Algorithm to Manage Inconclusive RBC Antibodies by Reflex Manual Testing.

Objectives: Inconclusive RBC antibody identification (ABID) may delay RBC crossmatch. An increased number of inconclusive ABID was observed, and an algorithm was developed to improve ABID efficiency. Methods: RBC antibody screen (AS) and ABID were initially performed using solid-phase RBC adherence assay (SPRCA) and manual tube method. A retrospective analysis of AS and ABID results was performed pre- and postalgorithm implementation. Results: The number of inconclusive ABID results decreased from 26 to six per month pre- and postimplementation, respectively. SPRCA became the primary AS method, and manual tube became the gold standard for ABID. SPRCA was used for ABID upon reference specialist secondary review and allowed identification of 30 specific RBC antibodies, for which no patients developed signs or symptoms of a hemolytic transfusion reaction. Conclusions: RBC reference workflow using SPRCA and manual tube methods for AS and ABID decreases "inconclusive" ABID without adverse events.