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We perform our antibody screens at 37C and IAT only (since AABB STD's says methods that detect SIGNIFICANT antibodies). The problem is, that crossmatches are performed at Immediate Spin. Cold autos are missed at antibody screening, and the screen is reported as negative. When techs crossmatch units, the I.S. reading is positive due to a weak cold auto, but several techs keep reporting rouleaux when it's clearly not rouleaux. I have told them over and over, that rouleaux is rare and only seen in patient's with protein abnormalities such as Multiple Myeloma. They are reporting rouleaux at least 3 times a week. A saline replacement CAN disperse weak agglutination from a cold. What can I do to stop this mis-identification? I have tried over and over to explain and showed them the short cold panel results, but the rouleaux reports keep coming. Today's specimen was on an A patient with a weakly reactive A cells. The tech did not check for A subgroup with anti-A1 which should have been done with an ABO forward/reverse discrepancy. (It wasn't - patient was A1 with cold autoanti-I.) I have also explained that autoanti-H and IH can be seen with A1 or A1B patients. I always do an immediate spin on antibody screens, even though we don't record results in computer. Significant or not, I want to know what's there. No surprises for later when crossmatches are needed STAT! We do see a lot of colds, as our room temp is freezing (18-20C) even though we've in Miami!!! Have never been able to get our A/C fixed so we don't freeze! Gil