Previous Cold Agg reacting at 4 deg

[RL0121]

Previously Cold Agg at 4 deg ( 2 weeks ago). LISS xmatch recommended

Now: Gel screen W+ on 2 cells. Tube LISS screen was neg. Was told no need to report gel reactions? just tube LISS. then perform LISS xmatch.

Is this ok? My old facility have us report our gel screen too.??? I'm totally confused and see why I cant.

[Malcolm Needs ☆]

Gel is very good at detecting cold antibodies.

Cold antibodies can sensitise red cells very quickly (before the gel is incubated at 37oC) and, although you say the cold antibody only reacted at 4oC two weeks ago, the amont of I and H antigens on red cells vary quite a lot. The chances are that the cold antibody is reacting preferentially with these particular cells because they express higher amounts of the H and/or I antigens than the other cells used.

I would have no problems if one of my staff members completely ignored the gel results and just reported the tube results. In fact, I might actually have problems with them if they did not ignore the gel results!

[Likewine99]

A wise tech from our reference lab once told me that gel, LISS, PEG are "tools on our antibody ID toolbelt" and that different tools are better for different things. I agree with Malcom, gel is great at detecting cold abs.

I've seen cold abs that are so sensitive that if you were working on the bench directly under the airconditioner vent it appeared and if you moved to the other side of the bench where it is "warmer" it went away.

I'd be comfortable with reporting just a cold and be glad it's not a warm!

[RL0121]

I agree to you both. Its just I questioned why we dont need to report gel screen when tube LISS is negative. The fact it was performed and not ignored. Maybe I'm just too paranoid:-) lol. Newbie, new system...I have to adapt to their usual way.

[LCoronado]

We have a patient like this who presents every two weeks or so for transfusion. We used to do the gel screen and panels first, and there were enough negative cells to rule out all significant antibodies in the gel panels. The cold panel was positive for non specific cold agglutinin. We reported the screen as positive in gel, negative in tube ( I believe all the work which is performed should be on the record); the antibody ID report was non-specific cold, with all significant antibodies ruled out. The cold has gotten progressively stronger, to the point where nothing can be ruled out with gel. Intellectually I believe we are fine going right to the tube method. However, after many years of hearing about the greater sensitivity of gel, I worry about missing a new, signifcant antibody this way.

[jayinsat]

You could always report the negative antibody screen and indicate that it was by tube and comment the positive gel reactions. That's what I would do so that a tech following me knows that my negative antibody screen was positive on gel but ignored.

[Malcolm Needs ☆]

We have a patient like this who presents every two weeks or so for transfusion. We used to do the gel screen and panels first, and there were enough negative cells to rule out all significant antibodies in the gel panels. The cold panel was positive for non specific cold agglutinin. We reported the screen as positive in gel, negative in tube ( I believe all the work which is performed should be on the record); the antibody ID report was non-specific cold, with all significant antibodies ruled out. The cold has gotten progressively stronger, to the point where nothing can be ruled out with gel. Intellectually I believe we are fine going right to the tube method. However, after many years of hearing about the greater sensitivity of gel, I worry about missing a new, signifcant antibody this way.

The gel is, without doubt, more sensitive than the tube technique, but that doesn't mean that the tube technique isn't sensitive. As I've said on this site before, there has not been a sudden and massive decrease in the number of blood transfusion associated deaths since the introduction of gel, and we didn't kill loads of people in the days before gel, when we only had the tube technique.

[Malcolm Needs ☆]

You could always report the negative antibody screen and indicate that it was by tube and comment the positive gel reactions. That's what I would do so that a tech following me knows that my negative antibody screen was positive on gel but ignored.

I agree with you jayinsat, in that the results MUST be available in the laboratory for the next tech dealing with the patient. I just wouldn't include it in the formal report to the requesting doctor, who is unlikely to understand the nuances involved, and may be "phased" by the unnessessary (I'm certain I've spelt that incorrectly!) disclosure.

[LCoronado]

The gel is, without doubt, more sensitive than the tube technique, but that doesn't mean that the tube technique isn't sensitive. As I've said on this site before, there has not been a sudden and massive decrease in the number of blood transfusion associated deaths since the introduction of gel, and we didn't kill loads of people in the days before gel, when we only had the tube technique.

Yes I know and I love hearing you say it again - it's a reminder we all need on certain days.

[LCoronado]

Well Malcolm when you're right you're right. Our patient came in tonight and we went straight to the tube method - identifying a lovely Anti-K. Happy New Year!

[RL0121]

Happy New Year to all BB talkers. Looking forward to learn more from the experts. Keep up that great sense of humor Malcolm.

[Malcolm Needs ☆]

Happy New Year everyone!