Antibody Identification Using Different Methods

[JoyG]

All,

I wanted to know your opinion concerning rule outs/ins using multiple methods.  We have a patient that we identified a new anti-Kell and anti-Kpa.  We had Kell negative and Kpa negative cells react negatively in Solid phase.  We had enough Kell positive, Kpa negative cells react positively in solid phase to meet p-values but not enough Kell negative, Kpa positive cells.  We then ran Kell negative, Kpa positive cells in PEG and met our p-values.  My question to you is-do you then also confirm negative reactivity again in PEG by running another Kell negative, Kpa negative cell in PEG even though this was done (x3+) in solid phase?  My staff want to do this to rule out method dependent antibody (ie PEG)? I hope this makes sense!  When you use another method to rule in/out antibodies do you also reconfirm negative reactivity in that second method even though it was done in another?  What are your thoughts?

[Malcolm Needs ☆]

Yes, is the simple answer (but, then, being a Reference Laboratory, we have access to many more red cells, may more antisera and quite a few more methodologies than do our hospitals).

[goodchild]

We would run a couple expected negative cells in PEG to confirm that we were actually confirming the positive result was from the Kp(a) and not from the test method. So yeah.

[profbaud]

I don't think its necessary to run all cells in one method.  Ruling out in solid phase should be sufficient.  We do solid phase testing as our main method and then run select cells by peg/tube if necessary.  We do run a positive cell for the corresponding antibody on the select panel to make sure it will be reactive in another method.

[JoyG]

Thank you all for your comments!

[R1R2]

We would run a couple expected negative cells in PEG to confirm that we were actually confirming the positive result was from the Kp(a) and not from the test method. So yeah.

I agree

[5dogs]

I actually had an incident come up recently that was similar to this.  I had a tech who thought it was acceptable to rule-out using different methods.  He could not rule-out everything in Gel, so he completed the rule-outs using PEG.  I recently started this position and this is the first time I have encountered this.  All my previous experience was in an IRL and this would not have been acceptable there.  Thoughts?

[Malcolm Needs ☆]

Totally agree 5dogs.

[Justina]

I agree with everyone, that it is not  best practice.

 

Newbie- I have seen techs do that. Even  antibody Id'ed in gel w/ rule outs, performed ABSC testing in tube with LISS and saline, and then crossmatched in saline, because the ABSC was negative!

[EDibble]

I agree with everyone, that it is not  best practice.

 

Newbie- I have seen techs do that. Even  antibody Id'ed in gel w/ rule outs, performed ABSC testing in tube with LISS and saline, and then crossmatched in saline, because the ABSC was negative!

I also agree. And that scenario you mention gives me the willies Justina!