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JHDM

Rouleaux interference

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We recently had a positive antibody screen in gel, we ran a panel ( also in gel) and got some reactions but no pattern and everything was ruled out. We then did an antibody screen in tube and saw that there was rouleaux at immediate spin but the screen was negative at AHG.
Is it common to have rouleaux interference in gel?  
Also, there was some disagreement among techs on whether we should do an immediate spin crossmatch only or an AHG crossmatch in these situations. 
I would appreciate any input

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We use Ortho Biovue gel card, and I don't think rouleaux interfere much on the gel result, some MM patients have rouleux on tube, but gel results are good. In my experience, cold antibodies can do.

Just  personal opinion.

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14 hours ago, JHDM said:

We recently had a positive antibody screen in gel, we ran a panel ( also in gel) and got some reactions but no pattern and everything was ruled out. We then did an antibody screen in tube and saw that there was rouleaux at immediate spin but the screen was negative at AHG.
Is it common to have rouleaux interference in gel?  
Also, there was some disagreement among techs on whether we should do an immediate spin crossmatch only or an AHG crossmatch in these situations. 
I would appreciate any input

It's not uncommon to see rouleaux interference in Gel testing but it's not something we see frequently.  The crossmatch question is interesting:  Technically, the screen is negative for alloantibody reactivity so I think you'd be able to follow your procedure for that result.  However, with the immediate spin crossmatch, you may have to perform a saline replacement to obtain a "compatible" unit.  I wouldn't want to assume an incompatible IS crossmatch is due to the rouleaux without confirming that.

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My experience is that interference from rouleaux and cold autoantibodies in Gel is not unusual but this may depend on your patient population. 

As rouleaux is not an antibody an AHG crossmatch is not required. If you IS crossmatch you must (in my opinion) saline replace so you show any agglutination is interference and can therefore enter a negative/compatible/non-reactive result into your LISS, probably with a comment.

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Yes, Rouleaux interference is  common in gel testing. Make sure to follow what's recommended for time and speed when you spin your specimen.  if you have negative results on IgG phase I do agree with Ensis  do saline replacement if it's negative resulted as such and add a comment.

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