BackgroundPre-transfusion tests vary in sensitivity and specificity and should be evaluated before their implementation into routine use. The aim of this study was to evaluate the diagnostic accuracy of the Grifols DG Gel column agglutination system and to compare the data with two other column agglutination systems used in our laboratory: Ortho BioVue and Bio-Rad. Special attention was focused on using more vials of reagent red blood cells by Grifols DG Gel system when compared to other systems in order to investigate whether it increases the sensitivity for clinically significant antibodies. MethodsAll samples were tested in parallel with Grifols DG Gel, Ortho BioVue and Bio-Rad cards according to manufactures' instructions. Samples were processed through manual instrumentation. Tests were performed by trained and experienced staff. A total of 419 tests were performed on 302 samples. ResultsConcordant results between Grifols DG Gel system and the other two systems were obtained in 93.8% of the tests. For antibody screening by Grifols DG Gel system, sensitivity was 97.53%, specificity was 100%, predictive positive value was 100% and predictive negative value was 97.73%. For antibody identification, the accuracy was 96.03% for Grifols DG Gel system, 97.22% for Ortho BioVue and 94.44% for Bio-Rad. ConclusionsThe Grifols DG gel system shows high diagnostic accuracy and is safe for pre-transfusion compatibility procedures in blood transfusion laboratories. Using more vials of reagent red blood cells by Grifols DG Gel system when compared to other systems increases the sensitivity for some antibody specificities, particularly anti-Jk a . This could have major impact on the prevention of delayed transfusion reactions.