For those that do require microscopic reading of DAT, could you tell me why you believe it is valuable (besides that your older generalists shake the tubes too hard or need glasses )? When would missing a weakly pos DAT have clinical significance for you?

Wow- this sure sounds like age discrimination! What you really have is a long term training issue.

Rebecca you are absolutely correct. I remember when we started using monoclonal IgG and the first package insert said "Do not read microscopically". Then, several years later, I began working part time at another hospital that used the very same reagent and viewed them all microscopically. I pulled the package insert and it said that "a viewing aid" could be used and the supervisor said that the microscope was the "viewing aid". The pathologist at the first hospital was adament that we not use a microscope for any AHG reactions. Don't know what the "right" answer is I have only my opinion and feel that in reading them microscopically a lot of "trash" is called a reaction.

We read all DAT's that are negative macroscopically microscopically.

On our last two DAT surveys we had very weak, rough reactions with our poly specific antisera so the techs read them microscopically and saw nothing. Because they came off so rough, I had them repeat them and let them set for 5 minutes before spinning. The reactions were definitely weak 1+, but they still looked negative microscopically. We struggled how to report them the first time, called them positive, and that was correct. I didn't hesitate to call them positive the second time. This was very distressing to all of our techs, since we all "grew up" confirming anything iffy microscopically! We never had this problem before, so I don't know what to think.

On our last two DAT surveys we had very weak, rough reactions with our poly specific antisera so the techs read them microscopically and saw nothing. Because they came off so rough, I had them repeat them and let them set for 5 minutes before spinning. The reactions were definitely weak 1+, but they still looked negative microscopically. We struggled how to report them the first time, called them positive, and that was correct. I didn't hesitate to call them positive the second time. This was very distressing to all of our techs, since we all "grew up" confirming anything iffy microscopically! We never had this problem before, so I don't know what to think.

Seems like Peter Issitt was right!

Surely the thing is, is a positive DAT that is so weak that you have to look under a microscope, likely to be clinically significant? How are you helping your clinician by reporting an 'iffy' DAT that has 2 cells stuck together under the microscope as positive? Indeed, it could send him off on the wrong track completely. On the other hand, there are so many things that can go wrong technically with tube DATs........