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How does your institution handle the charges for routine antibody identification? When a full panel is performed, 86870 is charged. When selected cells are used, 86885 can be charged per cell. How do you populate this to a patient's record? Is it some sort of data entry submitted by the technologist working on the ABID? Manual charge entry after daily review? What LIS are you using? Please help!

One of my larger projects for the last few weeks has been to update our procedure for antibody identification. Most of the individuals who have been involved in reviewing/validating the procedure seem pretty satisfied with it but some of the techs think it's too detailed in some regards and insufficiently detailed in others. I do have a habit of trying making very long procedures that cover as many bases as possible but at the same time I didn't want to make the procedure too rigid because antibodies don't always' follow the rules' and in some cases there's a lot of art and intuition to performing an antibody identification. The procedure includes: Notification of caregivers of delay in testing/rbc availabilityDocumentation requirementsAcquiring transfusion historyProcess for performing full/selected cell panelsProcess for performing exclusion analysis (rule outs)Algorithms with suggested methods to perform in the event that the basic rule outs aren't enough and/or the autocontrol is positive.ProbabilityWhat common antibodies should be ruled out with every AB ID and what to do if unable to rule something outHow antibodies to low incidence antigens are handledHow we handle antibody of undetermined specificityHow/when to use expired panel cellsDirections for IRL consultationHow to determine the clinical significance of usually insignificant antibodies (anti-M)And a chart demonstrating the likely clinical significance of antibodies in transfusion/pregnancyI'm curious if anyone would be willing to share their documented procedure. If anyone is interested in having a look at what we're working on, PM me. Thanks in advance and happy Friday!!

We have a issue that has been up for discussion lately at my facility regarding identifying antibodies as cold agglutinins. Per (new) supervisor, if we rule out all allos on the abid panel and our auto control is negative, we should perform a prewarm screen and if it is negative, identification is documented as "cold agglutinin". We then perform prewarm crossmatches for the patient. I have seen this policy before at a previous facility I worked at, but this is new to some of the techs at my current facility. And because I have been at current facility for several years now and followed the policy of the recently retired supervisor of identifying everything or sending it to the reference lab, it now makes me a little uncomfortable too. The claim by some is that there are specific tests available for identifying cold agglutinins and that we shouldn't just call them that without doing these additional tests. Another claim is that the hematology sample would have erroneous indices if a true cold agg was present but it did not. Any input from the bb gurus on this? (Ortho gel panel A and B were ran along with the initial gel screen where there were multiple 1-3+ reactions but all allos were ruled out using at least 3 homozygous cells. Auto control negative.)

68 y/o african american female presents to ED with severe abdominal pain and heavy vaginal bleeding. Imaging is performed and there's a significant concern for malignancy. Patient has a history of multiple pregnancies, three live births, unclear transfusion history. Labs: 5 g/dL hgb. elevated coags, negative antibody screen in gel. Patient is transfused 4 RBCs during the first and second days of admission. Day three the patient is transfused 2 FFP for a procedure. Day ten the patient is tested for type and screen again for the upcoming OR case and the screen is 1+ positive in gel, three cell. The three cell is rr K+k+Fy(a+b-)Jk(a+b-)Le(a-b+)M+N+S-s+. The gel antibody panel was negative with a 1+ positive autocontrol. The DAT was 1+ positive by polyspecific and IgG. An acid elution was performed and found to be negative. On day eleven the sample is tested for antibody screen in tubes with PEG and found to be negative. The antibody is reported as undetermined specificity, requiring IAT XMs. The patient is transfused 2 RBCs operatively. On day twelve another RBC is transfused. On day thirteen another RBC is transfused. On day fifteen the patient is tested for type and screen again due to expiration and the screen is 2+ positive in gel, three cell, same lot as before. The gel antibody panel shows an obvious pattern with Jk(a). The autocontrol is still positive. The DAT is 1+ positive with poly, IgG and complement. The acid elution shows an obvious pattern with Jk(a). Segments from the transfused units are phenotyped for Jk(a) and 6 of 8 were antigen positive. If you encountered a scenario like this in real-time, how would you have approached it, from a reviewers standpoint? e.g. would you have performed any additional testing with the day ten sample or would that have been appropriate per your facility's policies? would you have performed any repeat testing with the day ten or day fifteen samples?

I realize that all automated systems will not catch all clinically significant antibodies as no automated system is perfect; however, when a clinically significant antibody is not detected on the antibody screen, I'm curious to know what actions facilities have taken before "trusting" the automated method again. Of course, any other recommendations on how you might address this type of situation would be most helpful.