TRabs10

One of our sister sites was recently cited by HFAP for not following their Anti-D package insert (BioRad Seraclone Anti-D blend for tube testing). Their procedure is to interpret any obstetrical RH type that reacts 1+ or less at immediate spin NEGATIVE until they refer the sample for genotyping. A chartable comment is added to the result stating that the reaction was discordant and that the sample was referred for genotyping. If genotyping shows a Partial D, the interpretation stays as Negative. If the genotyping comes back as weak D 1, 2, 3, or D+ the interpretation is corrected to Positive and a corrected report sent. However, the BioRad package insert says "agglutination of red cells is a positive result". hence the citation. We realized that the "less than 2+" rule in the procedure refers to the FORMER Anti-D reagent (Immucor Series 4) and the SOP was left that way when they switched to BioRad. They aren't interested in changing the current process, because it has helped identify at least 3 partial D mothers who would not have received RhIG if the insert had been followed to a T. My question is, does anyone else follow a similar "less than 2+" rule, have you been cited, and what Anti-D reagent are you using? Do you result these patients at "Indeterminate", at least until genotyping is complete? Thank you!

You may be interested in "Strategies to identify candidates for D variant genotyping" by Luo, Keller, et. al. (Blood Transfus 2018; 16: 293-301). Our facility currently uses BioRad Anti-D via tube testing. If an OB patient reacts 1+ or less at immediate spin we send the patient out for Weak D molecular testing. We just got an Ortho Vision, so I am looking at implementing the strategies outlined in the paper to help identify those Weak or Partial D patients.

I realize this is a very old post, but I am wondering about billing for DTT-treatment. Say we treat our 3-cell screen with DTT then perform a screen...I would charge for the additional screen run with the treated cells and CPT 86970. But do I only charge 86970 once, or 3x--once for each screening cell?

Is a 10% glycerol solution OK for a -70 C freezer, or do I need a higher concentration of glycerol? Or, do I need something else all together? Thanks!