We do this all the time Eagle Eye (something in CAT, nothing in tube and cross-match by tube) and have had NO problems whatsoever for well over a decade (and we are a Reference Laboratory). I say again, something that I have posted many times, there were no more patients killed by either AHTR or DHTR in the old days, when we only had tube techniques, than are killed now that we have all these other more sensitive techniques. The only difference is that we now detect a lot more antibodies that (theoretically) are clinically significant, but (practically) are not.

Malcolm,

Reference lab is different. You are making sure that all clinically significant abs ruled out.

I am talking about hospitals---pan reaction in gel, inconclusive. Tube negative and giving tube method xm compatible!!!

I am going to give different example on what can happen if weake assumption without completing work up-----

We had a patient who had warm auto and underlying three allo, I believe anti-C, anti-Fya, anti-K showing 3+ reaction in CAT. We have phenotypic ally matched gel best compatible ptbc. Patient went to different hospital in town, they called it warm auto and gave best compatible without completing work up getting history .

Patient ended up at our hospital soon enough and was ok even though he had delayed reaction!!!

I know I went off the topic but this kind of cases makes you paranoid... And it is based on comfort level also.

 

We do this all the time Eagle Eye (something in CAT, nothing in tube and cross-match by tube) and have had NO problems whatsoever for well over a decade (and we are a Reference Laboratory). I say again, something that I have posted many times, there were no more patients killed by either AHTR or DHTR in the old days, when we only had tube techniques, than are killed now that we have all these other more sensitive techniques. The only difference is that we now detect a lot more antibodies that (theoretically) are clinically significant, but (practically) are not.

 

Thanks Malcolm! Paranoia and comfort levels are understandable (all Blood Bankers should have a healthy dose of those), but you have to balance it with the science (what methods you have available to you) with the need for transfusion of the patient.

If your DAT is negative or auto control is negative and positive ECHO is inconclusive then  change methods to  Peg or if MTIDS  ORTHO gel. if negative then

 

Non-specific Solid Phase Dependent Antibody ( sometimes related to Liver disease or TPN alimentation ,cross reactions or (may be IgM to -IgG  phase development  see above)

 

after 2  negative  encounter post  NSPDA  change to negative screen delete history cross due to cross reaction.

We result the positive antibody screen on the Echo and then perform an antibody panel on the Echo. We add an IAT using manual tube method. If all cells are positive in Capture, with negative results in tubes, we result it as a Solid Phase Dependent antibody and use full coombs crossmatch.

 

I have concerns with techs calling results "junk." I have seen what looks like a WAA show up in the more sensitive methods, like the Echo, and later have found a specific alloantibody. IMO we should be performing a full coombs crossmatch (just in case) whenever a method gives positive results for an antibody screen, not just ignoring the results. Obviously we all know with increased sensitivity there is decreased specificity. But I would not want to be responsible for treating something as insignificant and having a delayed hemolytic reaction come back to bite us!

Immucor tells me that if I get reactions on the ECHO screen but negative or inconclusive (panagglutination) on panel cells, the best way to determine if reactions are due to stroma is to do a major crossmatch on the ECHO.  A negative crossmatch on the ECHO with no stroma in the well would indicate the reactions are due to an interference with the stroma (often caused by HLA antibodies) and not a true red cell antibody. 

 

To confirm a negative screen, we test with PeG and crossmatch on the ECHO since our initial reactions are on the ECHO.  Best to keep with the methodology that gives the strongest reaction especially when using an ECHO.  I too have found anti-E and anti-Jka antibodies that react on the ECHO but not in PeG so be very careful!!!!

We have an Echo and get these antibodies from time to time as well.  We have gel and tube available to us, and test with those, and due a full XM.

Most patients who are positive with all cells on the Echo but neg in gel and tube seem to have some sort of autoimmune disease, at least the ones I have looked at.  I don't think we'd benefit from sending these to our reference lab, since they only do tube testing.  If our tube is negative, I assume their tube test will also be negative.

 

Has anyone used Immucor's "Human Platelet ... something..." product (sorry I forgot the exact name) to neutralize Bg-HLA related antibodies?  And, if you have used it, do you run specimens treated with it on the Echo?

 

Linda

Echo user since 2008.  I see these sporadicaly mainly in Obstetric patients and septic patients.  My ARC reference lab advised me when we first got the machine to perform a tube screen.  If that was negative, there was no point in them working ( or attempting ) to work it up.  So...we do a tube screen and IF its negative, which it almost always is, we call it negative BUT put in an internal comment to perform AHG XM if needed just to be safe.  I always, also, run a Ready ID just in case there's multiple allos, which has happened on occasion.  I have used Gel, tube, and Solid Phase & in my opinion is detects E & JkA with way more sensitivity, like previous responses have said.