Antibody work-ups

[SportsFan]

Hello,

New here and I am hoping to see what other places do for antibody work-ups. At my prior hospital, we had the Galileo which we used for all T&S. If the screen was positive, we automatically ran a panel on it as well. From there, if needed, ran selected cells in gel.

At my new hospital, we have a NEO and Echo. We are running T&S and panels on them. But when using selected cells, we use PEG. I've been told by many staff members that PEG is closer to solid phase but I am not sure if that is true. Here, we run at least 1 panel if not 2-3 panels on the echo. I find this often to be a waste of time, reagents, sample, and cost.

What are other places doing that use automation? Are you running panel after panel? Also, when you use selected cells what are you using? Gel, PEG, LISS?

Thank you in advance. Your insight will be very helpful.

[carolyn swickard]

If the antibody is detected on our ECHO, we run a panel on our ECHO (just one). If that doesn't give us all we need, additional work is done in tubes with PEG (which is as close as you are going to get to solid phase in tubes, but is generally weaker.)

Solid phase Warm autoimmune antibodies we attempt to see under by gradually reducing the strength of the enhancement medias - we use PEG, then LISS, then a 1 hour 37C incubation with no enhancement medias - usually just with the trio to see how it is going. If the Warm auto is still reacting - off it goes to the reference lab for adsorbtion studies and all the rest of that wonderful hard work they do. Whether or not we are going to be successful usually depends on the strength of the DAT - which we still do in tubes. We do the IgG only DAT on the ECHO too, just to see what the pt is doing and because there is no auto ct on the solid phase panels, but repeat the whole thing in tubes to report the complement DAT.

Hope this helps.

Edited April 11, 2013 by carolyn swickard
trouble with the internet today - message doubled

[tbostock]

We do the initial 8 cell panel on the Tango (solid phase), then selected cells on gel. I would think PEG would also be fine as comparable.

[SportsFan]

Thank you. This is very helpful. My two issues have been that we are running multiple panels instead of going to selected cells and the second issue has been what media to use for selected cells. I was used to gel and now we are using PEG which just doesn't seem as sensitive. We are seeing strong reactions on solid phase and no reaction in PEG which makes me wonder what is going on.

Again thanks for the insight.

[John C. Staley]

We always backed up our solid phase (ABS2000 and Echo) with PEG. and this started in 1999. We seemed to have very good correlation bewteen the 2 technologies.

[Malcolm Needs ☆]

We use gel as our first line of attack, and tube as our second.

We've found, as a Reference Laboratory, and following a lot of samples being sent to us in which we can find nothing in the way of atypical antibodies, that certain solid-phase technology, and I am not saying which, has a good correlation with super-glue!

:devilish::devilish:

[John C. Staley]

Now Malcolm, no need to get nasty! :pointandl

[Malcolm Needs ☆]

Now Malcolm, no need to get nasty! :pointandl

True though John (for some, but not all, solid phase technology.

[jsherrie]

We use gel as our first line of attack, and tube as our second.

We've found, as a Reference Laboratory, and following a lot of samples being sent to us in which we can find nothing in the way of atypical antibodies, that certain solid-phase technology, and I am not saying which, has a good correlation with super-glue!

:devilish::devilish:

Good one Malcolm!

[EDibble]

We use an Echo for our primary method. If we get a positive screen, depending on any initial suspicions we can glean from patient history and or the screen results, we run at least one Echo panel. (The D negative panel is a godsend to rule out everything but D in a prenatal Rh neg patient who got Rhogam!)

Depending on the results of the first panel we either run another full Echo panel, or selected cells.

We may use our backup method, tubes with PEG, if we need ruleout cells.

As long as each methodology is QC'd appropriately, you can use the results from each. Just remember, of course, that reaction strength will probably vary. Apples and oranges indeed.

:confused:

[AMcCord]

We do our workups like cswickard, though if a 2nd panel on the Echo will complete the workup, we use the 2nd panel to save tech time.

Prior to the Echo, we used gel for about 5 years. I found PeG to be more sensitive than gel for many of the weak antibodies we worked with, though not all. When validating the Echo, we found PeG helpful in resolving discrepancies between gel and Capture, when gel was negative and Capture was positive. That's why PeG is our backup. No method is going to catch everything. You have to pick what works best for your patient population.