I am questioning my original work flow for processing cold auto antibodies.
Currently it is set up that if you suspect a cold antibody we will perform a 3 cell tube screen with auto control and test at IS, 4C, 37C, and IgG. If the patient is reacting at IS and/or 4C with all cells tested, and not at 37 or IgG, we report as a cold auto antibody without sending specimen to the reference lab.
Recently we had a positive gel screen = mixed field in both of the 2 cells of the Ortho Gel screen. The cold antibody was also interfering with the blood type. Patient was positive with the IS and 4C phases, and negative with the 37 and IgG phases of the tube screen.
The tech was having some trouble resolving the blood type, so it was sent to the reference lab (using Grifols gel) and they found the Cold auto and an Anti-E (mixed field reactivity with all E pos cells in panel). I repeated the tube screen, had another tech do the tube screen and it repeated negative at 37 and IgG.
Is it wrong to not send Cold autos for a full panel workup?