Cold vs No Specificity

[Vic]

I work at a small hospital that performs limited testing. We use the gel card and that is about it. We do not keep any antibody tube testing reagents in house. We recently had a patient that had 3 non-specific reactions on a 11-cell panel. All clinically significant antibodies are ruled out but the antibody was reported as a Non-specific Cold. My problem now is, the pathologist was informed that the patient had a cold auto and he requested that a blood warmer be used(which we rarely use). Would you have reported this as a cold? How can you tell it is a cold just using the gel card? Wouldn't Antibody with no Apparent Specificity be a better ID? My suggestion would be to just give crossmatch compatible red cells and not use a warmer, what am I missing? Thanks!

[Malcolm Needs ☆]

I work at a small hospital that performs limited testing. We use the gel card and that is about it. We do not keep any antibody tube testing reagents in house. We recently had a patient that had 3 non-specific reactions on a 11-cell panel. All clinically significant antibodies are ruled out but the antibody was reported as a Non-specific Cold. My problem now is, the pathologist was informed that the patient had a cold auto and he requested that a blood warmer be used(which we rarely use). Would you have reported this as a cold? How can you tell it is a cold just using the gel card? Wouldn't Antibody with no Apparent Specificity be a better ID? My suggestion would be to just give crossmatch compatible red cells and not use a warmer, what am I missing? Thanks!

Yes, I would agree with you that "Antibody with no apparent specificity" would have been a much better report, especially as there appears to be no proof that the antibody was a "cold" antibody.

That having been said, using a blood warmer for the transfusion appears to me to be totally unjustifed and a complete overkill, and I simply amazed that your Pathologist did not veto the idea at its inception.

:(:(

[rravkin@aol.com]

Vic,

Your case is an example of how mystical we all become in the face of "Non-specific reactivity. We rule out all clinically significant Ab's and yet feel some obligation to entitil this reactivity; a "Non-specific Cold" (do to RT testing despite the 37C incubation), a "Cold Auto" (do to what?? was an Auto Control run??),and an "Antibody with no apparent specificity" from Malcolm's post (is it always true that any reactivity detected using the gel card involves Ab-Ag reactions?) Your approach is the best way to call, and work with this situation. Gel cross-match compatible units are what's best for this patient, because it was in gel that you detected the non-specific reactivity in the first place. The use of a blood warmer based on these results is a precaution which doesn't seem to be entirely justified. However, I have always wondered why a blood warmer is not routinely used in tranfusion. It seems entirely logical that transfusing a warm, or body temp., liquid directly into the blood stream would be of greater benefit then a 5 to 10 degree liquid, for an obviously ill patient. Maybe this is why vital signs are taken twice within the first 30 minutes of transfusion, and, of course, the blood warms to RT during this time. Maybe the RN could take a vital sign after the first 15min of a prewarmed transfusion and then monitor the patient for the remaining transfusion time. Has it ever been shown that blood warmers are of no consequence? And, has it ever been shown that they are benefical? Are blood warmers really all that expensive and time consuming to acquire and utilize?

Edited August 11, 2010 by rravkin@aol.com

[David Saikin]

I think you solution sounds fine. As has been said, there is no documentation that there is a cold ab. We only recommend blood warmers when the cold ab is very strong.

[Vic]

Thank you for the responses!

[OPUS104]

Just a question here Vic. Did your Gel reactions show the typical abnormal appearance often (though not always) seen with "cold antibodies" in Gel. We call them waterfall, though we have hear them call hazy through whole matrix. Just wondering.

[tbostock]

For the blood warmer question: I think they should be used for clinically significant (hemolytic) cold agglutinin disease, and for massive transfusion (trauma) where hypothermia would contribute to coagulopathy. Otherwise, I think they are overkill.

[Eagle Eye]

I think if you give Gel crossmatch compatible blood, you will be fine...I think there is no need for blood warmer.

[Vic]

Just a question here Vic. Did your Gel reactions show the typical abnormal appearance often (though not always) seen with "cold antibodies" in Gel. We call them waterfall, though we have hear them call hazy through whole matrix. Just wondering.

No, it did not appear hazy, it generally looked like a weak 1+.

[Yanxia]

I work at a small hospital that performs limited testing. We use the gel card and that is about it. We do not keep any antibody tube testing reagents in house. We recently had a patient that had 3 non-specific reactions on a 11-cell panel. All clinically significant antibodies are ruled out but the antibody was reported as a Non-specific Cold. My problem now is, the pathologist was informed that the patient had a cold auto and he requested that a blood warmer be used(which we rarely use). Would you have reported this as a cold? How can you tell it is a cold just using the gel card? Wouldn't Antibody with no Apparent Specificity be a better ID? My suggestion would be to just give crossmatch compatible red cells and not use a warmer, what am I missing? Thanks!

I don't think you can report it as a cold antibody. And I find some cold antibodies in get is mix field reaction, but I don't think I can report it as cold just from the gel reaction. Because some thing can show the same reaction like this .