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Immediate spin crossmatch when patient reverse is weak?


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If you have to perform an enhancement on a patient's reverse to obtain a 2+ reaction, shouldn't you have to perform the exact same enhancement when performing an xmis? Otherwise you would miss an ABO incompatibility. 

Gel match theoretically isn't intended to pick up IgM antibodies, so that's out.

How do you handle this situation when there is no previous blood group (electronic is not a possibility) on file, and the patient's screen is negative?





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If using a paper results entry system, then I would the same methodology for immediate-spin crossmatch as the ABO plasma grouping test.  If using a computer results entry system (properly configured), I would enter initial immediate-spin crossmatch results obtained without enhancement..  A properly configured computer system will not allow crossmatch of ABO incompatible rbc unit (regardless of whether or not electronic crossmatch is available)!

In my world, your patient would be electronically crossmatched after all required pretransfusion compatibility testing requirements had been met.  We see such patients routinely where the expected anti-A and/or anti-B is not detected in ABO Plasma grouping test done in gel.  To enhance detectability of the missing antibody, we do immediate-spin tube test with 3% A1 and/or B cells which resolves 80% of this type of ABO grouping discrepancy.

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I will not use enhancement in the immediate spin crossmatch.

1.If the weak reverse antibodies are caused by sub group, I will select the compatible ABO group components for the patient. Such as AxB we will give the patient B washed red cells and AB plasma and platelets.

2.If the weak reverse antibodies are caused by age or immunosuppression, we will treat it as normal ABO group accoding to the forward grouping result.

Since we use the IS crossmatch is safe for most of patients, it means it can detect lots of clinical significant IgM antibodies, the sentivity is ok, so I will not add enhancement.


Edited by shily
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I guess I agree with those above.  The forward typing sorta puts the reverse results into question in these types of situations - not the other way around.  If a subgroup is present, use the appropriate product type for transfusion.  


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