Hi all, just wanted to get some advice from more seasoned techs.

Is it wrong to let tubes sit before looking at them under the microscope to catch rouleaux and cold? I feel like they don't always clump up immediately.

And regarding tech to tech variation, do you just ignore it if you are able to shake out small clumps in the back type? I usually work it up and make sure there isn't rouleaux or cold but some techs think that's too much work. Thanks.

If the test is showing no immediate rouleaux or agglutination due to a "cold reacting" antibody, I'm afraid that I am at a loss to see why anyone would leave the tests to see whether one or the other develops.  Rouleaux is clinically insignificant  in terms of blood transfusion, and ditto "cold reacting" antibodies, unless they are of wide thermal amplitude (in which case, there would almost certainly be agglutination visible straight away.

Why waste reagents and expensive technician's time investigating a clinically insignificant phenomenon?

19 minutes ago, Malcolm Needs said:

Why waste reagents and expensive technician's time investigating a clinically insignificant phenomenon

Totally agree!  In all honesty, we do whatever we can to NOT encourage any COLD or Rouleaux interference.  They're a nuisance!  

 

I echo the above sentiments - why go out of your way to "catch rouleaux and cold" which are just "a nuisance" ? It's a "waste [of] reagents and expensive technician's time."

From a technical/regulatory point of view......if you do want to detect rouleaux and/or cold-reactive antibodies, use an assay/test designed to do so. I don't think the various regulatory bodies would appreciate what you're doing - a deliberate deviation from an existing test protocol or SOP.

My question is, why are you looking at them under a microscope?  My transfusion service stop doing that back in the late 80s!  

On 6/20/2024 at 8:02 AM, exlimey said:

a deliberate deviation from an existing test protocol or SOP.

definitley NOT deviating - 

just following SOP and performing IS - not IS-after-sitting-5-min-bc-you've-been-otherwise-occupied, etc..........

33 minutes ago, Bet'naSBB said:

definitley NOT deviating - 

just following SOP and performing IS - not IS-after-sitting-5-min-bc-you've-been-otherwise-occupied, etc..........

I don't understand this statement.

On 6/20/2024 at 8:02 AM, exlimey said:

From a technical/regulatory point of view......if you do want to detect rouleaux and/or cold-reactive antibodies, use an assay/test designed to do so. I don't think the various regulatory bodies would appreciate what you're doing - a deliberate deviation from an existing test protocol or SOP.

maybe I didn't understand this statement.............I thought it implied that in doing "everything we can to avoid rouleaux/colds" from coming up was interpreted as us doing something deliberately to deviate from SOP???  ..........which we are not doing.........

I'm still wondering why you want to look under the microscope and why you want to see cold-reactive antibodies and rouleaux.  Are these things written into your SOP and following the manufacturer's instructions?

On 6/24/2024 at 10:18 AM, Bet'naSBB said:

maybe I didn't understand this statement.............I thought it implied that in doing "everything we can to avoid rouleaux/colds" from coming up was interpreted as us doing something deliberately to deviate from SOP???  ..........which we are not doing.........

I think we're confusing ourselves. I was referring to the original post which suggested a modification of procedure in order to enhance rouleaux/colds.

Serological assays are typically read "without undue delay", i.e., immediately. If some techs have a practice to "let tubes sit before looking at them", that could be construed as deviating from the procedure, unless they have some bizarre and very specific local instruction to do so.

On 6/21/2024 at 4:58 AM, John C. Staley said:

My question is, why are you looking at them under a microscope?  My transfusion service stop doing that back in the late 80s!  

Our SOP still includes looking under the microscope to confirm rouleaux

On 6/26/2024 at 6:38 AM, applejw said:

I'm still wondering why you want to look under the microscope and why you want to see cold-reactive antibodies and rouleaux.  Are these things written into your SOP and following the manufacturer's instructions?

This was just speaking in the situation of resolving extra reactions in the back type.

On 6/19/2024 at 8:12 AM, Malcolm Needs said:

If the test is showing no immediate rouleaux or agglutination due to a "cold reacting" antibody, I'm afraid that I am at a loss to see why anyone would leave the tests to see whether one or the other develops.  Rouleaux is clinically insignificant  in terms of blood transfusion, and ditto "cold reacting" antibodies, unless they are of wide thermal amplitude (in which case, there would almost certainly be agglutination visible straight away.

Why waste reagents and expensive technician's time investigating a clinically insignificant phenomenon?

My bad, I should've specified this was in the case of resolving extra reactions in the back type and not for IAT purposes. As in should I disregard small clumps (that can be shaken out) in my back type if I don't see chains and clumps immediately under the microscope?  

Edited June 30, 20241 yr by Noooooodles

If there ARE extra reactions in the back type, then they do need to be resolved IF, and I mean IF, they look as if they could signify that the forward ABO type is false.  That having been said, I STILL would not go looking for rouleaux or agglutination that was not present when the tests are read at their normal incubation period and temperature.  Why would you want to look for a herd of Zebra, when you hear a herd of Horses (thank you John C Staley - or, at least, I think it was you who used to say this to me on a regular basis - apologies if it was not - but it was a great comment!)?

I went back to your original post and it clearly said "Trigger" for some posters.  My lab only uses the microscope for FMH screening tests and rarely (like once in a blue moon) looking for mixed field during post-transfusion reaction investigations.  I would consider it to be looking for Zebras, as Malcom said, to want to see rouleaux or a cold-reactive antibody by letting tubes "sit before looking under the microscope" (slightly adulterated version, my apologies).  I didn't see any mention of "only for ABO discrepancies" or even "reverse type".

I've seen cold reactive antibodies look like rouleaux and rouleaux that gave the same appearance as cold reactive antibodies. Some are helped to be clearer with saline replacement, some not.  That's probably where I stopped looking at these things under a microscope.  We predominantly test using automated gel method with tube usually being the "come to the rescue" method to not see just those things you were talking about.  Do I saline replace or pre-warm the test components for those things?  If I need to, but I try not to wake the sleeping beasts so I don't see them in the first place.

Malcolm, I've up graded that from Zebras to Unicorns.  Thanks for remembering.