Transfusion Medicine

ADVANCE looks at the role of genotyping in the future of the healthcare industry

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In hospitals and healthcare institutions across the country, there are challenges in every aspect of patient care.  Blood banking is vital in that it provides a safety net for any number of clinical patients as they received treatments and therapies. Like other areas of the healthcare industry, it can also be broken down into smaller specialties, such as immunohematology, which incorporates the primary concern of getting a patient the blood they need and takes it one step farther, analyzing that blood's effect internally.

For patients who require more chronic blood transfusions due to diseases, infections or complications like sickle cell disease or thalassemia, it can be exceedingly difficult to find the appropriate donors. During this time, they experience discomfort while the hospitals or healthcare facilities search for a donor source. Not only are these patients prevented from returning to work, but the extended stay ends up being expensive for both those in need of blood and the facilities responsible for tracking down and sometimes even having to ship the appropriate match.

"It all kind of depends on who you have as patients in your hospital," said JoAnn Moulds, PhD, MT(ASCP), SBB, director of scientific support services at LifeShare. "If you're a big medical center and you see a lot of sickle cell disease, it's going to be a huge problem for you - and a very costly problem, too."

The major challenge facing chronic transfusion candidates is the immune system's natural reaction to build up new antibodies with each transfusion. It's difficult to gauge a patient's reaction to a transfusion. While some patients have little-to no reaction, with symptoms like a light-fever, others can have violent reactions such as a stroke, seizure or even death. Patients that produce antibodies are at the highest risk and, subsequently, are the hardest to match.

"The patients that make antibodies -- they're the ones that are at the greatest risk, because a lot of the time, what happens is those antibodies will go away to the point where we can no longer detect them," continued Moulds.

Although blood group typing has historically been beneficial, it has not always been efficient. The reagents used in the tests are usually from animal or human sources and can be expensive as those resources become more limited.  Additionally, the process is slow without an automated system.  Genotyping, on the other hand, utilizes a technique that produces the necessary synthetic materials without having to rely on foreign specimens.

"It's an unlimited source, because we can artificially make the probes we need for genotyping," explained Moulds. So, we don't have to rely on immunizing animals or humans or anything like that, which makes it non-infectious - which is also an advantage."

Because of its "unlimited" applications and sustainable nature, genotyping stands to benefit the testing medium in both treatment and prevention. Despite major limitations like not yet being available in the form of clinical applications, the technique, used mainly in research efforts, allows physicians to better prepare for transfusions - especially in potentially problematic areas such as the growing number of patients who require chronic transfusions. Access to more detailed information in more immediate and accurate data not only prevents risk factors for patients with hidden antibodies, but could also prevent those antibodies from forming in the first place and prove more cost-effective in the long run. 

"If we can match them early on, then they don't make the antibodies. So, we never get into that situation where they're at risk of having a reaction - and that's probably the better scenario," said Moulds. "Rather than try to match them after they've made all this stuff, let's prevent them from even making those antibodies. And that's kind of where the role of genotyping has come in."

Another limitation of genotyping is a lack of communication between healthcare facilities.  With patients who produce antibodies with each new transfusion, it's possible to miss something in preliminary blood work - be it an underlying problem or just an unusual combination of antibodies - and, even though their primary hospital will have that information on record, other hospitals will not have access to that information. Moulds noted the implementation of electronic health records (EHRs) in hospitals across the country as a good start, but hardly a solution.  She continued, discussing the need for a more universal method of data sharing between healthcare facilities.

"That is certainly a step in the right direction, but we need to get those linked together," explained Moulds. "It's fine if you've got a group of hospitals that are all owned by a company and they can share that information, but it still needs to be more global than that."

Genotyping is a technique still on the cutting edge of the field. Even with all of its potential benefits, the technology remains a research-use assay rather than a clinical test, and is subsequently controversial in the healthcare industry. Once an FDA-approved application is developed for bulk-testing in patients in need of a transfusion, Moulds commented that the test should gain acceptance and become a viable option.

Michael Jones is on staff at ADVANCE.


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