How not to miss a weak reaction

[mommymini1]

Hi, I am a new bloodbanker and forgive me in advance for asking this question. My question is….I am afraid when reading tube agglutination I will miss a weak reaction and call it negative. I think it’s my technique. When I am reading a tube reaction after centrifuging ….I hold the tube so that the button is facing upwards and then I gently swirl while watching the button to see how it falls off. I look for any granules. Is this right ? Are there any tips on how not to over shake a tube and miss the weak agglutination . Thanks for reading my question. 

[Malcolm Needs ☆]

It sounds to me like you are doing everything that you should do, without either over-shaking the tube, or over-reading the contents.

I am extremely glad that you are not using a microscope, as, if you did, you would almost certainly see the odd couple of red cells "kissing each other", even if they have been incubated in isotonic saline.

The other thing is (and I speak with some 43 years of working in blood group serology) if the reactions in the tube are THAT weak, the chances of any atypical alloantibody that you might miss being clinically significant are absolutely minute.

If you are still worried, however, get a more experienced worker to read your tests as well, until you feel confident.  That is how I learned when I started.

I wish you the best of luck in your future career.

[mommymini1]

Thank you so much for your suggestion …I really appreciate it. 

[TreeMoss]

I remember being really confused in school as I was trying to copy the swirling that the grad student did when reading his tubes. When I went to the hospital for my clinical rotations, the blood bank supervisor taught me to hold the tubes with the button up and just tip the tubes over the finger on my other hand and watch the button as it came off the tube. This has worked so well for me all of these years in the blood bank.

[Bet'naSBB]

I've been a BB'er for 35 years (at the same hospital)  my very first manager (who was a good,  seasoned BB'er) used to tell us........., "if you have to hunt for it - it's not there".

As you become more adept at reading tube reactions - your eyes will not fail you!  Trust your gut.

As for your technique - it all sounds good!  Practice with a few techniques to find the one that works best for you

I "tilt and giggle", button up, The tilt helps with seeing Mixed Field - which we tend to see a lot here - It also helps with seeing "how" cells are falling off the button - are they chipping off or are they "swirling" off.....or is there a little of both?  (For some reason I always think of the "tail" of an old RPR test .....which probably dates me, LOL!)

[John C. Staley]

My motto was "when in doubt, shake it out".  Seemed to work for me.

[exlimey]

Something one of my mentors said early in my career: "Don't worry about junk. If it's a real antibody and you transfuse against it, it'll be nice and strong by the next time you see the patient."

[Malcolm Needs ☆]

3 minutes ago, exlimey said:

Something one of my mentors said early in my career: "Don't worry about junk. If it's a real antibody and you transfuse against it, it'll be nice and strong by the next time you see the patient."

Sounds like the late, great Dr Sheila Worlledge?

[mommymini1]

Wow , thanks everyone!!! Such great advice! I am so grateful for all the tips. They are all really helpful!!!

[exlimey]

On 10/20/2023 at 12:39 PM, Malcolm Needs said:

Sounds like the late, great Dr Sheila Worlledge?

Not she, but it's possible the person that conveyed it to me got it from Dr. Worlledge.