Reporting of ABO incompatible (ABOi) titre investigations performed by RCI

RCI has reviewed the way that it tests and reports ABOi titre investigations. The aim of the review was to standardise the ABOi titre methodology used within the 7 RCI laboratories taking into consideration the recommendations made by the National External Quality Assurance Scheme (NEQAS). The panel performing the review included RCI laboratory staff and managers, NHSBT Consultant haematologists and a Hospital Transplant Consultant Lead. 

As a result we will be changing the way that these investigations are tested and reported and the change will come into effect on the 20 September 2021. 

There are multiple advantages to moving to a single standardised method. This includes:

• Improved ability for testing laboratories to compare the titre results obtained in order to maintain accuracy and quality of the process (improved inter-laboratory reproducibility)  
• Improved ability for transplant centres to compare transplant protocols used at different Hospitals when RCI is used to provide the ABOi titre results (important when assessing the immunological risk associated with ABOi transplantation and the requirement for pre-transplant antibody removal)
• Greater resilience and contingency to be able to ensure continuity of service
• Simplification of the results and reports

The impact of the change will depend on which laboratory currently performs the testing for your hospital. Your blood bank will be able to provide you with the name of your referral laboratory. 

In order to allow you to prepare for the change RCI has performed some comparison studies to allow you to assess the impact that the change will have on the titre endpoint, that we will report following the change. The expected effect that this will have on the titre result compared to our current method is provided in the tables below. 

Table 1 Example for IgM ABOi titre

* ABOi titres are tested using doubling dilutions therefore the results reported will be one dilution higher

** Based on comparison testing using NEQAS (National External Quality Assurance Scheme) results over the last 4 exercises

Table 2 Example for IgG ABOi titre

* ABOi titres are tested using doubling dilutions therefore the results reported will be one dilution higher for Birmingham and Newcastle

** Based on comparison testing using NEQAS (National External Quality Assurance Scheme) results over the last 4 exercises

The format of the report will also change for samples processed by RCI Barnsley. In the new style report the titre results will be laid out in a table as shown in Table 1. 

If you have any questions regarding this change please contact Fiona or Tracey.

For clinical questions Fiona Regan, Clinical Director for Diagnostics, fiona.regan@nhsbt.nhs.uk 

For laboratory questions Tracey Tomlinson, Head of Lab RCI Filton, tracey.tomlinson@nhsbt.nhs.uk

Tracey Tomlinson - Head of Laboratory, RCI Filton