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We, too, encounter Anti-M often using Gel. Apparently, Gel is just acidic enough to enhance this pest. Because the enhancement is more about pH than temperature, whenever we suspect Anti-M, we revert to other methods to help determine it's 'etiology'. Prewarming Gel does not change the pH issue so we don't do that. We can't trust that negative results in prewarmed Gel are truly due to a cold Anti-M or that the positive results aren't due solely to the acidity. (Besides, if testing is done using a Blood Analyzer (e.g. Vision, Eflexis), the cards are pre-warmed anyway.) So, we test the plasma using Prewarmed Tube Testing (e.g. PEG which has similar sensitivity for most antibodies sans the low pH). If positive with that, it's a Warm Anti-M. We also test at Room Temperature using Pooled Screening Cells. If positive, then it's a cold Anti-M. If negative with both Prewarmed Tube and RT Pooled O Cells, it's 'Anti-M (Detected using Gel Only)' ... just due to the pH drop, no clinical significance. Likewise, positive with both, it's an Anti-M with a broad thermal amplitude. Do what you like with the results. PS. Testing positive with Anti-M reagent does not mean the patient can't make Anti-M (Patient may be Mg Pos). Someone please correct/confirm that or am I working on old reagent data? (Like we don't see Anti-T or Aquired-B anymore because the reagents are 'purer'.)