I apologize, this may be a stupid question. For example, if you are trying to do a gel cross match and the donor cells have Rouleaux, can you tell that from looking at the gel card? If so, can you tell me where I can find some pictures of this reaction. Thank you for your time and help in advance.

Look in the interpretation guide you should have received with your gel system. It has some good pix of rouleaux in the gel matrix. Whenever I suspect rouleaux in my gel, I set up a tube with plasma and cells, centrifuge it then resuspend and check it microscopically to verify I am seeing this phenomenon.

Same here ...

Ditto.

Rouleaux does look a little funny in the gel; you either get hazy reactions (no clear agglutination) or a "mixed field" appearance. When we see this, we usually repeat the screen using tube testing (PEG usually) and the washing process disperses the rouleaux.

Thank you all for your help. I usually work in microbiology, but we lost some employees recently, and so they have me training in blood bank to make up for the loss of man power. And it's been a while since I worked blood bank, oh boy. Haha, thanks.

T. Ramon, MT(ASCP)

trisram,

Blood Bank can be quite intimidating but in this day and age even a Microbiologist can do BB!!

Seriously though, David is absolutely correct. You can also tell rouleaux because sometimes the cells kind of "cling" to the sides of the gel tube. It sort of looks like a ropey thing sliding down the side of the tube. Sorry for the highly technical, BB terms!

BTW, you wouldn't want me in Micro, there are organisms out there that weren't even around the last time I worked Micro. Good luck in the BB.

I think the best way is simply to look under the microscope for it...

We look for it in a tube microscopically when we suspect it in the gel. Then we fall back to tube method to alleviate the rouleaux. We see it quite often. Probably one of the few drawbacks to gel.

I apologize, this may be a stupid question. For example, if you are trying to do a gel cross match and the donor cells have Rouleaux, can you tell that from looking at the gel card? If so, can you tell me where I can find some pictures of this reaction. Thank you for your time and help in advance.

First of all, the only stupid question is the one not asked! Secondly, remember that rouleaux is a property of the plasma. Not the red cells. So it would only be demonstrable if your recipient had rouleaux. It is very clear what rouleaux looks like in gel. As a previous post, look at your insert.

If having to do a gel crossmatch, take the extra couple minutes to WASH the donor's cells freeing them of the proteins and fibrinogren that may cause rouleaux but mostly freeing them of storage byproducts.. Experience has taught me that spending a little extra time in preparation will eliminate the need to troubleshoot and worry later.

If having to do a gel crossmatch, take the extra couple minutes to WASH the donor's cells freeing them of the proteins and fibrinogren that may cause rouleaux but mostly freeing them of storage byproducts.. Experience has taught me that spending a little extra time in preparation will eliminate the need to troubleshoot and worry later.

Excellent points Carol.

:):)

Ortho provides a really nice interpretation guide-if you do not already have one you should ask your Ortho rep. to give you one-it is very useful. We find that we can make an educated guess about rouleaux in gel-but other things that may also cause 'mixed field' reactions can look similar. I think your best bet would be to repeat the test using a tube method and examine microscopically-then if you suspect rouleaux you can use a saline replacement technique to further rule in/rule out rouleaux.

Well, there won't be a need to do a gel crossmatch if the patient's screen is negative. I was talking about the screen mostly, since rouleaux is mostly a property of the plasma, not cells. Of course washing cells is mandatory and important. Anyways, everyone always wash the patient and donor cells.

If having to do a gel crossmatch, take the extra couple minutes to WASH the donor's cells freeing them of the proteins and fibrinogren that may cause rouleaux but mostly freeing them of storage byproducts.. Experience has taught me that spending a little extra time in preparation will eliminate the need to troubleshoot and worry later.

Edited January 5, 201015 yr by trisram

Way too much work here!

Yes, Ortho has issued an excellent 'Interpretation Guide' for MTS. Get one and use it.

Rouleaux shows up in gel as either haze or mixed-cell (see the pictures).

Haze = rouleaux (there's nothing else significant that causes this picture). Period. Yes, in tube testing it's very hard to tell rouleaux from weak agglutination unless you use the microscope and/or saline replacement. This is not the case in gel. Leave it, you are done. It's rouleaux, get over it and move on.

Mixed-cell could be a cold agglutinin or rouleaux (yes, mixed-cell population, too, but it's not so for reagent rbcs, most donors, etc. so let's set that aside for this discussion because it doesn't apply to antibody screen/panel). To tell the difference, we run the patient's plasma IS/RT with pooled O cells and determine if we see rouleaux (yeah, the microcope!) or true agglutination. If it's a cold agglutinin ... use a blood warmer.

There's no other information we need for the purposes of transfusion.

Done.

Ditto

Way too much work here!

Yes, Ortho has issued an excellent 'Interpretation Guide' for MTS. Get one and use it.

Rouleaux shows up in gel as either haze or mixed-cell (see the pictures).

Haze = rouleaux (there's nothing else significant that causes this picture). Period. Yes, in tube testing it's very hard to tell rouleaux from weak agglutination unless you use the microscope and/or saline replacement. This is not the case in gel. Leave it, you are done. It's rouleaux, get over it and move on.

Mixed-cell could be a cold agglutinin or rouleaux (yes, mixed-cell population, too, but it's not so for reagent rbcs, most donors, etc. so let's set that aside for this discussion because it doesn't apply to antibody screen/panel). To tell the difference, we run the patient's plasma IS/RT with pooled O cells and determine if we see rouleaux (yeah, the microcope!) or true agglutination. If it's a cold agglutinin ... use a blood warmer.

There's no other information we need for the purposes of transfusion.

Done.

Very well said!! People often tend to waste far too much time chasing down insignificant issues as far as what is important for transfusion.