Hello all, I have encountered some controversy regarding a few of our patients that have historical antibodies. As a general policy, at our facility a patient that exhibits a positice Ab screen must have an Ab ID. Normally, we do our own identifications which includes antibody rule--outs using at least 2 cells, preferably 1 that is homozygous (when applicable). However, we have had a couple patients recently that didn't quite fit the criteria. Example: Patient has a historical Anti-D and Anti-C. Using our panel cells, Anti-D and Anti-C were confirmed (again), with 2 stray reactions in gel. Autocontrol was positive. DAT was negative. Reviewing these 2 stray reactions, based on my experience, they looked kinda "funny." I suspected some proteins in this patient's system were causing the stray reactions (patient was on chemotherapy). All clinically significant antibodies were ruled out using at least 2 panel cells, EXCEPT for Kell. I could only find 1 rule-out cell. So, instead of sending this patient to the Refence Lab to investigate the stray reactions, I (as supervisor of the department), screened units that were negative for C and Kell (as a precaution). Both units were XM compatible through AHG and transfused without incident. Later, another tech (who happened to be the supervisor before me) questioned this strategy. She claims this patient should have been sent to the IRL from the begining. I disagree. In my opinion, she is being to strict. Even if we would have positively identified an anti-Kell, we still would have given Kell-neg units! Clinically, either way results in the same outcome, the difference being using my approach saved at least a $500 Reference Lab bill and the patient got their blood at least 24 hours sooner. My Lab Director responded to the other tech's request and a sample was sent to the IRL anyway. The results from the IRL confirmed Anti-D and Anti-C. So, did I do the right thing? Is this a decision that should be based on judgement or policy? Thanks for the replies! Tom