Help, we are using a 16 cell panel and we can't rule out Anti-C or E when an Anti-D is present due to a rhogham injection! We are having to send our work-ups to the ARC for an Anti-D!! grrrrr. We ran 1 full panel and then 4 additional panels were used for selected cells and we still couldn't rule them out! Does anyone have any suggestions or noticed how the panels are starting to not be helpful at all!!??

Do you not have an example of an r'r and an r"r in this panel?

when r/o anti-D due to RhIg, you should be able to r/o using r'r and r"r cells. You can r/o using these cells anytime if you either enzyme pretreat or use PeG. (of cousre it will be depend on the comfort level of your Medical Director). When you know the pt rec'd RhIg thee is no need to go to great lengths esp if the D+ cells are weak - I assume you are using gel or capture.

I agree David.

The only other way you are going to rule out is by use of r'r', r"r" or ryry red cells - and if any of my staff tried using such rare cells just to do that, they wouldn't be a member of my staff for very long!!!!!!!!!!!

We come across the r'r'/r"r" cells so infrequently that using them is a moot point. I purchase 3 panels and if those cells occur at all in a year it is a surprise.

I'm amazed you have ANY in a panel ANY year David. We freeze down the donations of ALL of our r'r', r"r" or ryry donors. We never offer them for panels.

when r/o anti-D due to RhIg, you should be able to r/o using r'r and r"r cells. You can r/o using these cells anytime if you either enzyme pretreat or use PeG. (of cousre it will be depend on the comfort level of your Medical Director). When you know the pt rec'd RhIg thee is no need to go to great lengths esp if the D+ cells are weak - I assume you are using gel or capture.

We do not have gel or capture yet. We do use the cells that are bracketted, but it still isn't enough. I was thinking about getting PeG becuase this is getting a bit crazy. If the doctor's would stop ordering type and screens 5 days after giving rhogam, it would be a big help!!!

If the doctor's would stop ordering type and screens 5 days after giving rhogam, it would be a big help!!!

What is the situation causing them to make this sort of order? Might an educational session between your pathologist and the physicians producing orders be of benefit for all parties involved? Just my .02 worth.

We do not have gel or capture yet. We do use the cells that are bracketted, but it still isn't enough. I was thinking about getting PeG becuase this is getting a bit crazy. If the doctor's would stop ordering type and screens 5 days after giving rhogam, it would be a big help!!!

Some docs mistakenly believe that if they can document anti-D after giving RhIg then the efficacy of its adminstration is verified. Your Medical Director should intervene to have them cease this practice. If this was true, you would not have to give post-partum RhIg since we can usualy detect the antenatal dose at the time of delivery. Get your doc involved!!!!

If this was true, you would not have to give post-partum RhIg since we can usualy detect the antenatal dose at the time of delivery. Get your doc involved!!!!

Good point, David.

I have used selected cells of the Ficin Treated cell panel to rule out anti C and E, for which I initially used the neat panel in the presence of Anti-D.

what about diffrential adsorption....elimnate anti -D remains your anti E and Anti -C ,if still its hard then adsorb any of these two ....hope it helps

Presume you have phenotyped patient as they themselves may be r'r or r"r and that solves one problem

Selection of blood will be the same anyway CDE (-)

I guess you are worried about infant ?

My Ortho Resolve Panel A has 1 r'r cell and 1 r"r cell. I realize that they are not homozygous, but it helps differentiate along with selected cells in most cases. I agree that performing cell types for C and E will provide more information and ammunition.

My Ortho Resolve Panel A has 1 r'r cell and 1 r"r cell. I realize that they are not homozygous, but it helps differentiate along with selected cells in most cases.

But, unless you have unlimited supplies of ryry, or r'r' and r"r" red cells (which nobody has), without differential alloadsorption, then an r'r and an r"r will have to do!

I thought in the presence of Anti-D you can rule out E and C using the heterozygous cells on the panel. Usually there is one cell for E and one for C that are not positive for D. I learned that from a thread on here a few years ago?

You can, as far as I am concerned, or, at least, you can rule out clinically significant anti-C and anti-E.