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I know large institutions that use an immediate spin titer of 51 or less. Whether this is a titer or dilution I cannot say. The medical director there told me that it is a titer.

Congratulations Malcolm! You have every right to be excited about this honor. Thanks for letting us know about it!

years ago all we had was warm saline or ether. We used warm saline on cord bloods with +DATs.

It looks to me as though you may have some spontaneously agglutinating IgM in the sample. Do you have some neutral cards? If so, put 50ul of the cell suspension on the neutral card and centrifuge directly. That won't necessarily differentiate between an agglutinating IgG and an IgM but it would tend towards the latter if it were positive. Also, in case it is LISS-enhanced, you could try suspending your cells in Cell Stab or Alsevers or PBS and repeating. Just beware of cells 'training' through the gel. And make absolutely sure that whatever you use has well come to room temperature before you use it! Anyway, from those results, even though the control is positive, you clearly have a major component of IgG present.

In Immune Hemolytic Anemias Garratty suggests a warm saline wash to resolve the problem of a positive control for DATs. I've used that successfully for a patient with a pretty strong cold agglutinin, to report out a negative DAT IgG (after consultation with our medical director). It was unsuccessful for a couple of other patients with colds. It wouldn't resolve a problem with the control for IgG coated cells.

TRM.30900 appears to apply to those situations that do not follow standard operating procedures and policies. However, if the hospital and blood bank HAS policies and procedures that cover release of uncrossed blood (approved by the Lab Medical Director -- just like every other P&P in the Lab), then the need for a "written authorization" would not be needed in those situations, as they are not "deviations from SOPs". Scott