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Can you convert the tube panel cells from 3% to 0.8% and test in gel? We primarily do that to run selected cells that are not already diluted to 0/8%

We frequently did this in the Reference Laboratory where I was the Manager (but you have to include both a positive and a negative from the "gel" technique into the "tube" technique - or vice versa, to ensure that the "sensitivity" of both techniques, while not being necessarily identical, are reasonably close).

We do that. You could also use LISS (or PEG) to complement your SIAT. Make it more sensitive. sandra

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Column agglutination technology is an excellent technique, but does have a tendency to detect antibodies that react at temperatures well below 37oC, even after fairly prolonged incubation at 37oC. However, the fact that the blood group, including the "reverse grouping" is clear of atypical agglutination suggests that this may not necessarily be the case for this patient. Just to be on the safe side though, and if you can, I would either treat the plasma from the sample with rabbit erythrocyte stroma (which will adsorb out most "cold" agglutinins), treat the plasma with 0.01M dithiothreitol (which will denature the J-chains of IgM molecules, meaning that, although they can still sensitise the red cells, they are no longer able to agglutinate the red cells) or, and my personal favourite, is to pre-warm the plasma and red cells to 37oC before mixing, perform the IAT at strictly 37oC in glass tubes, wash with saline warmed to 37oC and use monospecific AHG. If any, or all, of these techniques lead to negative results, the chances are that the antibody is a clinically insignificant "cold" IgM antibody, such as an auto-anti-HI (given that the patient is group A, and the test cells are all group O).. Failing the above, send a sample to a red cell reference laboratory. I hope that helps a little bit.