By training a computer to analyze blood samples, and then automating the expert assessment process, the AI processed months’ worth of blood samples in a single day

New technologies and techniques for acquiring and transporting biological samples for clinical laboratory testing receive much attention. But what of the quality of the samples themselves? Blood products are expensive, as hospital medical laboratories that manage blood banks know all too well. Thus, any improvement to how labs store blood products and confidently determine their viability for transfusion is useful.

One such improvement is coming out of Canada. Researchers at the University of Alberta  (U of A) in collaboration with scientists and academic institutions in five countries are looking into ways artificial intelligence (AI) and deep learning can be used to efficiently and quickly analyze red blood cells (RBCs). The results of the study may alter the way donated blood is evaluated and selected for transfusion to patients, according to an article in Folio, a U of A publication, titled, “AI Could Lead to Faster, Better Analysis of Donated Blood, Study Shows.” 

The study, which uses AI and imaging flow cytometry (IFC) to scrutinize the shape of RBCs, assess the quality of the stored blood, and remove human subjectivity from the process, was published in Proceedings of the National Academy of Sciences (PNAS,) titled, “Objective Assessment of Stored Blood Quality by Deep Learning.”

Improving Blood Diagnostics through Precision Medicine and Deep Learning

“This project is an excellent example of how we are using our world-class expertise in precision health to contribute to the interdisciplinary work required to make fundamental changes in blood diagnostics,” said Jason Acker, PhD, a senior scientist at Canadian Blood Services’ Centre for Innovation, Professor of Laboratory Medicine and Pathology at the University of Alberta, and one of the lead authors of the study, in the Folio article.

The research took more than three years to complete and involved 19 experts from 12 academic institutions and blood collection facilities located in Canada, Germany, Switzerland, the United Kingdom, and the US.

Jason Acker, PhD (above), Senior Research Scientist, Canadian Blood Services, and Professor of Laboratory Medicine and Pathology at the University of Alberta in a white lab jacket in a laboratory
“Our study shows that artificial intelligence gives us better information about the red blood cell morphology, which is the study of how these cells are shaped, much faster than human experts,” said Jason Acker, PhD (above), Senior Research Scientist, Canadian Blood Services, and Professor of Laboratory Medicine and Pathology at the University of Alberta, in an article published on the Canadian Blood Services website. “We anticipate this technology will improve diagnostics for clinicians as well as quality assurance for blood operators such as Canadian Blood Services in the coming years,” he added. Clinical laboratories in the US may also benefit from this new blood viability process. (Photo copyright: University of Alberta.)

To perform the study, the scientists first collected and manually categorized 52,000 red blood cell images. Those images were then used to train an algorithm that mimics the way a human mind works. The computer system was next tasked with analyzing the shape of RBCs for quality purposes. 

Removing Human Bias from RBC Classification

“I was happy to collaborate with a group of people with diverse backgrounds and expertise,” said Tracey Turner, a senior research assistant in Acker’s laboratory and one of the authors of the study, in a Canadian Blood Services (CBS) article. “Annotating and reviewing over 52,000 images took a long time, however, it allowed me to see firsthand how much bias there is in manual classification of cell shape by humans and the benefit machine classification could bring.”

According to the CBS article, a red blood cell lasts about 115 days in the human body and the shape of the RBC reveals its age. Newer, healthier RBCs are shaped like discs with smooth edges. As they age, those edges become jagged and the cell eventually transforms into a sphere and loses the ability to perform its duty of transporting oxygen throughout the body. 

Blood donations are processed, packed, and stored for later use. Once outside the body, the RBCs begin to change their shape and deteriorate. RBCs can only be stored for a maximum of 42 days before they lose the ability to function properly when transfused into a patient. 

Scientists routinely examine the shape of RBCs to assess the quality of the cell units for transfusion to patients and, in some cases, diagnose and assess individuals with certain disorders and diseases. Typically, microscope examinations of red blood cells are performed by experts in medical laboratories to determine the quality of the stored blood. The RBCs are classified by shape and then assigned a morphology index score. This can be a complex, time-consuming, and laborious process.

“One of the amazing things about machine learning is that it allows us to see relationships we wouldn’t otherwise be able to see,” Acker said. “We categorize the cells into the buckets we’ve identified, but when we categorize, we take away information.”

Human analysis, apparently, is subjective and different professionals can arrive at different results after examining the same blood samples. 

“Machines are naive of bias, and AI reveals some characteristics we wouldn’t have identified and is able to place red blood cells on a more nuanced spectrum of change in shape,” Acker explained.

The researchers discovered that the AI could accurately analyze and categorize the quality of the red blood cells. This ability to perform RBC morphology assessment could have critical implications for transfusion medicine.

“The computer actually did a better job than we could, and it was able to pick up subtle differences in a way that we can’t as humans,” Acker said.

“It’s not surprising that the red cells don’t just go from one shape to another. This computer showed that there’s actually a gradual progression of shape in samples from blood products, and it’s able to better classify these changes,” he added. “It radically changes the speed at which we can make these assessments of blood product quality.”

More Precision Matching Blood Donors to Recipients

According to the World Health Organization (WHO), approximately 118.5 million blood donations are collected globally each year. There is a considerable contrast in the level of access to blood products between high- and low-income nations, which makes accurate assessment of stored blood even more critical. About 40% of all blood donations are collected in high-income countries that home to only about 16% of the world’s population.

More studies and clinical trials will be necessary to determine if U of A’s approach to using AI to assess the quality of RBCs can safely transfer to clinical use. But these early results promise much in future precision medicine treatments.

“What this research is leading us to is the fact that we have the ability to be much more precise in how we match blood donors and recipients based on specific characteristics of blood cells,” Acker stated. “Through this study we have developed machine learning tools that are going to help inform how this change in clinical practice evolves.”

The AI tools being developed at the U of A could ultimately benefit patients as well as blood collection centers, and at hospitals where clinical laboratories typically manage the blood banking services, by making the process of matching transfusion recipients to donors more precise and ultimately safer.

—JP Schlingman

Related Information:

Objective Assessment of Stored Blood Quality by Deep Learning

Machines Rival Expert Analysis of Stored Red Blood Cell Quality

Breakthrough Study Uses AI to Analyze Red Blood Cells

Machine Learning Opens New Frontiers in Red Blood Cell Research

AI Could Lead to Faster, Better Analysis of Donated Blood, Study Shows

Blood Safety and Availability