Dansket

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.

My original post was in response to StevenB's post regarding to his perceived limitation of gel testing.
Regardless if the plasma is technically diluted 1:1, if it resolves the ABO discrepancy, I run with it!
In the past, I limited the use of the saline-replacement technique in standard tube testing to resolving ABO discrepancies detected in the immediate-spin ABO plasma grouping test.  I have not used saline-replacement for antibody identification.

OK, point well taken.
If you add 50uL of low-ionic strength saline to the mixture of 50uL plasma and 50uL 0.8% rbcs, then the ionic strength as well as the plasma/cell ratio is maintained in the reaction chamber  This provides a tool to mitigate rouleaux formation in Gel.

WE do - because it is more accurate.

We follow the same process for antibody identification whether it is being done the first time or the 21st time on a patient.

We follow the same process for antibody identification whether it is being done the first time or the 21st time on a patient.

On subsequent workups, we no longer "rule-in" the antibody.  We just pick selected cells to rule out anything else, and our same "ruling-out" rules apply.

An auto-control and a DAT have not always given the same result in my experience!

An auto-control and a DAT have not always given the same result in my experience!

An auto-control and a DAT have not always given the same result in my experience!

That's what we do.   Cord bloods on O and Rh negative mothers.  Or if the mother has and antibody.  
We don't even do elutions here.  Just report the Mom is O and the baby is A with a positive DAT ..for example.

Our rules regardless of methodology:
K, rule out heterozygous
C, E, rule out heterozygous ONLY when Anti-D is also present.  If no Anti-D, rule out homozygous

We keep a shelf for special screened units.  I try to keep  2 O Pos and 2 A pos C E K and Hgb S negative.  
That helps a lot for us. 

Agree.

Do you use EDTA blood samples?
We use EDTA blood samples and Anti-IgG gel cards.  We don't reject hemolyzed blood samples unless black text on white paper cannot be read through the hemolyzed plasma.
 
 

Yes, I will rule out anti-K with a single non-reactive K+k+ panel cell.

Send me private email.  I would be eager to assist you.

Do you use EDTA blood samples?
We use EDTA blood samples and Anti-IgG gel cards.  We don't reject hemolyzed blood samples unless black text on white paper cannot be read through the hemolyzed plasma.
 
 

Discontinued routine washing of cord blood cells for standard tube testing decades ago.  Routine washing assumes all cord blood samples are contaminated to the extent that false-positive results would be obtained without washing. In the absence of supporting data,  it is a "solution looking for a problem".

FDA, CAP, AABB are all minimum requirements.  Your policy can exceed FDA minimum requirements.  I have always used the 'issue' time as the start of the 4 hour clock for units not issued in a cooler.

Discontinued routine washing of cord blood cells for standard tube testing decades ago.  Routine washing assumes all cord blood samples are contaminated to the extent that false-positive results would be obtained without washing. In the absence of supporting data,  it is a "solution looking for a problem".

4mL EDTA, 12x75mm
Used BioHit automated pipettor (go through plasma to aspirate rbcs after dispensing plasma into antibody screen and reverse grouping, xmatching)
Packed RBCs
Yes

Automated testing eliminates all these issues.

We weigh each one of our units before issue (for the RNs input/output numbers) and our ADULT units range from 270 ml to 420 mls - a huge range to begin with.  The small ones are the pheresed units.  So - we base our decision to issue the remaining amount of a pedi-pak unit on the weight of the unit.  If it still exceeds 270 ml and has been handled correctly, we will give it to an adult.  After all, it is no smaller than some of the ADULT units our distributor sends to us to begin with..... 
 

In a word - NO!