Extended red blood cell matching for all transfusion recipients is feasible

OBJECTIVE

To demonstrate the feasibility and effectiveness of extended matching of red blood cells (RBC) in practice.

BACKGROUND

At present, alloimmunisation preventing matching strategies are only applied for specific transfusion recipient groups and include a limited number of RBC antigens. The general assumption is that providing fully matched RBC units to all transfusion recipients is not feasible. In this article we refute this assumption and compute the proportion of alloimmunisation that can be prevented, when all donors and transfusion recipients are typed for A, B, D plus twelve minor blood group antigens (C, c, E, e, K, Fy^a , Fy^b , Jk^a , Jk^b , M, S and s).

METHODS

We developed a mathematical model that determines the optimal sequence for antigen matching. The model allows for various matching strategies, issuing policies and inventory sizes.

RESULTS

For a dynamic inventory composition (accounting for randomness in the phenotypes supplied and requested) and an antigen identical issuing policy 97% and 94% of alloimmunisation events can be prevented, when respectively one and two RBC units per recipient are requested from an inventory of 1000 units. Although this proportion decreases with smaller inventory sizes, even for an inventory of 60 units almost 50% of all alloimmunisation events can be prevented.

CONCLUSION

In case antigen of both donors and recipients are comprehensively typed, extended preventive matching is feasible for all transfusion recipients in practice and will significantly reduce transfusion-induced alloimmunisation and (alloantibody-induced) haemolytic transfusion reactions.

A note on uniformization for dynamic non-negative systems

The classical technique of uniformization (or randomization) for bounded continuous-time Markov chains and Markov reward structures is extended to dynamic systems generated by arbitrary non-negative generators. Most notably, these include so-called input-output models in economic analysis. The results are of practical interest for both computational and theoretical purposes. Particularly, the recursive computation and the limiting behaviour of cumulative reward structures for non-negative dynamic systems is concluded as a special application. Two numerical examples are included to illustrate the conditions and the results.