Panels every 3 days

[LAURAA80]

Hi! I'm wondering whether anyone ever omits performing a panel. When a patient is originally admitted, we will run an antibody screen and identification, if required. For patient's with antibodies on a long term admission, if the patient is not transfused, do we need to run the panels every 3 days? If the patient receives blood, but it is antigen negative for the antibody identified, the panel does need repeated every 3 days, right? Since there is potential to develop new antibodies. The staff says they know of places where the panels don't need performed every 3 days. Is this even possible?? Any information would be appreciated.

[MEG]

Yes, the panel would still need to be repeated every three days. There are other antigens on those cells that the patient has potential to develop antibodies to. There is also the possibility of one tech grading reactions one way and the next tech reading reactions differently. Although they should all be reading fairly closely, in my facility this is not always the case.

[Bill Sinn]

Laura,

You do not need to perform a full panel. You need to test sufficient cells to rule out other clinically significant antibodies. For instance, if patient has anti Fya, we would probably test all the Fya negative cells on a panel, and see what still needed to be ruled out. Usually, on a well designed panel, other antibodies would be ruled out by testing the Fya negative cells. You may need to run just 2 or 3 cells in addition to your negative Ab screening cells to rule out "others" when the antibody is Anti K or Anti E.

Bill

[Malcolm Needs ☆]

I would agree with Bill. When we are following an antibody during pregnancy, we only ever run "mini-panels" (with one cell positive for the antigen corresponding to the antibody known to be present). However, there is one caveat. Be careful that the patient has not recently been transfused elsewhere before they come into your hospital. They could be developing another antibody specificity that was not yet detectable when you first tested them, that may jump out and bite you later.

[David Saikin]

I also agree with Bill and Malcolm . . . we run selected cells on pts with known abs (I also like to run an ag+ cell for the known ab just to see if it is still there - if I know they have an ab I don't do a screen, just the mini ID).

[Yanxia]

Do the mini- panels is convenient, but if there is another antibody to be stimulated by the previous transfusion, how can we detect it.

I think the previous detected antibody is here or not here, we will transfused the antigen neg panels, so we have not the necessaty to detect it.

[butlermom]

Along these same lines, I have a question regarding the "mini-panel" (the Rh negative cells from the Ortho panel to rule out anything else) that we perform for patients with history of anti-D. The majority (about 99%) of our Rh negative Moms receive antenatal RhIG. Many receive it in the physician's office so the first time we see them is at delivery and they have a positive screen. Since the mini-panel cells will rule out everything else, why must we do a complete panel?

[Mabel Adams]

There is another thread on here that covers antibody ID frequency. There are certainly respected labs that do not do new IDs with each specimen. The previous discussion got quite passionate as I recall. My vote is that every patient deserves a screen (or panel or mini panel) that is capable of ruling out additional antibodies with the same rigor as a screen is for patients without other antibodies. That is, double-dose cells for all but K and the weird ones. As Yanxia points out there is no need to keep proving the anti-Fya; you will give negative units for the rest of the patient's life regardless of whether it is still detectable. If you can rule out everything else (with the necessary double-dose cells) with 3 cells, go for it. Automation does not lend itself to this practice I understand and I have seen some inexperienced techs who found it simpler to run the whole panel than think about what cells to choose.

[Eagle Eye]

we only do panel if pattern for screening is different. All panels must be repeated every 7 days regardless of pattern. ( we use gel automation, I would be hesitant to do this with manual/tube method)

eg. If anti-E id'd today and we receive specimen again after 4 days, we comapre screening (strength & reactivity), if only cell 2 reacts on screenign cell and with same strength we fill out a form(with information as previous antibody, lot# of screening cells) and do not repeat panel on 4 th day.

[butlermom]

Thank you for your responses, but I think I need to clarify what I intended to say. I was referring to those patients whom we do NOT have any history, but strongly suspect that they have anti-D due to RhIG (Rh neg, labor & delivery patient). According to the note on Ortho's panel sheet, the Rh negative mini-panel cells may be used to rule out all other antibodies in patients for whom there is ALREADY a history of anti-D. My question is, if they rule out everything else, why does it matter whether you have a history of anti-D or not? (I always make sure there are homozygous cells for Duffys and Kidds so we often add another cell or two in addition to what Ortho has designated with the @ symbol.) Thanks.

[Liz]

Since I use BioRad (Diamed) gel cards I run the whole panel.

[Mabel Adams]

I guess whether there is a history or anti-D or not only matters if you want to detect anti-D. If you know it is there, you don't want to detect it so you run the @ cells (plus some). If you don't know it is there, but you don't care if you detect it, you could still run the @ cells mini-panel. If you run the @ cells in place of your screening cells and get negative with all, did you want to turn out the screen as negative? Most of us would have run the screen and so feel convinced that the passive anti-D is there so would be okay running the mini-panel to rule out everything else. If you need to prove the anti-D as well, run one D cell from the panel as well and you have 3 pos and 3 neg to ID the anti-D plus enough neg @ cells to rule out everything else. This also serves to make sure you added the sample. OK, I'm rambling.

[butlermom]

Thanks Mabel, and you're not rambling! We always run the screen--I wouldn't consider NOT doing that. I like the idea of running one D cell along with the @ cells (plus the other 1 or 2 that I usually add to have homozygous Kidds and Duffys).

[Brenda K Hutson]

Two things:

1. For Rh Negative pregnant (or recently pregnant) women for whom you can confirm receipt of Rhogam (recently; I like to see within past 3 months but have seen it hang out longer)...both Ortho and Immucor designate specific cells on their panel that you can use on these patients (instead of performing an entire panel). On the Ortho Panel A, look for the cells with the @ in the Special Antigen Typing column. On the Immucor Panels, look for the cells with the brackets [ ]. You will notice that these cells do not rule antigens out to the same degree that your Policy likely dictates (i.e. you will be ruling some antigens out with only 1 heterozygous cell; including C and E). If any of those cells react (since they are all D-), you will need to perform a complete panel. But I never allow that without documenting the date the patient received Rhogam (so it is confirmed). I have never run into a problem in using this.

2. As far as the frequency of repeating antibody work-ups on patients with a history of antibodies...the "optimal/ideal" is to repeat a work-up with each new specimen (provided the antibody screen is still positive). That being said, none of the 6 Hospitals (including current one), do that. I also once did a rather extensive poll to find out the frequency with which Hospitals repeated them; the most common finding was every 7 days (which would mean on a patient for whom you were receiving a specimen every 3 days, there would be 1 specimen between work-ups without a repeat antibody ID). That being said...you would have to make sure staff looked at the following:

a) Does the cell(s) reacting, fit with the previously identified antibodies? Staff will need to be reminded that when Lot numbers change, so does the antigram (except for the Rh system which are the same from Lot to Lot).

Has the strength of reactivity increased?

If either of these changes are noted, a new work-up is in order.

That being said, neither of those is a guarantee that there is not a new antibody!! And I have seen it happen. After all, titers of known antibodies can decrease; new antibodies may show dosage; you don't always see that cumulative effect; et. al. So consider that a word of caution. The "safest" thing to do would be to at least perform a minimal rule-out panel (select cell panel). You don't necessarily have to reconfirm the known antibodies; just rule-out any new ones.

Brenda Hutson, CLS(ASCP)SBB