speedwalker2k

Thank you everyone for your input. I am going to talk to my supervisor about this & we may stop this practice!

Hi Everyone, When adding on units to patients who already have a type & screen done, we currently do a front type on the patient's original blood bank tube for confirmation before transfusing. This has been done for many years & we are now wondering whether a retype is necessary in this case. I'm wondering if anyone else out there does this & if so, what is the reasoning behind it? We always perform an immediate spin cross-match, so a mistype would be picked up at that point. We always retype new patients that have never been in our blood bank system. I am looking forward to any input others may have out there! Thanks, Judy

AMcCord, That is all so helpful, I think that is a great way to alleviate this problem! Thank you so much for sharing your experience. Funny how the gel seems to pick up nonspecific reactions, yet it can also miss some clinically significant ones. I agree that these issues are a lot more common, now that Ortho has had a reformulation of their screening & panel cells.

Shelleyk, That news is very disturbing to me! I know that our gel system has not picked up on anti-M antibodies, but they ended up being clinically insignificant. We too have had to extend our incubation period to pick up on things. Thank goodness that the patient that you mentioned was not harmed in any way! We have experienced so many nonspecific reactions in gel. When running the same patients with LISS, we usually get negative reactions. Thanks for sharing your experience. This will really help me as I delve deeper into this issue!

Nancanne, I hope that this thread will help you when deciding what to choose in your comparison study. It has become a very big problem for us, since we now have a large population of prenatal profiles that we have recently taken on as our workload. I will continue to look into this & will welcome all the feedback that I can get. Good luck on your comparison studies...keep me posted!

David, That is very interesting. I think that you may be onto something! I think that the gel system is very sensitive, but doesn't always pick up clinically significant antibodies. Another question, while we are on this subject, is about the centrifuge for the gel cards. We do an RPM check every day, but do not know of any other maintainance. Do you do anything more on your centrifuge? We use 15-40 mins as our incubation time, as that is what the package insert instructs you to do. Bottom line on all this workup on certain patients...it really seems like a lot of work for no significant antibody outcome. I am hoping that we can resolve this issue.

Maybe I should print all these responses out & mail them to an Ortho representative? Thank you to all that have responded. I am new to this & was not aware that there was a similar thread. I will be sure to be more careful in the future.

That is all so helpful, thanks for responding. It looks as though we will have to make some kind of policy to troubleshoot these hazy gel reactions! I will run it by my supervisor. Too bad that is causes so much extra work to resolve this issue!

This is a question to all gel system users: Our blood bank uses the Ortho Gel System for ABO/Rh, antibody screens & panels. We seem to have a lot of trouble with weak reactions & have been working hard to resolve this problem. Rouleaux is a contributing factor, as well as cold antibodies. We always make sure that we spin our EDTA tubes for 10 minutes, which has helped somewhat. We now do a lot of prenatal type & screens & have noticed that we are getting a lot more weak reactions. A lot of these weak reactions are haze/hazy, which could indicate rouleaux, but this is not always the case. When working these up, we rarely find an antibody. My question to everyone out there, is do you use Ortho Gel & do you have a lot of weak reactions, especially with pregnant women? I think that there may be an interfering substance (perhaps protein?) with the prenatal type & screens. Any ideas or help on this issue?