As analyzers evolve, so does transfusion medicine

As analyzers evolve, so does transfusion medicine

By: Fernando Chaves   

September 21, 2017

Today, labs face growing pressure to do more with less and produce the most accurate results for the best patient outcomes. These issues are even more severe in blood banking because it is a specialty with one of the highest overall vacancy rates in the United States.1 In part as a response to these pressures, transfusion medicine is experiencing a breakthrough in blood bank solutions.

Immunohematology is the science of blood compatibility, whose application is to ensure that each patient receiving a blood transfusion is matched correctly to the transfusion that he or she receives. Tests to identify antigens and antibodies in both the blood of the donor and the recipient have historically been performed by manual tube techniques, which are time consuming and prone to human subjective interpretation. Due to this limitation, blood banking has focused primarily on identifying those blood type incompatibilities most relevant to patients, because they can cause immediate and potentially fatal transfusion reactions. That’s why the blood types most commonly known are A, B, AB or O, and Rh, whether positive or negative.

Blood analyzers in transfusion medicine

Traditionally, immunohematology testing was done manually. The cells of the donor and the serum of the recipient are mixed together in a single tube, and the blood banker makes a visual assessment to determine the results. Compatibility is determined primarily by whether the cells are clumping together. This approach presents challenges in that the results are subject to human interpretation and error and testing is labor-intensive.

Analyzers were available for testing in other areas of medicine long before they were developed for transfusion medicine about 20 years ago. The technology offered a way to remove human error from testing and improve lab efficiency. The fundamental advantages of blood analyzers are the decrease in labor required and the increase in the consistency and efficiency of results. They may also use computer algorithms to determine results, providing a standardization of measurement.

More recently, analyzers have helped labs optimize their blood bank capabilities, going beyond types and screens to offer a full range of testing, including serial dilutions for titration studies and selected cell panels. They combine secure monitoring technology and dynamic workflow management to enhance accuracy and efficiency. They also provide responsive safety checks and balances to give blood bankers the ability to monitor and record every step of the automated process. There are several different kinds of analyzers for transfusion medicine. Some are designed to respond to challenges unique to each lab with customization features and the adaptability to accommodate unpredictable workflows while reducing the need for batch testing.

Because automation in transfusion medicine has made labs more efficient, it also has helped ease the effect that a lack of specialized technicians has had on the industry. In the past few years, there has been a trend for laboratorians to be generalized. Blood banking, which is critical to the basic function of any hospital, has suffered a particularly serious need for highly trained personnel.

As a result, analyzers have been widely adopted by blood banks in the U.S.; however, this has not been the case in every country around the world. One challenge to incorporating analyzers is the need for a sufficient volume of testing to justify the investment in the instrument. For labs whose volumes do not justify fully automated solutions, semi-automated systems have been created to manually perform the test and use an analyzer to read results. This saves on labor and provides the desired consistency and accuracy even for mid- to low-volume laboratories.

Anticipated breakthroughs

To date, analyzers in immunohematology have primarily addressed efficiency needs such as throughput, cost, and turnaround time. The time has come for the focus to be on improvements that can clinically impact blood recipients. Beyond the ABO and Rh blood typing systems, there are many other antibodies and antigens which can impact patients. It is easy to forget them simply because we don’t routinely test for them all of the time; it would be economically and logistically prohibitive to do so with currently available technology.

Therefore, the next challenge for technology in immunohematology is the offering of clinical improvements for patients, through improved blood matching for as many antigen-antibody combinations as possible.

Such comprehensive immunohematology testing is more critical for some patients than others. There are hundreds of weaker antigens that can cause the development of antibodies that a person may have in their blood. They might not cause a reaction in a patient with a first transfusion; however, that patient’s immune system could build a resistance against any particular antigen. With subsequent transfusions, if the donated blood contains the same antigen, the patient’s reaction could become strong and more serious. Over time, the immune system builds up so much resistance to certain antigens that it becomes very difficult to find blood that will not cause a reaction.

The development of new technologies is underway that will make it possible to test for at least dozens of those weaker antigens and antibodies and provide patients with more compatible blood. This may help avoid the sensitization of patients who need multiple transfusions and promote better outcomes. Furthermore, the technology also will be able to accomplish all this testing in the same amount of time it takes to do less testing today. As technologies advance, labs become more efficient and better able to handle the shortage of specialized staff.

Automation has made immunohematology testing more manageable and reliable. Now, leaders in the industry are driven to continue advancing the technology to provide healthier, safe outcomes for all transfusion patients.




  1. Garcia, E, Ali AM, Soles RM, Lewis DG. The American Society for Clinical Pathology’s 2014 Vacancy Survey of Medical Laboratories in the United States. American Journal of Clinical Pathology. 2015;144(3);432-443.

Current U.S. Blood Supply Now Adequate to Handle Demands Resulting from Hurricane Harvey

Current U.S. Blood Supply Now Adequate to Handle Demands Resulting from Hurricane Harvey

Blood Centers Continue to Encourage Donations to Ensure that Blood Will Be Available When Needed

ethesda, Md. – The AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism has determined that the current blood supply in the United States is now adequate to meet the needs of patients in areas affected by Hurricane Harvey. Thanks to the support and donations of blood donors nationwide in the aftermath of the disaster, blood supply needs are being met in Southeast Texas and other impacted areas.

“Blood centers across the country rallied to provide blood to Houston in the days following the storm when donor centers there were closed and blood drives couldn't be held,” said Dennis Todd, chair of the Task Force. “However, as always, we encourage eligible individuals to give blood and platelets regularly so that the U.S. blood supply remains sufficient.”

The Task Force applauds those who wish to help and encourages all eligible individuals to schedule regular blood and platelet donation appointments so that blood is available whenever and wherever it is needed. 

Those interested in donating blood may contact the following organizations to find a local blood drive or donation center and to schedule an appointment:

AABB:; +1.301.907.6977

America’s Blood Centers:; +1.202.393.5725

American Red Cross:; +1.800.RED CROSS (+1.800.733.2767)

Armed Services Blood Program:; +1.703.681.8024

The Task Force was formed in January 2002 to help make certain that blood collection efforts resulting from domestic disasters and acts of terrorism are managed properly and to deliver clear and consistent messages to the public regarding the status of America’s blood supply. The Task Force is composed of representatives from U.S. blood services, associations and commercial entities, as well as liaisons from governmental agencies, who work together in an effort to ensure that safe and adequate blood product inventories are in place at all times in preparation for disasters. In addition, the task force operates as a mechanism to assess the need for collections and/or transportation of blood should a disaster occur. 

AABB serves as the designated coordinating entity for the Task Force. In addition to AABB, members include AdvaMed, America's Blood Centers, American Association of Tissue Banks, American Hospital Association, American Red Cross, Blood Centers of America, College of American Pathologists, National Marrow Donor Program and the Plasma Protein Therapeutics Association. Liaisons from the following government agencies also participate in task force discussions: Armed Services Blood Program and the U.S. Department of Health and Human Services, which includes the Centers for Disease Control and Prevention, and the Food and Drug Administration.

About AABB

AABB is an international, not-for-profit association representing individuals and institutions involved in the fields of transfusion medicine and cellular therapies. The association is committed to improving health through the development and delivery of standards, accreditation and educational programs that focus on optimizing patient and donor care and safety. AABB membership includes physicians, nurses, scientists, researchers, administrators, medical technologists and other health care providers. AABB members are located in more than 80 countries and AABB accredits institutions in more than 50 countries. For more information, visit