My routine for cold/rouleaux encounters is to add two drops of saline and re-spin. With weaker rouleaux reactions, the clumping is ususally dispersed. If not, I incubate the tubes in a BB refrigerator (top shelf) 2 minutes and re-spin. Increased reaction signifies a cold; I re-set up the reaction using plasma prewarmed in the reaction tube.

If cold incubation reaction did not increase I suspect rouleaux, re-set up the reaction and do a saline replacement. We have capablility of attaching Patient's comments, and describing your results guides the next Tech.

NedB, nice to meet you! You said you will add two drops of saline and re-spin the tube to exclude rouleaux. I don't know if do this will diluet the original antibodies .

We see a fair amount of rouleaux here as well, must be patient pop. The auto I shouldn't cause too much trouble in the transfusion as that happens at body temp so, ask them to saline replace with warm saline or to do the 5 minute incubation in a heat block before they can report rouleaux. Regular cold room/temp saline replacement shouldn't completely get rid of the "stickiness" for the cold anti-I. Warmth is the key thing here. I ask my staff to do the warm incubation before they do the saline/albumin treatment for rouleaux.

GilTphoto, I hate to say it but it sounds like your problem is a personnel one. One of our QA monitors is 'procedure not followed,' as it really is a serious problem. If your employees are not following your procedure (if your procedure clearly states what you are saying should be done) then you may have to go to disciplinary action.

Not sure if it's in the literature, but we have noted 'artifact' and even 'are these positive?' reactions in gel if the sample is not spun down enough.

We are using an EBA20S at 4800rpm for 3 minutes ... so far, that seems to be keeping the problem under control.

The manufacturer of the Pink Top EDTA tubes we use for pretransfusion testing has recommended that we mix the tubes by a few inversions just prior to spinning. Not sure how or why this works, but it does.

The refrigerator?! Over kill!

The reason we are concerned is because we about cold agglutinins is to determine the need of a blood warmer. There are many opinions about this but I do believe that we really don't care what happens at 4oC ... in fact many of us produce cold agglutinins that react at 4oC ... no significance whatsoever.

I instruct 'my' techs to check under the scope. If they SEE rouleaux, then perform Saline Replacement. If it's gone, then no blood warmer is needed. The rationale for that is - even if they did wash/dilute a cold aggluntinin, with such small amounts, it's not worthy of a blood warmer.

Yes, there are those who will argue that a blood warmer is not necessary at all if the cold agglutinin only reacts at 22oC. We are being overly cautious, I agree. The alternative is to perform a Thermal Amplitude to determine if the cold agglutinin will react at transfusion temperatures. Do you really want to do that each time? It's not always necessary ...

:boogie:If the plasma has been seperated and refrigerated for awhile, it is also a good idea to recentrifuge the plasma to prevent artifact from fibrin.