[Dealing With Cold Agglutinins]

On 1/28/2024 at 11:15 AM, Clarest said:

As the prewarming technique was also mentioned here, I am wondering if my confusion with the Notes below in the Method 3-6 Prewarming Procedure of AABB Technical Manual (20th ed.) could also be discussed here.

"2.      Cold-reactive antibodies may not be detectable when room temperature saline instead of 37 C saline is used in the wash step.³ The use of room temperature saline may avoid the elution of clinically significant antibody(ies) from reagent red cells that can occur with the use of 37 C saline. Some strong cold-reactive autoantibodies, however, may still react and therefore require the use of 37 C saline to avoid their detection."

Why are the cold-reactive antibodies not be detected when washing with RT saline, but are detected with a warm saline wash? I was thinking the opposite way And the last sentence in the above notes seems to confirm my thoughts 

I read this as washing with room temp saline is sufficient to remove reactivity from cold-reactive antibodies. Some strong ones may require washing with warmed saline, but you risk losing some clinically significant antibodies. In practice, most of our cold antibodies picked up in gel do not require pre-warm and it's unnecessary extra time. Our current procedure is to go straight from our most sensitive method (gel) to our least sensitive method (PW PBS-IAT) and I'd like to change that! Thank you @snance for the references!

[COOLER FOR THE OR]

Does anyone have a policy for returning freshly thawed plasma to inventory after issuing in one of these MTP coolers? We apply Safe-T-Vue irreversible temp monitors to each unit of RBCs and thawed refrigerated plasma, but are unable to apply those to plasma that's still warm.