Ward_X

Most warm auto-antibodies have a specificity within the Rh Blood Group System, although some others, more rarely, have a specificity outside of this system, such as auto-anti-Wrb.
Most of the auto-antibodies from within the Rh Blood Group System mimic anti-e, anti-E, anti-C, anti-c or a combination (or even a compound antibody, such as anti-Ce or anti-Rh7), but, in reality, they are actually weak forms of anti-Rh17 and/or anti-Rh18, although strong examples are not unknown).  As they are usually mimicking antibodies, they can usually be adsorbed out with red cells that do not actually express the actual antigen on their surface (for example, an apparent anti-e can be adsorbed out using R2R2 red cells).
PLEASE DO NOT try to identify them yourself, as the actual specificity is not significant, but will take an awful lot of time and you will require some VERY rare red cells, such as Rhnull, D--/D-- and the like, and these should be reserved for when they are required to identify the specificity of rare allo-antibodies, such as anti-Hr, anti-HrB or anti-Rh29, where a true specificity may well be vital to identify.
In contrast, most "cold" auto-antibodies are true specificities.
For more information, you would find it hard to beat reading, Petz LD and Garratty G.  Immune Hemolytic Anemias, 2nd edition, Churchill-Livingstone, 2004, although I would advise you to be selective, as it is a very detailed book!

It depends (again) upon the antibody.
If the antibody is NOT known to cause clinically significant transfusion reactions, our doctors MAY decide that giving known uncross-match compatible blood, with a cover of IVIgG (+/- something like methylprednisolone), and keep the cryopreserved units in reserve.
If the antibody IS known to be clinically significant, AND the patient's pre-operative Hb is both stable and adequate (depending upon the condition of the heart, and the underlying pathology - and the co-operation of the Anaesthetist), how much the patient is expected to bleed, and how far the hospital is from the blood centre, we may thaw and reconstitute the units, but keep them at the Centre local to the patient's hospital.  This would allow us to get the units to the hospital quickly (blues and twos, if need be), but, if the units are NOT required, we keep them and send them out to all of our Centres as a rare reagent cell.
If the antibody is known to be clinically significant, and the patient is likely to bleed/has a low pre-op Hb (i.e. nothing is going right for them), we would provide the units thawed and reconstituted, at the hospital, and if they are not used, and are wasted - so what?  At least we tried!

Just from a safety standpoint, receiving products transported from an outside facility should be retyped, regardless if that outside facility is in your "network."
For example, even if a historical donor donating at a regular frequency gives red blood cells directly to Hospital B, the unit itself is still retyped at that given point and before transfusion.

We don't honor phenotypically matched blood on a newborn unless the baby has a positive antibody screen due to the mother's antibody. The product that is set up for the baby is fresh ( less than 5 days old), O =/O+(depending on the babies type),  irradiated (same day), leukoreduced(comes that way from supplier) and hemoglobin S negative.

I don't think the posters in this thread were talking about "repeating" panels - they were talking about "running" a panel with the same method when you get equivocal results on your primary method.  If using solid phase  - run a solid phase panel.  If running gel - run a gel panel, etc.  Don't just step down to tubes (or a weaker method) without giving the primary method (and usually more sensitive method) a chance to show you what it is trying to show you.
For your next question - working with the specimen might have some validity if you have centrifuge problems or are running clots (red tops) for screens instead of EDTA (purple tops) specimens.  Make sure your spin speeds and times will clear the white cells in a EDTA tube.  Make sure you follow Immucor instructions on degrees of lipemia and hemolysis that are allowed.  Otherwise - if you are running the same lot # of strips on 2 different ECHOs - I would be surprised if they give different answers.
Does that help?

BloodBank Guy is right. Immucor did have a problem with inconclusive results and did a root cause analysis to try and fix the problem. Things seem to be much improved - we are not getting very many inconclusive results currently. And also agree that if your are seeing problems that seem to be reagent related, report it to Technical support. They aren't going to investigate a problem unless they know they have one and it needs to come from more than one customer.
 
Remember, too, that no one method is going to always detect all antibodies. No one method is going to be free of inconclusive results. You need a good backup method for those times when your primary is giving you funky results. You just have to pick the method that is going to be the best fit for your patient population and your workload, understand the limitations of that method and your backup method, and develop a protocol for interpreting the results you get. We love an automated process because of our staffing levels. We have a patient population (elderly, oncology patients) that is frequently transfused, so we need a method that is sensitive to developing antibodies, without too many inconclusive results. Those facts are a big part of what guided our selection process for the methods we use. (And of course...we can't forget the money angle ...management expects a good deal.)

Karrie
Remember you are going to a more sensitive method - you should anticipate losing some specificity. That is part of the deal whether you use solid phase or gel. This does not happen a great deal but you will need to have a process in place to deal with it when it does. More importantly, you and your Medical Director will have to determine at what point you will revert to a less sensitive methodology.
Enjoy

We have had the same issues and are looking at using gel as our backup instead of test tubes.  We have found in a small comparison so far that most are negative in gel but we have found true antibodies in gel that were negative in PEG and LISS and that gave no apparent pattern with solid phase even with homozygous cells that turned out to be Fy, E antibodies.  I have attached some literature comparing SP to GEL (one includes comparision to PEG).
Cleveland Clinic_final.pdf
ECHOSP 240.doc
ECHOSP 263.doc

The Echo is very sensitive, so you will see 'stuff' you wouldn't see with tube testing that is garbage. You will also see (and identify) weakly reactive antibodies that you can't pick up with tube testing. I've seen various explanations for the non-specific reactivity - possible HLA antigens, crypt antigens exposed when the red cells are bound to the test wells and reativity to reagents rather than red cell antigens - but there are no solid answers right now. There are fewer non-specific reactions currently, as compared to the past, so the last rework Immucor did to address the problem of non-specific reactions seems to have helped.
 
We handle the question of significant vs non-significant very much like Beth does. Run the Echo panels and see what you get. If all solid phase tested cells are not positive, try to rule out all clinically significant antibodies. Look for a pattern - are all the reactive cells positive for the same antigen? If there is no pattern, at this point we document a solid phase reactive antibody of undetermined specificity in our patient record. Next we run a tube/PeG screen and if it's all negative, then we report the screen as negative. I would most definitely not ignore a screen because one of three cells is weakly positive - you wouldn't do that with a manual screen would you? That's scary. If you have a weak anti-K for example, you've just ignored it. Solid phase crossmatch compatible blood for transfusion is recommended by the Immucor technical specialists I've talked to about this. Obviously you can't do this if all cells tested are reacting, but for the rest of your patients it's recommended.