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I wonder about using a patient known to have atypical antibodies qualifying as an adequate positive control. Antigen-antibody reactions vary drastically, dependent on the type and quantity of both the antibodies and antigens in question. The point being that a panel that produces a positive for a known anti-K (that particular vial has RBCs that are "viable" for the K antigen), is not necessarily going to detect any other antibody. It would be like saying that if your QC for a potassium checks that everything else on a Basic Metabolic Panel must be OK. Having said all that, it is obviously impractical to QC every cell we use for every antigen that appears on it--we certainly do not even come close to that using commercial QC antisera with our screening cells every day. But when we consider using expired cells--even for "just rule-outs"--I can kinda see the regulator's point about whatever QC we justify using would be considered a lab-developed technique. Scott

My AABB/CAP inspection is in 2 weeks...I'll let y'all know. LOL

Thats great to hear! I did my undergrad in clinical lab science at marquette and still work in milwaukee. I have been looking a lot into the program at BCSW and the masters degree at MU. It's good to hear that you had a good experience and also good to know about the education subspecialty

We also do something similar to Seraph44. If we start with ECHO and then move to Gel or tube, we choose a positive panel cell to prove that the antibody could be detected using a different method. I called CAP a year or so back about doing QC on panel cells in general but expired panel cells in particular. As far as doing QC on indate panels, each time we use panel cells as controls for antigen typing, you are performing QC on the panel. The control cells should react as expected. However this has to be documented. So.... I redid my antigen typing form and included the panel lot # used to perform the controls. If it is not documented, you didn't do it. So in the life of a panel, it should have QC performed several times without much effort. As far as expired panels, we do not have to do QC to prove the antigen worked. It must be written in our procedure that indate panel cells are used first and expired cells are only used to confirm or ruleout. The expired panel cells would be considered rare or difficult to obtain since we couldn't find exactly what we needed in the indate ones. Also you must follow manufacturers package insert so if it says you must do QC, you must do QC. I certainly hope they don't change this to where it is a LDT to use expired panel cells. Who thinks up these things? Do they try to make our lives miserable?

Yes, I agree that, in this particular case, you could have missed the immune anti-D gagpinks, BUT, as I have said several times throughout this thread, this is a very unusual case. I am no statistician, and so I would not like to say that it is 1 in a million or something like that, but I will say that it is 1 in an awful lot and, because of the rarity of such a case, I would also say that, if a cost/benefit study was to be performed, to see if there should be any changes to the BCSH or RCOG Guidelines with regard to when to test the women's plasma during pregnancy, the answer would be that the Guidelines would not change, as so few cases would be detected, compared with the cost of being able to detect such cases. So, yes, in this case if you had not noticed the strength of reaction, the immune anti-D may not have been detected, and it may have resulted in a baby affected by the anti-D, but one cannot change general Guidelines using such unusual cases.

If antibody screen is positive and if we have upto date record of prophylaxis anti-D than we report as AntiD detected due to prophylaxis or sensitizing event. Please check history and confirm with clinician. BUT If patient has sensitizing event prior to 28 weeks we treat as immune antiD and send sample for quantification and continue antenatal and postnatal prophylaxis.