Room Temperature antibody positive cell

[eltonsey]

Hi everybody

I hope you are all well

If I found one cell of the antibody screening cells positive only for room termperature phase only should I do antibody identification or not and what is to be written in the report and is it important in the crossmatch

Thanks

[Malcolm Needs ☆]

From my point of view, I would say, no, nothing and no!

[eltonsey]

thank you very much

[L106]

From my point of view, I would say, no, nothing and no!

I can't believe I have a slightly different view from Malcolm......(Please don't beat me up, Malcolm!)..

Not knowing any details about what type of testing techique eltonsey is using, etc., I would be a little more cautious. I have to admit, I would do an Antibody Panel to see what I am dealing with. Years ago (before our current enhancement solutions, techniques, and automation), I saw a few patients who were just starting to produce new antibodies that were most IgM (and little or no IgG yet). Those antibodies might not have caused serious transfusion reaction if the patients were transfused, but they could be important information if a patient was a pregnant woman.

Donna

[Malcolm Needs ☆]

Fair comment Donna!!!!!!!!!!!!

[EDibble]

I had the same reaction as Donna. Especially if the patient had been recently transfused, they could just be beginning to make an IgM of a significant antibody.

[eltonsey]

antibody pannel was negative for all cells, we are using gel technique

[Malcolm Needs ☆]

I am not at all surprised (despite agreeing with Donna, and EDibble), which brings me back to my original answer (except the first one) of nothing and no!

[L106]

One other question... (I might be missing something here)....Why are you doing the immediate spin phase of testing if you are going to ignore whatever the results are?

Donna

[Yanxia]

I agree with Malcolm, it is not significant.

[bduff]

If you are using gel what exactly are you doing at room temperature?

[Deny Morlino]

If you are using gel what exactly are you doing at room temperature?

I was wondering the same thing.

[eltonsey]

if i see the reaction directly after centrifugation of the card it is not room temperature reading

[Deny Morlino]

Are you performing any sort of incubation prior to centrifugation of the card? The testing performed in IgG cards is listed as an AHG process according to the Technical manual and in the MTS instructions for use of the IgG cards. I don't think the process is considered a room temp procedure, although I do follow your logic I think.

[eltonsey]

i don't want to be strange for you but i get the result sheet to interpret it is done by technician and i think they are familiar with the test technique as i belive

[David Saikin]

If you are using IgG cards, they are supposed to be incubated at 37C prior to centrifugation . . . you could use the buffered gel if only looking for RT abs, but why would you want to? Is this a donor or patient antibody?

[eltonsey]

patient

[mrmic]

Agree with Mr. Needs.

The only reason to do RT is with the xm is to look for ABO incompatibility (If you are doing xm at all). RT incubation antibody screens are not for routine testing. Only for complex antibody workups and Reference labs.

[Malcolm Needs ☆]

Only for complex antibody workups and Reference labs.

Actually, as a Reference Service manager, I can assure you that we wouldn't do room temperature tests in the UK, unless it is likely to help with a complex serological case. Usually, they are a complete waste of time!

[galvania]

Dear Eltonsey, I think there is some confusion about exactly what test you are doing. Can you tell us which cards (Coombs, neutral, other) you are using, which cells, and by what technique. Then I am sure we will be better qble to help you

[mrmic]

Actually, as a Reference Service manager, I can assure you that we wouldn't do room temperature tests in the UK, unless it is likely to help with a complex serological case. Usually, they are a complete waste of time!

Agreed, as a former Reference Lab manager we used them only when trying to reproduce what our clients were seing so could help them understand what was happening. Why it is still hanging around in the US hospital transfusion services is mystery to me.

[eltonsey]

thank you very much Anna we use LISS/Coombs Diamed and cell I II III

[galvania]

Dear Eltonsey. Thank you for that precision. In that case, the correct method, which I am sure is what you are using, is to pipette 50ul of the I-II-III cells followed by 25ul patient plasma. Incubate 15 minutes at 37°C, then centrifuge and read. If you had 1 cell positive in this method, with a negative panel, then the ptient maybe had an antibody against a low frequency antigen. In that case, if you let me know the lot number of the I-II-III cells you were using, I can see if maybe I can get any more information. In this case, if you do a normal crossmatch, you should be OK. On the other hand, there used to be a method where 50ul of plasma is used instead of 25, and the LISS Coombs cards are incubated for 10minutes at room temperature. Although this method still exists, it is not to be recommended for routine use - but sometimes can be quite helpful in elucidating funny anti-S or M or N antibodies. If this is the method you are using, I recommend you change immediately for the normal method (ie 15 mins at 37°). If you need any other help, please let me know

Anna

[eltonsey]

Anna you are very helpful thank you very much

[rravkin@aol.com]

Anna,

By "normal crossmatch" do you mean AHG X-match or IS X-match?