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I feel your pain! So much for evidence based medicine

We were doing titers in the gel and kept failing our CAP surveys for titers. They were always one titer too high (CAP gives you a 3 titer range the results can be within to pass). After investigation (I was new at this job at the time) I found where the Technical Manual says that they shouldn't be performed in gel. (Like SMILLER says above). It goes on to state that there is a danger with interpretation by the physician and the higher results of unnecessary invasive procedures performed due to that combination. They, strangely, do not tell what studies they base that comment on. We switched to the tube method and haven't failed a survey since. We are in the process of deciding on new Blood Bank automation. When we saw the Vision, that seemed to be one of the "hot" selling points - the ability to perform titers. We questioned them about how they felt about it being contrary to AABB recommendations to do titers in the gel. The response was something like, "Do you want it to be faster and more hands-off or more exact? We would rather see it be more hands-off." (Not a direct quote, but you get the picture.) Personally, I would prefer the "exact" results to one that may or may not be too high. I would also prefer to pass my CAP competency surveys! Just saying.

We are a small facility which uses manual gel technology. We rarely see titers ordered. However, when reporting an antibody on a pregnant patient (detected and identified in gel) we faced this dilemma: the antibody was so weak it was not detectable in tube. We then started using gel for titers with the understanding that it is the change in titer over time that is significant. For proficiency, we use the split sample method every 6 months. CAP and State (NJ) inspectors have been OK with this.