Panreactive antibodies on echo, negative dat

[medtechristy]

ATTENTION ECHO USERS,

Over the past couple of years, we have seen the following scenario several times:

*Patient with no antibody history is panreactive with screen and Ready ID panel on the Echo.

*DAT performed on Echo is negative

*LISS screen is negative

*Supervisor made the decision to call this an "atypical warm autoantibody"

Has anyone else experienced this same issue and how was it addressed/what do you call this?

Thanks for any input/feedback that you could provide us

[John C. Staley]

Just out of curiosity, were all crossmatches compatible? Were the crossmatches performed on the Echo or manually? It's hard to say with out really seeing the results but my inclination, with the LISS screen being negative and the DAT negative as well, would be to report the patient as a negative antibody screen and write it off as an anomoly (sp?) to the test method. It happens sometimes. If it becomes a more common occurence I would certainly run it past Immucor.

:juggle:

[Malcolm Needs ☆]

Although not an ECHO user (nor an ECHO enthusiast) myself, I would agree wholeheartedly with John.

[jayinsat]

I am an ECHO user and have seen a significant number of what I like to call "anti-ECHO antibodies". We have maintained gel as a backup for the ECHO. When we see these panagglutinins on ECHO, we repeat them on the GEL. If it is negative on GEL, we call the screen negative and carry on. The ECHO seems to have more false positives than GEL.

[DPruden]

We do the same as jayinsat. Someone explained to me that the solid phase screens and panels use RBC stroma, and not intact RBCs. Our assumption is that the "anti-Echo antibodies" are related to something that is within the cell membrane that is not exposed in other methods, hence no reaction in LISS or Gel.

[BldBnker4]

We have also had this problem. We have noticed that the patients have cold antibodies. We do a "Cold Screen" by setting a manual antibody screen (with no enhancement) along with an autocontrol and "incubating" in the 4 degree C refrigerator for 15 minutes. Spin at 3000 rpm for 15 seconds. Usually they have a 2+ to 4+ reactions. Not sure if the cold antibody is binding complement or interferring with the stroma or "glue" on the testing well. We still go by the "Gold Standard" of the bench. If manual testing is negative then we turn out negative!

ATTENTION ECHO USERS,

Over the past couple of years, we have seen the following scenario several times:

*Patient with no antibody history is panreactive with screen and Ready ID panel on the Echo.

*DAT performed on Echo is negative

*LISS screen is negative

*Supervisor made the decision to call this an "atypical warm autoantibody"

Has anyone else experienced this same issue and how was it addressed/what do you call this?

Thanks for any input/feedback that you could provide us

[John C. Staley]

Just a comment, I have also seen things we wrote off as Anit-LISS antibodies, Anti-Preservative antibodies, etc. In other words this is not unique to the Echo. Unlike Malcolm, I am a fan of the Echo and before that the ABS2000 and I just wanted make sure no one thought this was just an Echo thing.

:crazy:

[Malcolm Needs ☆]

Just a comment, I have also seen things we wrote off as Anit-LISS antibodies, Anti-Preservative antibodies, etc. In other words this is not unique to the Echo. Unlike Malcolm, I am a fan of the Echo and before that the ABS2000 and I just wanted make sure no one thought this was just an Echo thing.

:crazy:

I agree entirely with you there John, that it is NOT just an ECHO thing.

[AMcCord]

And you will see anti-pregnant lady garbage and anti-oncology patient garbage, etc. Goes with the territory.

If we see panreactivity on the Echo, we do a PeG antibody screen. If that's negative, we report a negative antibody screen. We did the same thing when we used gel routinely.

[gagpinks]

On 17/07/2012 at 5:12 PM, Malcolm Needs said:

I agree entirely with you there John, that it is NOT just an ECHO thing.

We had a similar case where antibody scree and panel positive in all cell line by IAT and enzyme but auto control and DAT were negative using IH 1000 (gel technology ) .And also Crossmatch was negative for 8 units. Sample sent to reference lab and reported as pan-reactive autoantibody. 

Why pan reactivate autoantibodies when auto and DAT were negative.  And also why xmatch was compatible but panel was positive(in all cell line) using same technique. ?

[gagpinks]

On 17/07/2012 at 5:12 PM, Malcolm Needs said:

I agree entirely with you there John, that it is NOT just an ECHO thing.

We had a similar case where antibody scree and panel positive in all cell line by IAT and enzyme but auto control and DAT were negative using IH 1000 (gel technology ) .And also Crossmatch was negative for 8 units. Sample sent to reference lab and reported as pan-reactive autoantibody. 

Why pan reactivate autoantibodies when auto and DAT were negative.  And also why xmatch was compatible but panel was positive(in all cell line) using same technique. ?

[Malcolm Needs ☆]

16 hours ago, gagpinks said:

We had a similar case where antibody scree and panel positive in all cell line by IAT and enzyme but auto control and DAT were negative using IH 1000 (gel technology ) .And also Crossmatch was negative for 8 units. Sample sent to reference lab and reported as pan-reactive autoantibody. 

Why pan reactivate autoantibodies when auto and DAT were negative.  And also why xmatch was compatible but panel was positive(in all cell line) using same technique. ?

It is unusual, but it could be that the patient had made an antibody directed against the antibiotics that are used to keep the screening cells and panel cells free from infection, and this antibiotic would not be in either the patient's own circulation (hence the negative auto and DAT) or the units of blood that were cross-matched.  As I say, this is an unusual phenomenon, but by no means unknown.

[Malcolm Needs ☆]

16 hours ago, gagpinks said:

We had a similar case where antibody scree and panel positive in all cell line by IAT and enzyme but auto control and DAT were negative using IH 1000 (gel technology ) .And also Crossmatch was negative for 8 units. Sample sent to reference lab and reported as pan-reactive autoantibody. 

Why pan reactivate autoantibodies when auto and DAT were negative.  And also why xmatch was compatible but panel was positive(in all cell line) using same technique. ?

It is unusual, but it could be that the patient had made an antibody directed against the antibiotics that are used to keep the screening cells and panel cells free from infection, and this antibiotic would not be in either the patient's own circulation (hence the negative auto and DAT) or the units of blood that were cross-matched.  As I say, this is an unusual phenomenon, but by no means unknown.