Leaderboard

I don't think the AABB comments are evidence based. Washing with 37 degree saline is extremely unlikely to cause false negatives with clinically significant antibodies, and I'm unaware of any evidence that this is so. Any such antibody would be very low affinity to be washed away by saline at any temperature, and unlikely to have in vivo/clinical significance. As argued persuasively above by Malcolm Needs, anything that doesn't react at 30 degrees or above in typical serologic testing isn't going to cause clinical problems. Patients are neither at 30 degrees nor centrifuged :). Our serologic techniques are overly sensitive, in general, for clinically insignificant agglutinins. No need for cold panels ever, with rare exception, and more for intellectual curiosity than clinical decision making. Perhaps a mini-cold screen someetimes just to confirm you are indeed detecting a weak cold agglutinin in 37 degree testing, which disappears with prewarm technique. Like Malcolm, I've never seen a patient with an hemolytic reaction due to an antibody that disappears with prewarming, in close to 50 years of clinical practice. I know there are in vitro examples of clinically significant antibodies that weaken or disappear with prewarm, but I've never seen any clinical consequences.

or 12. As I mentioned, it is imperfect data, but overall, I think it likely reflects our staffing ages.

Thanks Cliff, that is some interesting data. When I was working in Utah there was a push for licensing Clinical Laboratory Scientists every couple of years in the state legislature. What I found most interesting, surprising and some what alarming was that the most strident lobbying opposition came from physician groups. My assumption was that they did not want to have to pay for qualified people to do the testing in their office and clinic labs.