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You took the words right out of my typing fingers Malcolm!

In the circumstances (I don't live in the USA, so I would never be "In the circumstances"), I would be more keen to charge the MD who has changed his or her mind, rather than the patient!

I have never seen this phenomenon interfering with titre results. That is not to say it couldn't happen - it just means that I have never seen it.

The only thing I would worry about with pre-natals, where titers from one month are compared to the next, concerns things that may intermittently cause gel interference. For example, if I am not mistaken, CRP goes up and down with any pregnancy, and could cause gel interference (potentially upping the titer I would think) for one month but not necessarily the next. What would one do with gel titers were interference is noted in one specimen but not another? Or maybe this would never happen? Scott

The nursing references I have seen specify only normal saline for infusing blood. If we were releasing a FFP and a RBC at the same time (or two RBCs for that matter), we would ask if they have two lines running. Scott

I am looking at the Participant Summary for latest CAP proficiency, anti-D titer. For tube testing using the "uniform procedure tube method" that CAP suggests, they reported the following results: 333 participants, mode 64, consensus range 16 to 256. For Gel testing "uniform procedure gel method", 138 participants, mode 256, consensus range 64 to 1024. Per CAP, Consensus is determined by the Mode +/- two of the most frequent titers. It looks like in the previous 2 surveys for the gel anti-D titers, the mode for gel was 1 to 2 dilutions higher than tube, but so was the consensus range. It seems like there are a fair number of labs reporting gel and if you report that as your method you should be compared to other gel titer users. I would also think as more instruments are implemented that can do gel titers, the number reporting gel will go up. And of course what ever you do, perform method correlation and communicate with the obstetricians any changes they may see in titer results. We are contemplating this also. Also I am little confused by ""Do you want it to be faster and more hands-off or more exact?" It seems to me that automated titers in gel should be much more reproducible. We are just starting to look in to performing titers on Vision.

ABO antigens are basically sugars structures. The development and expression of these antigens and antibodies are controlled by various genes an individual inherits. The antibodies are also possibly produced based on the various "natural" exposures to similar antigens in the environment, gut, etc. and the immune system functionality of the antibody producer. (or in the case of commercial antisera, the particular antibody producer(s) or cell line(s) used to produce the antibody can vary from manufacturer to manufacturer). Actually, as I ponder this, maybe all antigens/antibodies are effected by some of the same processes...... Therefore, in my humble opinion, the strengths of the agglutination reaction within in any one test method, maybe affected by these factors as well as the method itself. If everyone was group O it would be nice for Blood Bank ................. but what's the adventure in that? Variety is the spice of life!

We have the TOPS 550s and we plan to implement HIT testing next year.