DJN

We have a new supervisor, who has advised us to add 6% albumin to the reagent anti B (for serofuge calibration). We previously added normal saline to dilute. Is there a difference?

We were picking up several anti-Ms a month using the Echos. As the instrument is designed to detect IgG, the conclusion was always that the antibody was reactive at 37 C. Yet, it doesn't make sense to see so many. We noted comments of interest in the package insert for the Capture-R Ready Screen under Limitations, 11. "...the Indicator Red Cells (may) carry the antigen toward which the IgM antibody is directed. Some IgM antibodies have been found to link Indicator Red Cells to immobilized red blood cell monolayers by binding to antigens on both. Thus, examples of anti-M, anti-Lea, anti-Leb, anti-P1,etc that are detected in Capture-R tests should not be assumed to contain an IgG component without further study." Here is another useful article on cold agglutinins and cold cardioplegia in surgery: Barbara DW, Mauermann WJ, Neal JR, et al. Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery. Sept 2013 http://dx.doi.org/10.1016/j.jtcvs.2013.03.009

Thank you to everyone! I appreciate your detailed responses. Have a great day.

Dansket and Mabel, Thank you both. The decision to discontinue antibody screens as part of our postpartum workup is what we are looking at, for the same reasons you mentioned. It simply does not seem to make any sense to do them under the circumstances I outlined. And, I do not think the physician thought it through, even after much encouragement to do so.

Are antibody screens required at delivery in obstetrics patients who had a negative antibody screen at 28 weeks? When RhIG is administered at 28 weeks, all screens are positive in our experience. We do not have an option for a mini-screen using solid phase. At least one obstetrician wants all of these extensively worked up, "in case the RhIG did not work". Thank you in advance for taking your time to comment.

Thank you, Malcolm and Yanxia. Your comments are much appreciated. Will update this post as I know more.

Questioning our results. Patient with hemolysis on the pre-transfusion sample. Phlebotomy was non-traumatic, and later draws produced the same result. Hgb 9.0 Only transfusion was 29 years ago. No history of hemolytic anemia Front type: A 4+; B 2+; D 4+; Rh control 2+ Looking at blood with no reagent: agglutination, large aggregates (is doing the same thing in heme lab)--warmed at 37C for 30 min, with no change Back type: A no reaction; B +; D no reaction Re-draw into warm, kept warm to the lab: still agglutinated Cannot be warmed away. No precipitate in plasma after 4C incubation. Antibody screen: (solid phase): 2 cells pos, 1 cell neg Antibody panel (solid phase): anti-e (cannot phenotype at this time, send out) DAT polyspecific 2+: IgG 2+ and Complement 2+ Within 1 day, Hgb 6/Hct 14, LDH elevated (> 1000 IU/L); total bili went from 1.2 mg/dL to 3.4 ; haptoglobin not detectable, creatinine climbing slowly Thoughts/comments appreciated.