i apologize if this question has already been posted... we have noticed a substancial increase in rouleaux since we started using EDTA plasma (i assume due to the increase in compliment-protein) the rouleaux seems to get stronger if the plasma is cold, but easily goes away with saline replacement. i just found out at least one of the techs here routinely warms up her plasma before doing any IS crossmatches...so my question is: does warming the plasma to 37 degrees decrease the detection of abo incompatibilities? just wanted to make sure we can't get "sited" for it:confused:

thanks

Not, as far as I know, under normal circumstances, BUT, if the patient's ABO antibodies are weak in the first place, and as they "work" optimally at 4oC, I should think that, logically, there is fair chance of missing them.

Someone once reported less trouble with rouleaux in EDTA specimens if they spun the original sample longer and/or harder. It was just an observation as far as I know, but a cheap thing to try. It doesn't really seem logical to me, but maybe some cryoglobulins agglutinated or something so they spun down.

You are at risk of being cited because the tech is not following the procedure as written.

I prefer to change the EDTA tube than warm out the rouleaux.

This brings up something that we had this past weekend. The patient had a very strong cold agglutinin (hemolytic; high thermal amplitude). The CLS called me at home asking how to peform the I.S. crossmatch since of course everything was positive. Even if the GEL had been negative (which it wasn't), we are still now required to perform I.S. with the AHG crossmatch. The PeG was negative so I also had him perform a PeG crossmatch (but recently we have been told that we still have to perform an I.S. crossmatch). So I did tell him to prewarm the plasma to perform the I.S. crossmatch. Otherwise, they would have printed out on the Form as Incompatible. We had established that there were no uderlying antibodies but seems to me that when you "change up" your system like that you are opening yourself up for missing something.

Brenda Hutson, CLS(ASCP)SBB

A little off topic but......... Isn't this one of those cases where an electronic crossmatch would be very helpful!!

You have ruled out any concern for atypical antibodies so the best way to get a compatible IS crossmatch is not to do one. Let the computer do the heavy lifting.

:pointandl

YES! It is on my to-do list....along with about a hundred other things(I'm sure none of you can relate). But absolutely; have used that elsewhere and it is a definite goal here.

Brenda

A little off topic but......... Isn't this one of those cases where an electronic crossmatch would be very helpful!!

You have ruled out any concern for atypical antibodies so the best way to get a compatible IS crossmatch is not to do one. Let the computer do the heavy lifting.

:pointandl

the rouleaux seems to get stronger if the plasma is cold

It's not rouleaux. It's a cold antibody. Very weak cold antibodies can look like rouleaux. Rouleaux does not go away if warmed.

Rouleaux is also a RARE condition seen in patient's with protein abnormalities such as Multiple Myeloma.

If your antibody screen comes out positive, your computer may not let you do electronic xm even if you have concluded that it is insignificant.

Rouleaux is also a RARE condition seen in patient's with protein abnormalities such as Multiple Myeloma.

Personally, I wouldn't classify rouleaux as "rare". We see it fairly frequently (a few times per month.) But the difference in frequency can probably be explained by our clientele. (We service a large Oncology practice.)

Donna

Someone once reported less trouble with rouleaux in EDTA specimens if they spun the original sample longer and/or harder. It was just an observation as far as I know, but a cheap thing to try. It doesn't really seem logical to me, but maybe some cryoglobulins agglutinated or something so they spun down.

We have found spinning 15 minutes at 3600 RPM takes care of nearly all the junkiness of using plasma. Though I am talking issues on gel system (mixed field,non-specific antibodies). Not just rouleaux or colds cause interference but high protein values and hi okra and in diagnosed stuff. Except strong strong colds which interfere with front typing have had NO IS problems at all. Maybe because of how we spin?

I also used to think it was rare....until I went to another Hospital where it was "somewhat" common. At first I thought the Techs. must not know what rouleaux looked like and that they were over-reading. So I asked them to let me look at any reactions they were calling rouleaux for awhile. Turns out it was rouleaux. 2 explanations:

1. Duh....I had just come from a Medical Center where I had worked for 12 years...performing an electronic crossmatch! No

problem with rouleaux there!

2. The frequency will vary baed on your patient population and their conditions.

Brenda Hutson, CLS(ASCP)SBB

It's not rouleaux. It's a cold antibody. Very weak cold antibodies can look like rouleaux. Rouleaux does not go away if warmed.

Rouleaux is also a RARE condition seen in patient's with protein abnormalities such as Multiple Myeloma.

We get a few patients that have rouleaux. I am able to resolve the discrepencies most of the time by adding 22% bovine albumin to the red cells and mix before adding the plasma. We also have a large Oncology patient population.

Bill is correct. If an assessor/inspector sees that, they will note that it does not follow your procedure.

Is your lab excessively cool or are your samples pulled directly out of the refrigerator before use? That could be part of the problem. It is also possible that you happen to have a patient population that is more prone to rouleaux. As others have mentioned, you could look at electronic crossmatch and get rid of the problem almost entirely.

Edited June 3, 201114 yr by adiescast
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thanks everyone for your replies, we do have a high percentage of cancer patients here which would explain the rouleaux problems, but why do they seem to get stronger after time spent in frig, they are not cold antibodies since they go away with saline replacement (even using cold saline)??

I think the cold enhances the "rouleaxing substance" (I've never seen an official designation for that). It may be a proximity thing or a physical thickening of the whole mixture that brings cells and substance into closer contact and promotes more stacking. My experience is different from that of GilTphoto in that I have seen rouleaux formation weaken at warmer temperatures. It doesn't always react at 37 (but it can). It does not react in the absence of plasma, which is why saline replacement works.

I always wondered if those rouleaux cases that seemed to react more in the cold contained cryoglobulins. Maybe there is more cryofibrinogen in plasma samples than there was in serum???