Ortho Gel Testing

[Malcolm Needs ☆]

Maybe I should print all these responses out & mail them to an Ortho representative? Thank you to all that have responded. I am new to this & was not aware that there was a similar thread. I will be sure to be more careful in the future.

I wasn't being critical about the thread. I was just pointing out that there is obviously a problem as there were two similar threads, and yet the manufacturer says there is no problem. That, to my mind, sounds fishy.

Edited September 12, 2009 by Malcolm Needs
As usual, my spelling is awful!

[BankerGirl]

I agree whole-heartedly with the comments about Ortho's 0.8% suspensions. We had so many problems with weak reactions that did not ID an antibody, that I contacted our reference lab and they suggested that we use 3% cells and dilute them daily. We even went a step further and use our "other" manufacturer's screening cells and we very seldom have problems with fuzzy antibody screens.

My question is for those who say they repeat these in tube (LISS or PeG) and wonder if getting a negative reaction in tube is enough, or do you perform the gel panel first and then do the tube screening. We have had 98% or our Rh negative Labor and Delivery patients show weak anti-D in gel that we do not see in tube. What are everyone's thoughts on using tube only for these patients? One of our Techs didn't think the AABB inspector would go for different methods for different patients.

[Brenda K Hutson]

We do experience problems from time to time (problems meaning reactions for which a clinically significant antibody cannot be identified). I have attributed them to the following (though there may be other reasons):

1. Cold Agglutinins

2. Rouleaux

3. Fibrin (even when using an EDTA specimen and spinning it well; this usually demonstrates a weak

reaction around the top of the gel column which is clearly not a true mixed field reaction)

4. An increasing number of "false positives" in recent months; some hazy reactions. There have been

previous threads on this where it appears that a number of us are experiencing these problems.

When we contact Ortho, we are being told that there is a new formula for the cells and that

flourescent light may be causing problems; we are told to keep the bottles covered to decrease the

light issues.

I have recently been repeating such testing (questionable reactions on the Antibody Screen and/or Panels) by performing a LISS and GEL Antibody Screen. These are frequently coming up Negative. It is frustrating and it does result in a lot of wasted time. I think these problems have been going on long enough by a significant percent of their clients, that Ortho needs to step up to the plate and try to resolve them. Just my thoughts.

Brenda Hutson, CLS(ASCP)SBB

[Dar]

We are seeing more "gel crap" daily. You are right about the pregnant woman. I'm thinking it could be the pre-natal vitamins??? We are also seeing it on our trauma patients. Maybe it's the plasma expanders or whatever they are using to infuse these days. My concern is that it isn't always every cell, so it looks like it's something. After everything is ruled out, we go to PeG & it totally disappears.

[gomerby]

At our facility, when the reaction in any of the three cells was 1+ or less, we would make up the 3-4% cells as described by AMcCord and rerun the ab screen on gel. If it was still positive, then we ran the panel. We're no longer doing this as we now have the Galileo, and are currently validating the Echo.

[Malcolm Needs ☆]

Much as I do like the gel technique (we use DiaMed in my laboratory) I think that they are very sensitive at detecting such antibodies as anti-McCa, anti-McCc, anti-Kna, anti-Yka, anti-Csa, anti-Bga, anti-Bgb, anti-Ch, anti-Rg, etc.

We are detecting many more of these (and I do mean many) than we used to when we were using tube or liquid-phase microtitre plate techniques. I suspect that manyof the reactions being seen "at the hospital level" (and I do not mean that to sound disparaging) are of this ilk. In most cases, I suspect, hospital-based laboratories will have neither the time, nor the reagents to sort these out (although they would certainly have the expertise). The lack of sufficient reagent red cells may also be true for many Reference Laboratories.

In cases where the reactions are 1+ in gel with some panel cells, but weaker (0.5%+ !!) with others, but the auto was quite clearly negative, we will often "diagnose" these as anti-CR1-related, without assigning an actual specificity. On other occasions, if we find nothing by tube IAT, we will put out a report saying that there is nothing there (on the grounds that there are no clinically significant atypical alloantibodies detected).

I suspect that this may be part of the problem, but I think that there is more to it than just this explanation.

:confuse:

[bbbirder]

Ditto what others said about the reformulated cells. Before we switched to the Echo, we were using manual gel testing and getting so much junk that we started diluting cells up each day. End of junk.

We still use manual gel as our backup method for antibody screens, but we love our Echo.

Linda Frederick

[jlemmons]

I have worked with Ortho folk for several years and they work very hard at making sure problems are addressed. I assume that other companies do the same. I do know that the issue with Screen Cell II seems to be a problem with leaving the red cells out in the light and at room temp. If they are placed in a container in the refrigerator when not in use, there are less problems seen. And yes, I work for Ortho but am very new to the company. I speak as a customer not as an employee. It is very interesting to see both sides of the issue and try to work through the problems for the sake of the patients. End of soap box.

[Brenda K Hutson]

We actually cut the flaps off of 3 of the boxes the screening cells come in (we keep 3 racks) and place the box upside down over the Screening Cells. That way, they are always in the dark (even when out of the refrigerator). I have to admit, I was skeptical about the flourescent light theory; but it seems to have worked!

Brenda Hutson

I have worked with Ortho folk for several years and they work very hard at making sure problems are addressed. I assume that other companies do the same. I do know that the issue with Screen Cell II seems to be a problem with leaving the red cells out in the light and at room temp. If they are placed in a container in the refrigerator when not in use, there are less problems seen. And yes, I work for Ortho but am very new to the company. I speak as a customer not as an employee. It is very interesting to see both sides of the issue and try to work through the problems for the sake of the patients. End of soap box.

[macarton]

We are one of the first BB's to go with gel in 1995. We had issues as you described on all cells for a spell and started storing our gel cards in the refrigerator and eased the problem. We keep cards at RT that we are testing with. We are also seeing occassional cell 2 haziness that most of the time if you run a tube cold screen will explain the issue. We also do antibody screens on all OB's coming in L&D.

[Deny Morlino]

We also do antibody screens on all OB's coming in L&D.

I have another thread started on this very topic. Can you help me to understand why this is the practice at your facility?

[macarton]

We've had several that have hemorrhaged after delivery over the years. They used to just draw specimens to hold in case, but when they break loose they need blood now. It's part of protocol as a result. Also comes in handy to know about any antibodies we are dealing with since we aren't the reference lab for all of the practices.

We use the Echo also, but are seeing a lot of all cells positive. We repeat by gel and report the gel results.

Edited January 13, 2012 by macarton