PeG Reactors

[MEG]

Our blood bank is currently using PeG. We seem to have an increase in what our techs. are calling PeG reactors. When they are seeing these reactors not all cells are positive. I would think that if a patient reacts to PeG they would react to PeG in all tubes at the same strength. Does anyone have any input on this. They are then using albumin and of course many of the reactors go away. If anyone has any literature on the subject that would be great also.

[David Saikin]

My experience with PeG is that if there is immunoglobulin (IgG) in the pt plasma I am going to see a panreactivity (usually 1+). While it seems to be common practice now, I did not and still do not allow my techs to use PeG on a routine basis. It can be difficult to read; enhances cold aggl; and can cause more problems than it is worth. It is a great adjunct to abid work and I feel that is where it belongs, not as a routine enhancement. To further answer your question, I agree that "Peg" reactions should be everywhere, not just selected cells. However, unless you use gel or solid phase, LISS or albumin do not have the sensitivity seen with Peg. Hope this helps.

[L106]

We use PeG as our back-up method, and we have not seen any increase of unexplained reactions recently.

I would wonder if your staff is encountering patients with cold autoantibodies or weak warm autoantibodies (and they are blowing them off as PeG problems instead of fully identifying what they are dealing with.) Of course, the more dangerous situation would be if the patient had a weak clinically-significant antibody that looks negative with albumin.........that scenario is a delayed hemolytic transfusion reaction waiting to happen!