Enhancing blood transfusion safety through extended Rh matching in preparation for electronic crossmatch in Hezhou

This study aims to prepare an electronic crossmatch (ECM) system in Hezhou People's Hospital and to evaluate its clinical applicability based on ABO/RhD and extended Rh antigen matching. A retrospective analysis was conducted on 36196 transfusion records from 2022 to 2024. ABO and Rh blood typing were performed using the gel card method on a fully automated analyzer. An ABC grading standard was established to evaluate Rh phenotype compatibility as follows: Grade A (complete match of C, c, E, e antigens), Grade B (avoidance of introducing new antigens), and Grade C (priority matching of strongly immunogenic antigens). The ECM system preparation involved three key steps: (1) consolidating all ABO/RhD and RhCE phenotyping results into a standardized digital database; (2) developing an ABC grading algorithm and applying it to previous transfusion records; and (3) validating the algorithm against historical transfusion outcomes. The results demonstrated 100% concordance for ABO/RhD matching. The overall Rh phenotype matching rate was 64.32%, with CCee (59.08%) and CcEe (28.43%) being the most prevalent phenotypes. Among the matched phenotypes, Grade A accounted for 84.05%, Grade B for 4.47%, and Grade C for 11.48%. The study suggests that the donor-recipient blood group database provides a solid data foundation and facilitates the establishment of the ECM system within the hospital. The high Grade A matching rate demonstrates its strong supply reliability and safety, offering an effective and efficient alternative to traditional serological crossmatching. This study presents a feasible approach to promote the implementation of ECM in primary-level hospitals.