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Previously identified antibodies


CSP0102

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How do you handle rule outs on a future work up when the patient has a previous known antibody. Currently we require 3 homozygous (if possible)  rule out cells for a new antibody, but only one homozygous rule out for all significant antibodies on future work ups. I was wondering what everyone else does in this situation 

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If we can't identify the antibodies off the panel and enzyme, we have a 2nd panel with a further 11 cells. Occasionally we have used the 3 cell D-neg screen too. Usually these 28 cells (plus 11 enzymes) will give us the answer. But then we send all of ours away to our reference centre for confirmation, so it doesn't really matter... 

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I might not have been clear with my question. Say the patient has a history of Anti Kell. The first time we identify the antibody we use the rule of 3. 3 positives to rule in and 3 negatives to rule out. On repeat work ups. We only require 1 homozygous negative to rule out significant antibodies. I want to know if others always use the rule of 3

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We do the old 3 x 3 rule, but someone recently pointed out that the statistical basis for this is to rule in a particular antibody --- which makes sense to me.  After all, for most negative screen patients, we are ruling out all significant antibodies with only one or two cells.

(Having said that, our system does also require at least one homozygous cell to rule out those antibodies that show dosage.) 

I am not sure why you would require 3 in one case but only 1 in another.  In fact, a patient that has been known to produce a significant antibody has probably been transfused, and is likely to produce others, so it seems as though you would want to be more careful with a repeat ID and rule outs at a later time.\

Scott

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We do as Terri does, exceept for solid phase we cant "select" the cells, so a whole panel is run.

Also, if the current antibody screen pattern matches the previous antibody we do not do new workups.  A new workup is done a) if an unexpected incompatible xm is encountered or (b) the current antibody screen reactivity does not match the identified antibody (ex. prev. anti K, but a K neg screen cell is now positive) or  c)  if the previous antibody was a non-specific antibody, or clinically insignificant antibody, and we wish to interpret the current screen as cllinically insignificant .  Warm auto's are considered on a case by case basis, but in general a workup is done with each new patient admission.

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