Optimization of Extended Red Blood Cell Matching in Transfusion Dependent Sickle Cell Patients

Blood transfusion is a life-saving treatment for people with sickle cell disorder (SCD). Presently, blood is matched manually for transfusion using incomplete red cell blood type information, to minimize the immunological incompatibility between donor and patient. We are investigating alternative approaches to blood allocation that exploit extended blood type information measured by a new genetic test shortly to be introduced by the National Health Service in England. We formulate sequential allocation decisions as a Markov decision process and study penalty-based policies for matching, which consider up to 17 blood group antigens, including policies that look ahead to future patient appointments. We tune the policy parameters of a matching rule to minimize formation of antibodies (alloimmunization) in SCD patients and estimate that a 98% reduction in alloimmunization can be achieved compared to current policies. Finally, we show that the tuned policy parameters are robust to major supply shocks.