(38) Repeat Type and Screen Testing in Antepartum Admissions: Where is the evidence?

Objective:
The 72-hour repeat type and screen (T&S) practice in inpatient hospitalized obstetrics patients is based on guidelines from Association for the Advancement of Blood & Biotherapies with no data to support its use in pregnant patients. In hospitalized patients without bleeding, new clinically significant alloantibodies are exceedingly rare. This study evaluated the incidence of newly detected alloantibodies after an initial negative screen and calculated the financial cost of routine repeat testing.

Study Design:
This was a retrospective review of obstetric hospitalizations from July 2020 to October 2024, who were ≥ 24 weeks gestation, had a hospital stay greater than ≥ 72 hours, and had ≥ 2 T&S tests performed. All obstetric hospitalizations regardless of indication were included such as, hypertensive disorders of pregnancy, preterm labor, preterm premature rupture of membranes, fetal indication for admission, placenta previa, and placenta accreta spectrum. CPT codes were collected for T&S, crossmatch, blood transfusion, and antibody identification. First and last T&S were compared. The itemized cost-estimation for testing was derived from the hospital charge master which by law is publicly available.

Results:
A total of 107,718 patients accounting for 128,476 obstetric hospitalizations were included. The length of stay among of patients is summarized in Table 1. Among them, 2,472 (2.2%) had a positive antibody screen, of which all were detected on admission. Of the positives, 1.13% (n=28) were anti-D, 0.24% (n=6) were non-Rh D, and 98.6% (n=2,438) were due to Rh-D immune globulin. After admission, 62,587 additional T&S tests were performed with no new antibody detections (0/62,587). The estimated cost of excess testing was $60,099,166 with a monthly cost of $1,178,415 and a daily cost of $39,280 (Figure 1).

Conclusion:

This study highlights the high cost and low yield of routine repeat T&S testing in obstetric patients. This large cohort of > 100,000 pregnant patients, supports re-evaluating the practice of routine repeat T&S tests in hospitalized patients with obstetric complications.