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My experience is that interference from rouleaux and cold autoantibodies in Gel is not unusual but this may depend on your patient population. As rouleaux is not an antibody an AHG crossmatch is not required. If you IS crossmatch you must (in my opinion) saline replace so you show any agglutination is interference and can therefore enter a negative/compatible/non-reactive result into your LISS, probably with a comment.

It's not uncommon to see rouleaux interference in Gel testing but it's not something we see frequently. The crossmatch question is interesting: Technically, the screen is negative for alloantibody reactivity so I think you'd be able to follow your procedure for that result. However, with the immediate spin crossmatch, you may have to perform a saline replacement to obtain a "compatible" unit. I wouldn't want to assume an incompatible IS crossmatch is due to the rouleaux without confirming that.

In my experience, the two most common causes of weak reactivity in Gel and negative reactions in tube are either rouleaux (no, not my pet "go to", but still applicable) or reactivity seen only with the manufacturer's prepared 0.8% reagent cells. We encounter this fairly routinely: Hospital gets Gel reactivity, sends it in, we do a selected panel making our own 0.8% suspensions from various manufactures, get a negative Gel test, test with a manufacture's 0.8% panel and get reactivity. Basically, reactivity dependent upon something in the manufacture's product. Kinda similar to a "LISS panagglutin".

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Auto directed at senescent red cells can show mixed-field reactivity. With your additional information, kinda seems the most likely cause of your observed reactions. Garrartty and Petz discuss this in Immune Hemolytic Anemias, 2nd ed., pg 243. The issue with PEG adsorptions is they may work too well, potentially resulting in the loss of weak (low titered) antibodies. Of course, that could happen with any adsorption, I guess, but with the samples we see in our ref. lab, it is the last technique we would use to adsorb out an autoantibody. I'm not saying you are wrong to use it. I'm just saying it has it's drawbacks;

We use Ortho Biovue gel card, and I don't think rouleaux interfere much on the gel result, some MM patients have rouleux on tube, but gel results are good. In my experience, cold antibodies can do. Just personal opinion.

I had in my policy that we would review the Changes to Standards document published by the AABB and document on each change whether it affected us or not. (We did not draw donors so we just reviewed and put those changes as not applicable.). If we were already in compliance with the change, we would document no change in policy required with the policy number. If a policy had to be updated, we documented when the updates, training, etc were completed. The Medical Director signed this review and we kept it with our policies.

We issue Group A Plasma (or whatever is shortest outdate as long as it is not Group O) until we have a BB Specimen and the ABO/Rh is verified. Then we switch to ABO compatible/specific. The expiration date of the specimen does not apply to non RBC containing blood products, so as long as the patient is wearing the corresponding BB Band, we will issue Plasma, Platelets and/or Cryo. I agree, the non-ABO match allogenic stem cell transplant recipients are a challenge, but as someone pointed out in an earlier post, these patients become obvious and we can deal with their 'new' blood type 'in the moment' according to our current protocol.

Yes. Last month we implemented a trial program where our supplier got our standing orders from another location. We are a very large facility and our standing order is at least 100 RBCs a day. During the beginning of the trial (no returns allowed) we quickly got oversupplied, at one point we hit twice our optimum level. Our O Neg inventory was unethical. The supplier agreed to take back some of the units because there was a glitch in the cancelling process. I insisted they also take back some of the O Neg. Sorry, I hope you don't feel I was blaming any suppliers. I do not envy the job you have, it must be really hard keeping a facility like us, and the rest of the country, happy.