LisaMarie

Hello All!
I know this subject has been discussed extensively.  It continues to be a source of confusion in my TS, due mostly in part to the lack of solid Blood Bankers (all generalists who rotate through).
Currently, our SOPs for working up suspected cold agglutinins include a "cold screen" at 4 degrees using Immucor Panoscreen I and II, and patient autocontrol.
If Cold Screen is indicative of a cold Autoantibody, a Tube Pre-warm screen is performed, and subsequent panel, if warranted.
This is so confusing to my techs.  Last night I received a call at home from my 2nd shift tech, saying she had a patient coming in for transfusion for one unit of red cells, with no prior history with us, was found to be A+, Negative antibody screen in solid phase on Echo, BUT positive Immediate spin crossmatches.  She then proceeded to tell me she "prewarmed the crossmatches and then they were fine."  She wanted to know how to result the Cold Auto!!!!!!!!!!!!!!!
After swallowing to remove my heart from my throat, I explained that this was not a conclusive "work-up" for a Cold auto.  I talked her through the possibility of Rouleaux (She said she only saw "clumps" not "coins" microscopically); the possibility of an A2 or subgroup, but she assured me the reverse reactions were consistent with A.  I then told her the series of procedures to follow for a suspected cold agglutinin, all of which are in our SOPs.  I suspected Rouleaux, and asked her to follow the saline replacement procedure, explaining that if it was true agglutination, saline replacement would not "correct" it.  She performed saline replacement and the IS crossmatches were as smooth as silk. 
 
I guess my question is, does anyone have any suggestions for making this more clear to our staff?  Also, what are your procedures for identifying a cold agglutinin, or autoagglutinin, both specific and non-specific?  How about a flow-chart to make it easier for techs to determine what to do next?  Any info, SOP, chart anyone is willing to share will be so appreciated right now, and worth its weight in GOLD!!
Dawn

Can this be downloaded as a pdf

Really enjoy the courses

Thank you very much Malcolm. Very detailed explanation. I am waiting on the molecular testing results now and yes she has been transfused and we are issuing Rh negative of course. 

Too funny, I recently downloaded this podcast for CE and was planning on listening to it on my off day. The patient was transferred to another hospital for treatment, no additional workup will be done by us but I will keep you posted cause am curious too. 

Or if you wanted to teach in an MLT/MLS program at a community college or university.
 

Any master's degree (including business and public health) is going to set you up for management and/or administrative positions, if that is where you want to end up.
Scott

I think she's referring to a Masters of Laboratory Science.  I think it is available at a few Universities.  LisaMarie, I can't answer your question, if I am interpreting it correctly, but...... many years ago when I was considering getting my SBB. I had a lab director tell me that he didn't care how many degrees I had or how many letters I had after my name, he wouldn't pay me any more.  At that time I was supporting my young family so I elected not to pursue it.  Not too many years later I move on to another facility.   After 35+ years in healthcare I can say with confidence, any thing you can do to increase your knowledge and credentials will open doors that will otherwise be closed to you.