Wow, now here is a thread that has stayed the distance!!! I have been using Gel cards since first released many many years ago. That was in a hospital in Oz with large trauma and maternity centres. I have looked at this question a number of times (at others requests)> NOWWHERE in the literature does it say re-spin. Initial inspection of cards on receipt will show bubbles, or cards that have been shipped on their side. It is permissable to spin these to re-settle the gel. BUT it will not get rid of all nuisance reactions. Colloids and other plasma expanders would be one of my chief suspects (along with other s&%$) they pump in for ER or obstetric emergencies. The others like fibrin etc can be dealt with easily, but does mean a repeat. The others - Good Luck with all that. Experience is essential!! Remember, you can treat a patient with a reaction, but cannot help one who is exanguinated! Eoin