[feedback wanted on cost saving ideas]

Thanks for the letter of support ... but just one correction ... I'm a girl!

[Elution, yes or no?]

We do an elution only if the patient has been transfused. Q: What are you looking for? A: Antibodies that you will do something about in the future. In other words, WE need to know! (The MD really doesn't care what it's name is ... just get compatible blood next time.)

If the patient hasn't been transfused, your eluate will be 'all cells positive' or 'all cells negative' ... so what's the point?

AND if you happen to find one of those auto-antibodies that looks like an Anti-E or such ... you are only just going to confuse the world when it comes to transfusing the patient later. (The proper answer is you don't honor it. So again, what's the point?)

Ok, I agree ... there may be times when an eluate is useful ... such as if the MD wants to determine if a drug is causing the problem. But again, if he/she is suspecting that, he/she will either d/c the medication to clear the positive DAT or wait until the patient develops symptoms and THEN d/c the medication. We don't test eluates against drugs here. So, if that is ever requested, if we cannot convince the MD he doesn't need it, we'd send it to a reference lab that can perform the tests appropriately.

I guess my simple answer to your question is 'NO!'.

[feedback wanted on cost saving ideas]

1. We have validated antigen testing on gel for the Rh System, Fya/b, Jka/b, S, K1.

2. We do not do reverse typing for any ABO Rechecks (donors nor patients) ... and never have! Do request a copy of the reference for this citation.

3. We perform routine ABO/Rh/DAT on Cord Blood from Rh negative mothers. Testing should only be performed if it is clinically necessary. Why consider otherwise? Do we treat ABO Incompatibility (eg. Mom O, Baby A)? No, we don't ... so why chase it down? If the child is showing adverse symptoms of red cell destruction, the MD will order appropriate testing and we will go from there. Yes, this policy saves us a lot of time and money.

Another money saver: Don't run full panels. The question in mind is 'Are there new antibodies?' First, rule out using the screening cells ... we use the homozygous cells to rule out only (nb. But Anti-K1 is ok to use heterozygous, not a dosage issue there). Then, select cells from the panel (and saved panels) to rule out the rest. It's not unusual for the techs here to run a panel of 1-2 cells to get to the answer needed. I have the screening cell sheets attached to the bottom of the panel sheet and make copies as worksheets. This way, the screening cells become part of the panel and part of the patient's file.

Another ... if a patient has a demonstrable antibody, use the patient's serum/plasma to crossmatch FIRST. Then, perform Special Antigen Testing on only the compatible units. Patient plasma is $free.