AABB History: “But, Lo, There is Still Room Under Our Tent"

AABB President George J. Hummer, MD (1966-67) noted in a presidential message that AABB “is open to and accommodates… a wide spectrum of individuals and organizations.” He gave examples of the diversity in membership, including physicians, technologists, administrators, etc. He concluded his remarks with the observation, “But, lo, there is still room under our tent.” The most recent decade of AABB’s history demonstrates just that.

Patient Blood Management
The individual building blocks of what we now call patient blood management (PBM) began long ago. For years, AABB offered educational sessions and resources (most likely heralded by boardroom discussions) on topics such as the following:

• The hospital transfusion committee.
• Blood conservation.
• Autologous blood transfusion.
• Scientific/ethical dilemmas in blood banking.
• Improving transfusion practice: The role of quality assurance.
• Practical aspects of blood administration.
• Preventing fatal transfusion reactions.
• Blood utilization review.
• Blood recovery and reinfusion in surgery and trauma.
• Decision-making in transfusion medicine.

AABB did not create patient blood management, of course, but easily aligned existing activities under the label. It did not take long before “transfusion alternatives” as exceptions to the norm changed to patient blood management as the preferred standard of care.

AABB educational opportunities in PBM were coordinated and enriched, many in collaboration with others, including projects cosponsored with other organizations (eg, the Society for the Advancement of Blood Management, the Joint Commission, the ABIM Foundation and others). Additional professionals found a home at AABB—anesthesiologists, nurses, risk managers, educators, perfusionists, transfusion safety officers and pharmacists, to mention a few.

Advances in technology also had a positive impact. As point-of-care testing, computerized provider order entry systems with preprogrammed alerts, and hospital information systems supporting benchmarking activities became commonplace, additional perspectives were reflected in the membership.

Relationship Testing
Another group of practitioners who found a home under the AABB “tent” in earlier days, but who have also increased the Association’s diversity more recently, has been those interested in relationship testing. Originally called “paternity testing,” the work mainly involved determining the identity of a child’s father, usually a man who denied paternity.

Now considered “relationship testing” or “identity testing,” the field and, thus, interests of AABB members have expanded beyond determination of paternity to assist in child support or eligibility for government-funded programs. Eligibility is still a concern and, indeed, paternity issues have introduced AABB to new contacts in state judicial systems, among providers of social services and in groups of lawyers specializing in family law.

However, an additional focus of relationship testing is in forensic applications. These applications include the identification of victims after a disaster involving mass fatalities, crime scenes, missing persons, and unidentified human remains—all through familial relationships. In the last decade or so, AABB has increased its resources for, and support of, professionals who conduct DNA analysis in some of the most remote places imaginable. AABB also provides accreditation for laboratories that test samples used in forensic genetic genealogy, or identifying human remains and crime scene DNA through genetic relationships. Sample collection, confidentiality of data, maintaining chain of custody, complex familial calculations, reporting of results, interactions with people under great stress—all are topics that AABB members recognize as key elements in their skill sets.

AABB resources in relationship testing have supported immigration adjudicators as well. In recent years, the dual challenge of increased population and the exodus of large numbers of people as “climate refugees” or refugees from war-torn areas has increased the use of genetic testing to determine kinship for immigration purposes. AABB is a “home” for these professionals, too.

Molecular Testing
Advances in technology have influenced AABB in many ways, one of which is molecular testing. No longer in its infancy, molecular testing offers three advantages when compared with serologic testing.

• It is much faster than serologic methods.
• It can test for multiple antigens at the same time.
• It can test without having the antisera.

In locating donors with rare blood types, molecular testing has been so effective that in some cases, the blood type is no longer considered rare. Because the technology is being applied globally, donors who are “rare” in one country may be far more common in other countries. In the provision of rare units, an extreme level of international cooperation is required not only by medical personnel but also government officials, informatics professionals, and transportation workers. AABB can provide resources to support the international efforts.

Molecular testing is also an advantage in finding compatible units for patients who are chronically transfused. Patients with sickle cell disease, for example, are among those whose frequent transfusions have left them with multiple antibodies. Molecular testing can increase diversity in blood inventories, in parallel with any expansion in the variety of professionals who have found a place under the AABB “tent.”