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another "rule out" rule question: Solid Phase


suhu

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 Ok, I know I'm asking the same question multiple ways, but... For example, if no homozygous cells are available on a panel, is one negative  E+e+ or K+k+ cell sufficient to rule out anti E or anti K by solid phase?  Is the rule different for different antigens? Essentially, do you consider solid phase a more sensitive test, therefore one negative heterozygous cell is sufficient to use for rule out?  If a solid phase panel demonstrates a clear-cut antibody pattern (no extraneous, unexplained reactions), can a heterygous antigen expression be used for rule outs?

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Under our organization's policy, a heterozygous crossout would be acceptable in a technique that is considered an "enhancement".  We consider Solid Phase to be an enhancement technique so heterozygous crossouts are acceptable.

Ideally, we would prefer 2 crossouts for a specific antigen, but that is not a hard fast rule....just good practice in my opinion.

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I know places that use either of those policies.  I will r/o Rh's with a heterozygous cell if using enhancement - enzyme, PeG.  I consider the new technologies to be enhancements because of their increased sensitivities but I know folks that don't accept that.  I think it is whatever makes your Medical Director comfortable.

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Thank you for your replies.  I also consider Solid phase to be an enhancement, so a heterozygous rule cell is okay most of the time.  Solid phase does confuse me though, as we've had patients with antibodies that react with heterzygous cells but are negative with a homozygous cell, so I'm never sure if the homo/hetero "rules" apply to solid phase.

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