Impact of replacing manual polybrene with automated column agglutination on irregular antibody detection and transfusion reactions: A 6-year retrospective study at a medical center in Eastern Taiwan

A BSTRACT Objectives: This study aimed to compare irregular antibody detection and transfusion reaction rates between the manual polybrene (MP) method and an automated column agglutination technology (CAT) system in an eastern Taiwan medical center and to assess whether automation refines the detection profile without compromising transfusion safety. Materials and Methods: This retrospective study analyzed pretransfusion testing data and transfusion reaction reports from 2018 to 2020 (MP period) and 2022–2024 (CAT period). Irregular antibody screening was performed using the MP method in the MP period and an automated Ortho BioVue CAT system in the CAT period. Irregular antibody-positive rates, antibody specificities by blood group system, and transfusion reaction rates stratified by severity were compared between periods using Pearson’s Chi-square test or Fisher’s exact test, with P < 0.05 considered statistically significant. Results: Among 74,391 pretransfusion requests, the overall irregular antibody-positive rate decreased from 4.40% to 3.44% ( P < 0.001). Single-antibody detection declined from 76.95% to 73.46% ( P < 0.001), whereas multiple-antibody detection showed a modest, nonsignificant increase from 23.05% to 26.54% ( P = 0.158). Anti-Mi a remained the most frequent antibody, whereas several cold-reactive antibodies were detected less frequently with CAT. The overall transfusion reaction rate decreased from 0.97% to 0.74% ( P < 0.001), largely because of the fewer moderate reactions. Conclusion: The transition from MP to automated CAT was associated with a reduction in the overall irregular antibody-positive rate, with less frequent detection of cold-reactive antibodies of limited clinical significance and preserved detection of clinically important alloantibodies. The concurrent decline in transfusion reaction rates is consistent with the established benefit of prestorage leukoreduction, although the individual contributions of CAT adoption and leukoreduction cannot be determined from the present dataset. This study provides real-world evidence to support automation implementation and blood bank workflow optimization, with a sustained focus on clinically significant antibodies and transfusion safety surveillance.