Extensive red blood cell matching considering patient alloimmunization risk

Vox Sanguinis, vol. 119, pp. 368–376

Abstract

Abstract Background and Objectives Red blood cell (RBC) transfusions pose a risk of alloantibody development in patients. For patients with increased alloimmunization risk, extended preventive matching is advised, encompassing not only the ABO‐D blood groups but also the most clinically relevant minor antigens: C, c, E, e, K, Fya, Fyb, Jka, Jkb, S and s. This study incorporates patient‐specific data and the clinical consequences of mismatching into the allocation process. Materials and Methods We have redefined the MINimize Relative Alloimmunization Risks (MINRAR) model to include patient group preferences in selecting RBC units from a finite supply. A linear optimization approach was employed, considering both antigen immunogenicity and the clinical impact of mismatches for specific patient groups. We also explore the advantages of informing the blood bank about scheduled transfusions, allowing for a more strategic blood distribution. The model is evaluated using historical data from two Dutch hospitals, measuring shortages and minor antigen mismatches. Results The updated model, emphasizing patient group‐specific considerations, achieves a similar number of mismatches as the original, yet shifts mismatches among patient groups and antigens, reducing expected alloimmunization consequences. Simultaneous matching for multiple hospitals at the distribution centre level, considering scheduled demands, led to a 30% decrease in mismatches and a 92% reduction in shortages. Conclusion The reduction of expected alloimmunization consequences by incorporating patient group preferences demonstrates our strategy's effectiveness for patient health. Substantial reductions in mismatches and shortages with multi‐hospital collaboration highlights the importance of sharing information in the blood supply chain.

Authors 10

1. Merel L. Wemelsfelder

   Sanquin · University of Amsterdam

   Affiliation as printed

   Business Analytics Department University of Amsterdam Amsterdam the Netherlands

   Donor Medicine Research Department Sanquin Research Amsterdam the Netherlands

   Business Analytics Department, University of Amsterdam, Amsterdam, the Netherlands

   Donor Medicine Research Department, Sanquin Research, Amsterdam, the Netherlands

2. Ronald H. G. van de Weem

   Sanquin

   Affiliation as printed

   Donor Medicine Research Department Sanquin Research Amsterdam the Netherlands

   Donor Medicine Research Department, Sanquin Research, Amsterdam, the Netherlands

3. Jessie S. Luken

   Sanquin

   Affiliation as printed

   Department of Experimental Immunohematology Sanquin Research Amsterdam the Netherlands

   Department of Immunohematology Diagnostics Sanquin Diagnostic Services Amsterdam the Netherlands

   Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands

   Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands

4. Masja de Haas Aachen Department of Hematology Leiden University Medical Center Leiden The Netherlands Department of Hematology, Leiden University Medical Center

   Leiden University Medical Center · Sanquin

   Affiliation as printed

   Department of Experimental Immunohematology Sanquin Research Amsterdam the Netherlands

   Department of Hematology Leiden University Medical Center Leiden the Netherlands

   Department of Immunohematology Diagnostics Sanquin Diagnostic Services Amsterdam the Netherlands

   Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands

   Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands

   Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands

5. René W L M Niessen

   OLVG

   Affiliation as printed

   OLVG Laboratory BV Amsterdam the Netherlands

   OLVG Laboratory BV, Amsterdam, the Netherlands

6. C. Ellen van der Schoot

   Sanquin

   Affiliation as printed

   Department of Experimental Immunohematology Sanquin Research Amsterdam the Netherlands

   Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands

7. Han Hoogeveen

   Utrecht University

   Affiliation as printed

   Department of Information and Computing Sciences Utrecht University Utrecht the Netherlands

   Department of Information and Computing Sciences, Utrecht University, Utrecht, the Netherlands

8. Folarin B. Oyebolu

   University of Cambridge · MRC Biostatistics Unit

   Affiliation as printed

   MRC Biostatistics Unit University of Cambridge Cambridge UK

   MRC Biostatistics Unit, University of Cambridge, Cambridge, UK

9. Dick den Hertog

   University of Amsterdam

   Affiliation as printed

   Business Analytics Department University of Amsterdam Amsterdam the Netherlands

   Business Analytics Department, University of Amsterdam, Amsterdam, the Netherlands

10. Mart P. Janssen corresponding

    Sanquin

    Affiliation as printed

    Donor Medicine Research Department Sanquin Research Amsterdam the Netherlands

    Donor Medicine Research Department, Sanquin Research, Amsterdam, the Netherlands