysis shows that while the population of patients with WAA (n = 300) shared similar demographics, there was a statistically significant difference between the average time testing patients in TP (M = 264.18, SD = 15.06) and MP (M = 156.00, SD = 90.37), t(157) = 14.46, p < .001, 95% confidence interval [CI] (93.41-122.97). Additionally, the assumption that each patient received two RBCs per referral provided no statistically significant difference between average charges to the hospitals of patients in TP (M = 1222.58, SD = 165.69) and MP (M = 1269.78, SD = 433.52), t(192) = -1.25, p = .214, 95% CI (-121.95-27.54).
The MP has been effective in saving time spent testing patients with WAAs, which benefits referring hospitals, patients, and IRLs. Charges for prophylactic phenotypically matched blood were negligible and a MP would alleviate some of the current laboratory difficulties while providing safe products to patients.