drwajiha

If the information is required, then it is required.
If the nurses can't be bothered to fill it in, go down the disciplinary route.
If the information is NOT required, then ditch that bit of the form.

As long as the technical staff are using the technique on a regular basis, then I see no problem with them using it.  If they only do it now and again, however (and the same goes for all staff), then it may not be safe.

Malcolm.  I believe the occasional use of tube testing to get around gel interference (especially when a pre-warm is necessary)  is relatively common at many hospitals in the US.  And we do, indeed, have to show that we have documented P&Ps and competencies for tube testing to regulators, just like we do for all the testing we do in the Lab.
 
Scott

Dear Malcolm, This means that  i should take it as that it is better that I remove the tube testing from the routine procedure used by the technical staff and define it to be used in rare cases as non conformance by senior member or by me only. (actually in problematic cases I prefer to repeat the testing myself before interpretation of the test. a bit crazy !!! but better to be fussy and crazy than putting patient into problem)    

It would be nice to have the ability to perform tube testing for those rare cases of which you speak, but my only worry is, as they are rare, would you be able to guarantee competency when called upon to perform these tests.
It is slightly different for me, working in a Reference Laboratory, as, although such cases are rare within each of our hospitals, almost all of them pass through my laboratory, and so keeping up competency is extremely easy.
Tube testing in the wrong hands can be fraught with danger.

Dansket, my understanding, and please correct me if I am wrong galvania, is that the ratio of red cells to plasma, and the dilution of the red cells are both "sacrosanct", and that if you change either of these, you run the risk of getting false positive or false negative reactions?

I am in China, I don't know the rules or regulations in the USA.
I will keep tube as a backup since gel method sometimes are too sensitive and easy to be interfered by some factors, such as cold antibodies, proteins or sickle cells.

Dear Malclm, Sorry to hear about the tradegy. But knowing this has made me to respect you more. Inspite of your problems you spent time to answer my thread and give me advice. It is truly very nice of you. 
Best regards, drwajiha

I have explained earlier that at our facility we are using complete crossmatch gel card (by DiaMed / BioRad).
This card has two phases of crossmatch:
- AHG
- Enzyme phase.
I am getting positive result in enzyme phase only. NOT that I am doing crossmatch using only enzyme phase.
 
In reply to the other queries  and comments by Malcolm Needs and Abdul Hameed  i would like to say that at our facility we do serological crossmatch and my explanation given above might answer your queries that how and why so many units were tried .
If antibody screening was positive and Antibody Identification was conclusive, there would have been no problem. 
I brought up this problem in front of you because all of you are knowledgeable.
May be people are using these cards for a long time and they could give me information about any interferences encoutered or any similar experiences or advise me  to check my working or about my course of action to be taken now. 
Again thanking you all for your time and interest in this thread.

Well, neither actually!
If you think about it, the foetus/baby must inherit a "d" gene (I know that this doesn't exist - maybe I should call it a "D Negative" gene) from the mother, and so, at most, they can only be heterozygous for the RHD gene (Or, if the dad is also D-, they would be D- too). To mimic the "D-ness" of the foetus/baby, therefore, I would use a pool of R1r red cells (and there is a difference between the number of D antigen sites per red cell between R1R1 and R1r - albeit this is so slight that it is very difficult to detect serologically), but, if this phenotype is rare, as I believe it is in certain parts of Asia, I would certainly use a pool of R1R1 red cells in preference to a pool of R2R2 red cells for titration.
By the way, sorry to be pedantic, but the number of epitopes is the same for R1R1 and R2R2, but the number of antigen sites per red cell differs.