Incompatible with negative antibody screen

[Yanxia]

I have a similar issue. Gel antibody screen negative, therefore an immediate spin crossmatch done but all units attempted were incomaptible 2+. Carried to 37 and reactions are still present, although weaker. Now negative at coombs. Short cold shows positive for cold agglutinin. If my REST adsorption is negative screen at 4C, where does that leave me with the crossmatch. The original crossmatch shows incompatible at 37 which I consider significant. Is it acceptable to report as incompatible due to cold rather than prewarm crossmatch and then report compatible.

I really have a hard time just reporting compatible after prewarm technique. The evening staff is all generalist and they are too quick to jump on prewarm technique without investigating the cause of the reactions.

Does any one have a good flow chart for working with cold and the best approach to handle the crossmatch and reporting? I would greatly appreciate any help here from those blood bankers that have more experience.

If it is me, I will report this antibody can cause 37 C incompatible, and suggest to transfused it slowly and cautious. I prefer to think that gel technique and tube technique has the differ sensitivity about differ antibody. This antibody react at 37C tube but it is not strong ( as you say it is weaker than2+), but if it is stronger than 2+, the gel is neg , it is unacceptible.