Inconclusive Reporting

[RL0121]

Pos Antibody Screen gel method

ABID panel all neg

next step: report Antibody as Inconclusive and give gel(IGG) crossmatch compatible units

or perform cold screen at 4 deg 15-30 mins. If pos, report Cold Agg reacting at 4 deg. Perform LISS tube Antibody screen and recommend LISS crossmatch compatible units.

I'm seeing a lot of Cold Agg in our facility since majority of our patients are elderly. Inconclusive reporting is not routinely practice . Has anyone wrote a procedure suggesting "if all clinically significant antibodies are ruled out", report the Antibody as Inconclusive?. The previous facility I work has this practice but theres no written procedure thats directive to the process. I would like to eliminate unnecessary work but still provide a safe practice.

[David Saikin]

I just report that "Antibodies to the routinely encountered blood group systems are not demonstrated". Try enzyme pretreating your panel cells - you may be surprised. I have had to call a few anti-E's: screening cell 2 reacts; negative panel; enzyme pretreatment - R2R2 cells react; pt is E negative.

[Barbarakym]

Pos Antibody Screen gel method

ABID panel all neg

next step: report Antibody as Inconclusive and give gel(IGG) crossmatch compatible units

or perform cold screen at 4 deg 15-30 mins. If pos, report Cold Agg reacting at 4 deg. Perform LISS tube Antibody screen and recommend LISS crossmatch compatible units.

I'm seeing a lot of Cold Agg in our facility since majority of our patients are elderly. Inconclusive reporting is not routinely practice . Has anyone wrote a procedure suggesting "if all clinically significant antibodies are ruled out", report the Antibody as Inconclusive?. The previous facility I work has this practice but theres no written procedure thats directive to the process. I would like to eliminate unnecessary work but still provide a safe practice.

I report these out as non specific antibody. My procedure says for this ID all C.S AB must be ruled out.

[Annadele]

Our practice with a positive screen and negative panel is to perform a screen by tube in PEG. If it is negative, then the patient is cleared to receive electronically crossmatched units on that T&S.

Annadele

Pos Antibody Screen gel method

ABID panel all neg

next step: report Antibody as Inconclusive and give gel(IGG) crossmatch compatible units

or perform cold screen at 4 deg 15-30 mins. If pos, report Cold Agg reacting at 4 deg. Perform LISS tube Antibody screen and recommend LISS crossmatch compatible units.

I'm seeing a lot of Cold Agg in our facility since majority of our patients are elderly. Inconclusive reporting is not routinely practice . Has anyone wrote a procedure suggesting "if all clinically significant antibodies are ruled out", report the Antibody as Inconclusive?. The previous facility I work has this practice but theres no written procedure thats directive to the process. I would like to eliminate unnecessary work but still provide a safe practice.

[RL0121]

I report these out as non specific antibody. My procedure says for this ID all C.S AB must be ruled out.

Hi Barbara,

Although Inconclusive and non specific antibody translates same interpretation, my pathologist and CLS's suggested they'd rather report non specific . Can I take a peek at your facility's ABID procedure portion where non specific antibody reporting is mentioned when all C.S. AB was r/o.? Thanks in advance.

[RL0121]

I just report that "Antibodies to the routinely encountered blood group systems are not demonstrated". Try enzyme pretreating your panel cells - you may be surprised. I have had to call a few anti-E's: screening cell 2 reacts; negative panel; enzyme pretreatment - R2R2 cells react; pt is E negative.

Hi David,

So your facility wont allow to give "gel crossmatch " compatible units when all C.S AB are r/o in gel? Gel xmatch is more sensitive than a tube LISS xmatch right? Some techs can miss a macroscopic agglutination but you cant ignore minute speckles on gel.

Our current approach is like you mentioned. Cold screen in addition to tube LISS AB screen. If LISS neg, cold screen pos, a LISS xmatch is recommended.

My procedure will probably still include LISS AB screen if gel screen is pos and ELIMINATE cold screen work up. Report it as "non specific" and comment: "Antibodies to the routinely encountered blood group systems are not demonstrated". Give gel xmatch compatible units. Your thoughts David?

[David Saikin]

I'm sorry you interpreted my comment to mean we do not allow ahgxm compatible. We do. I was only commenting on how we report out the antibody workup. As for those of you who report "non-specific" . . . I believe all antibodies have a specificity. We may just not be able to determine it. I think a better phrase would be "specificity not determined."

[Rh-fan]

or perform cold screen at 4 deg 15-30 mins. If pos, report Cold Agg reacting at 4 deg. Perform LISS tube Antibody screen and recommend LISS crossmatch compatible units.

I'm seeing a lot of Cold Agg in our facility.

Maybe the low temp (4oC) is also a reason you find a lot of cold antibodies. I have alsways learned that at 4oC you will find cold antibodies in almost everyone, specialy when you incubate for 15 or 30 mins.

Antibodies reactive at 4oC have no relation with the patient and with the lab test you perform (20 to 37oC). It is better to test at 16oC, when there is something wrong with the patient (infection etc.) you will find them at 16oC. Antibodies reactive 16oC can also cause problemes in the lab (most test start at 20oC).

I think it is not right to blame a cold antibody (at 4oC) for a reaction in your screening perfomed at 37oC (and started at 20oC). It is nice to have a explanation but dont fool yourself.

Peter

[David Saikin]

I agree with Peter . . . gel is at best room temp and not colder . . . if I am going to put something at 4C it is only for 5 minutes.

[Malcolm Needs ☆]

As for those of you who report "non-specific" . . . I believe all antibodies have a specificity. We may just not be able to determine it. I think a better phrase would be "specificity not determined."

YES, YES, YES!!!!!!!!!!!!!!!!!!!!!!!!!!

....or, in other words, I totally agree.

:winner::winner:

[RL0121]

I think it is not right to blame a cold antibody (at 4oC) for a reaction in your screening perfomed at 37oC (and started at 20oC). It is nice to have a explanation but dont fool yourself.

Peter

I have seen a 45 min cold screen and was reported as CA. I want to !!! After 6 weeks as a supervisor, ahhh..i'm about to lose my hair

Thank you for all your useful inputs. I'm learning from everyone here. What am I supposed to do without BB talk?. Please keep on talking:-)

[Mabel Adams]

My nitpicky nature makes me want to mention that not all clinically significant antibodies are ruled out just because no panel cells react. I like the terms others used to say that all commonly encountered antibodies had been ruled out. Antibodies to low frequency antigens can still be clinically significant. Those antigens listed on our panels are just the "usual suspects" but there are many more lurking in the shadows.

[AMcCord]

I use the phrasing that our reference lab uses.........'antibody of undetermined specificity, all common clinically significant alloantibodies ruled out'.

[Malcolm Needs ☆]

We use the phrase, "Negative reactions suggest the absence of any (additional) clinically significant atypical alloantibodies directed against the major blood group antigens."

It's a bit long-winded, I know, but it acts rather like a "catch-all".

[jill]

Pos Antibody Screen gel method

ABID panel all neg

next step: report Antibody as Inconclusive and give gel(IGG) crossmatch compatible units

or perform cold screen at 4 deg 15-30 mins. If pos, report Cold Agg reacting at 4 deg. Perform LISS tube Antibody screen and recommend LISS crossmatch compatible units.

I'm seeing a lot of Cold Agg in our facility since majority of our patients are elderly. Inconclusive reporting is not routinely practice . Has anyone wrote a procedure suggesting "if all clinically significant antibodies are ruled out", report the Antibody as Inconclusive?. The previous facility I work has this practice but theres no written procedure thats directive to the process. I would like to eliminate unnecessary work but still provide a safe practice.

At our facility we run screens in solid phase. If screen is positive and the solid phase panel is negative we then

test in Gel If Gel screen or panel is negative then we report out a positive screen and enter the ABID result as

"CSRO" which stands for expands out to read "all clinically significant antibodies ruled out".

[Mabel Adams]

One could argue that we can't even claim that a normal negative antibody screen rules out "all" clinically significant antibodies.

[Liz0316]

I agree with David and Malcolm, that all antibodies have a specificty, we just don't always know what it is. I use the phrase "all common clinically significant antibodies ruled out." And of course if the antibody screen is positive, regardless of the cause, an AHG XM is used.

Liz