Problems with cell#2 ortho screen cells?

[LaraT23]

Has anyone else had problems with Ortho screen cells and cell #2 coming up pos when there isn't anything there? I cannot tell you how many of my techs want to call a presumptive anti-E! They can't prove it when we go to the panel but with ortho admitting to problems with E on panels in the past, it makes people over call? Any thoughts?:mad:

[Malcolm Needs ☆]

Has anyone else had problems with Ortho screen cells and cell #2 coming up pos when there isn't anything there? I cannot tell you how many of my techs want to call a presumptive anti-E! They can't prove it when we go to the panel but with ortho admitting to problems with E on panels in the past, it makes people over call? Any thoughts?:mad:

Hi LaraT23,

Are you absolutely certain there is nothing in the plasma? The reason I ask is that, very often, if the cell expresses a low incidence antigen (known or unknown to the producer) you will get quite a few apparently spurious positive results. Antibodies directed against low incidence antigens are quite common amongst the general population, more often than not as a "soup" of many specificities.

We had an Lu:14 cell on one of our panels not too long ago (we knew about this one) and detected 2 anti-Lu:14's in 2 weeks. I had never detected one before, and have not since.

If the Ortho screen cell and cell #2 are expressing low incidence antigens (not necessarily the same low incidence antigen, by the way) this may explain the problem.

On the other hand, of course, it may not!

[LaraT23]

The screen cells came down with a strong 1+ maybe 2+ in the ortho gel. Panel was +/- even with increased plasma and incubation times. We sent it to our reference lab and they reported a negative screen. When we questioned them, we were told that they were seeing an increased number of reference requests for a pos in cell#2 and that they get a neg most of the time. I am hoping that with this new lot maybe that donor was not used again to make the cells but we shall see! I was just wondering how everyone else is doing?

[Malcolm Needs ☆]

The screen cells came down with a strong 1+ maybe 2+ in the ortho gel. Panel was +/- even with increased plasma and incubation times. We sent it to our reference lab and they reported a negative screen. When we questioned them, we were told that they were seeing an increased number of reference requests for a pos in cell#2 and that they get a neg most of the time. I am hoping that with this new lot maybe that donor was not used again to make the cells but we shall see! I was just wondering how everyone else is doing?

In that case, it's unlikely to be a low incidence antigen, assuming they use exactly the same batch in exactly the same way.

We get this occasionally with our hospitals using a DiaMed panel, whilst we use our own NBS panel, which, of course, will not express the same antigens. Also, just ocasionally, it could be due to expression of a Bg antigen that can "disappear" by being soluble. If they wash or resuspend their panel in a different suspension medium (we use Diluent2, most of our hospitals use Alseiver's solution) this too can make a difference.

:confused:

[shelleyk482]

We've been having this problem for the last few lots; a lot of positive SSII reactions that end up being nothing. It's costing us a lot of tech time and money but it had validated our choice of purchasing the TANGO rather than staying with the gel technology (PROVUE). We are in the processing of validating the TANGO so we are running the samples using Gel and on the TANGO and then sending them to a reference lab to "break the tie".

My biggest problem with having this type of issue is that we have gotten to where we tend to discount 1-2+ reactions on SSII and one of these days we won't do a complete workup (we do a panel and if it is negative, we don't look any further) assuming that it's just the junky or nonspecific reactions.

[HWalker]

Has anyone else had problems with Ortho screen cells and cell #2 coming up pos when there isn't anything there? I cannot tell you how many of my techs want to call a presumptive anti-E! They can't prove it when we go to the panel but with ortho admitting to problems with E on panels in the past, it makes people over call? Any thoughts?:mad:

We've had the same problem with cell 2 and have reached the conclusion it must be contamination. Two times we've had actual visible fungal growth. Now we are keeping the screening cells refrigerated and using pre-racked pipette tips to see if it's helps.

[Sko681]

We have also noticed the same issues. I have found that in most cases it appears to be contamination. We even keep 2 rotating sets (one for first shift and one for second and third) so that we don't have them out at room temp for too long. However, lately I have had some very weak reacting anti-E cases but these have had reactions to MOST homozygous E cells (not that this is a big suprise). Thankfully the new lot is in use now so we will see!

[KarenJ]

We have seen it also, we spend a lot of time trying to chase it down and end up with nothing. We refer to it as an anti screen cell 2 after 2 panels come up negative. At least it doesn't happen with every lot, just enough to be annoying.

[estiner]

We just had two horrendous weeks of using Selectogen Lot VS280 where we had 8 workups that turned out to be nonspecific junk (nonspecific <1+ reactions). When I called Ortho, they suggested doing a DAT on the screening cells to rule out contamination - both cells were negative. Then they admitted that they had several calls about cell #1 on that particular lot. Some but not all of our workups involved cell #1. When we got in the new lot VS284, suddenly the workups stopped because we were no longer getting the junk. The new formulated cells from Ortho have been a nightmare - trying to figure out if you have a true antibody or not. The Tango may be a good alternative.

[Jody]

We just had two horrendous weeks of using Selectogen Lot VS280 where we had 8 workups that turned out to be nonspecific junk (nonspecific <1+ reactions). When I called Ortho, they suggested doing a DAT on the screening cells to rule out contamination - both cells were negative. Then they admitted that they had several calls about cell #1 on that particular lot. Some but not all of our workups involved cell #1. When we got in the new lot VS284, suddenly the workups stopped because we were no longer getting the junk. The new formulated cells from Ortho have been a nightmare - trying to figure out if you have a true antibody or not. The Tango may be a good alternative.

Your experiences mirror ours exactly. Our problems have focused around positive screening cell 2 on several lots.

[Antrita]

We also had problems with lot VS280 and I also called ORTHO. They also said low incidence antigen. I was never so happy to get a new lot.

antrita

[LaraT23]

We just got in lot # VSS247 and so far so good. Maybe it was an isolated lot thing? Glad to hear it isn't just me! Thanks everyone

[richardsonj]

Amen to all of you! I just told my other blood bank tech that we weren't crazy afterall! We have been seeing this on our last couple of lots also. I really liked the "anti-screening cell 2" label! hahaha! One lot was so bad, I called Ortho and had to get replacements. It sure does cause alot of stress and unnecessary work. Hopefully they will get it fixed soon!

[LShirley]

Yes!!! Once we get to within a few days of the screening cells expiration date, we frequently encounter these questionable results. Sometimes there will even be positive cells on Ortho 0.8% Panel A...usually cells #5 and #10. We never "assume" that it is an anti-E or that it is nothing. We run more cells from a different manufacturer in gel and with PeG. Sometimes we still find reactivity that we cannot identify and sometimes everything else is negative. We will usually classify as "unable to identify" and perform AHG crossmatch for the patient.

I don't think there is an easy answer.

[jayinsat]

I don't know how many lots of ortho screen cells we, as a system of 6 hospitals, have had with false positives. It happens about 3 or 4 times/ year. Yes, the last 2 lots have shown problems. SC1 and SC3, and then, on the last lot, SC2 only. This is just a headache you have to live with dealing with ORTHO GEL technology. You can confirm using 5% screen cells diluted to 0.8%. Sometimes, according to ortho, the preservatives in the 0.8% reagent rbcs will cause problems if not stored properly (see package insert). Making a fresh 0.8% suspension will eliminate that problem. That helps about 80% of the time, by my experience.

[Brenda K Hutson]

We have also had this same problem for the last several lots. In all honesty, I thought it had to do with keeping our racks out at Room Temp. too long. We always notice that when the bottle starts to get low, we get false positives. I have been trying to get the Techs. to put their racks away between shifts, but it still does not happen consistently. So conceivably, we may have a given rack out for 24+ hours at times.

That is interesting to hear though that others have been encountering this...

I may need to approach it with Ortho next time, rather than with my staff.

Brenda Hutson, CLS(ASCP)SBB:)

[JLF]

When we get a weak positive with Ortho screening cells in gel, we perform a PEG screen in tube. We have found the PEG screen is negative most of the time.

[NedB]

We had the same problem and concluded like most of you that it was contamination. We thought it was us doing the contaminating because it occurred twice, towards the end of the use of the vials. Opening new vials and repeating the screens produced negative results. In both cases of course being thorough blood bankers we had run panels. Now my guess is there was something slow-growing in the #2 vial.

[sdweaver29]

I have had the exact same problem with my previous lot wich expired 07/24/09. I contacted Ortho but they were not able to provide a clear answer. They did tell me that they hace changed formulation of the 0.8%, they removed the antibiotic and for some reason now the cells are more sensitive to light.

Noothing they have told me so far explains the problem. It is erratic because you see the problem with one patient but not others.

I am really loosing confidence with Provue.

[Brenda K Hutson]

When we get a weak positive with Ortho screening cells in gel, we perform a PEG screen in tube. We have found the PEG screen is negative most of the time.

Yes, we either repeat the test in LISS or PEG. But until we realize we have a bad cell, we have wasted a lot of time running Panels.

Brenda Hutson, CLS(ASCP)SBB

[sdweaver29]

We have just gone thru the false positive #2 cell and negative panel. Now with the new lots I see a different problems. Patient was identified with ANti-kell just last week. Then this weekend while working a new sample for crossmatch I went ahead and set the patient on provue to run antibody screen along with panel to save time. To my surprise, the antibody screen was negative but my panel was positive. The panel showed Kell in addition to something else. This sample was ran with the exact same lot of screening cells and panels.

Has anyone seen anything like this?

[Antrita]

We have a blood bank analyzer in our budget for this year. Is this problem worse using the ProVue than in manual gel?

Antrita

[Brenda K Hutson]

I was just talking with another Tech. about this. This rather disheartening (not to mention frustrating). You don't want to call Ortho too many times, saying you are having problems with yet another Lot#, because you are afraid it will look like it is just you having a problem. When they have received multiple calls like this for any given Lot#, I think they should send new cells to ALL of their clients, not make us all suffer until the next Lot# comes out. It is also happening too frequently. Maybe they need to go back to the media they were using previously...

Brenda Hutson, CLS(ASCP)SBB

[kelliott]

Our goal has been to find out the source of the reactitiviy. If the cell is double dose for the Jka antigen ...we have found in some cases anti-Jka. If the cell is P1s we have identified anti-P1, if the cell is double for the M antigen we have iin some cases identified anti=M, in some we have identified anti-E using ficin gel technique, in the rest we have identified anti=Bg. There is almost always a reason for the reactivity, rarely do we find non specificity. It takes extra effort but in the long run it pays off.

[BSIPHERD]

We use Gel. When we have a positive screening cell, we perform a panel. If the panel is negative, we repeat the positive cell with PEG. If it is negative, we report "Confirmatory panel studies were required because of reactions in initial testing. Confirmatory testing was negative." We have had less of these types of reactions since we started keeping our 0.8% cells in black boxes that Ortho provided for us (they look like plastic recipe boxes - in fact we got one at a discount store that was a little bigger to keep a panel in).