ArticleFrontiers in medicine2026
Quantifying red blood cell compatibility beyond ABO and RhD: a recipient-centered model for matching, allocation, and inventory curation.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Recipient alloimmunization remains the most frequent adverse effect of transfusion therapy. Routine transfusion decisions rely heavily on clinician judgment and informal rules, which limit consistency and reproducibility. Current transfusion decision-making practices do not systematically integrate patient-specific clinical and immunohematologic factors, phenotype-level requirements, and inventory constraints within a coherent framework. This study introduces a recipient-centered integrative model that unifies patient-group-based matching criteria, quantitative compatibility scoring, and phenotype-based inventory curation to support transfusion practices aimed at reducing alloimmunization risk. Methods: The ImmunoHematology Framework (IHF) uses demographic, clinical, and laboratory data to define phenotype-based matching requirements. It quantifies recipient-donor compatibility, calculates the degree of phenotype match using all available antigen information, and ranks recipient-unit pairs for selection and allocation. IHF also classifies donor phenotypes to support curation of refrigerated and frozen inventories. The framework was operationally evaluated as an integrated system, including its quantitative compatibility logic, using de-identified operational data and curated demonstration cases across routine and rare scenarios. Results: The IHF model produced extended phenotype matching outcomes (≥14 antigens) that demonstrated improved compatibility recommendations compared with clinician selections in the pilot evaluation, with complete agreement in 59% of cases, moderate deviation in 18%, and significant deviation in 23%. Matching 327 fully typed donors to 27 patients requiring extended antigen compatibility revealed a subset with substantially broader compatibility (median 9 vs. 4 recipients), identifying these units as candidates for long-term frozen storage. Conclusion: IHF formalizes recipient-specific transfusion risk associated with phenotype mismatch and quantitative compatibility as a computable construct the framework demonstrates how its logic, scoring method, donor unit allocation process, and phenotype-based inventory curation can be operationalized in real-world transfusion practice, with reproducibility confirmed by a functioning prototype.
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