So, we have an Echo (red cell solid phase agglutination). A screen is positive in all 3 wells (we use a 3-cell screen). It mostly looks like junk. A panel and auto control are run - panel is all positive and the auto is negative. It is set up in tubes and the tube screen is negative.

Would you report out the Echo result as positive and the tube as negative?

Or report out the Echo result as inconclusive, repeated by another method and the tube method is negative? This is an issue about once every other month.

Just wondering what others are doing

Thanks for your help.

Keep It Simple--if the end result is negative, report negative. This is what we do--however, we keep comments (so floors do not see) with all the pertinent info for the next guy to see.

Hi. I would probably make some monolayers with fresh RBCs. This would possibly tell me if the patient sample was actually reacting with RBC agn, or reacting to the stroma (or some alteration to RBC agn when stroma prepared and layered onto the microwells). If the tests were tests were neg with the fresh cell monolayers, I would report that the patient sample reacted with all commercial solid-phase cells tested (stroma) but was neg with fresh cell monolayers and tube tests. I would add a comment that patient serum reacting with stroma - no significant aby present.

Happy Holidays! rjt

When you have all cells positive and your auto is negative - are you certain it is not something "real" and high incidence? How strong were the rxs? I find it hard to understand how you can feel good about using a less sensitive method to verify your exquisitely more sensitive method? I like the idea of making fresh monolayers and rerunning.

Thank you to Bill, Rebecca and David. I guess my question was about reporting......how is that resolved? We do the resolution steps to make sure there is no signigicant antibodies, but then the confusion is how to best report it out, without adding to the confusion of doctors or nurses. The coordinator here wants a positive result reported out on the Echo (because it is interfaced) and then negative for the alternate method. Then a comment is added that is not canned and seems like everyone writes as much or as little as they want. Just asking what others might do. Thanks.

We report both results and a conclusion of no apparent specificy(NAS) if no allos are demonstrated. Of course, with the panel results that you present we would send this specimen out to our referance lab.

We report both results and a conclusion of no apparent specificy(NAS) if no allos are demonstrated. Of course, with the panel results that you present we would send this specimen out to our referance lab.

This is what we would do. With the negative auto, it would definitely be a reference lab project.

I agree with Bill - keep it simple. We also would report out only the negative tube screen result, then add internal comments that would not go on the external report, but would help guide the next blood banker working up this patient in the future. We would not report out the Echo results at all. Seems like it would be very confusing to the provider to see both a positive (or inconclusive) and negative for an antibody screen result.

Solid phase is so sensitive that it's going to pick up these insigificant "capture panagglutinins" from time to time. However David's point is good - how can you be certain that you are not missing a high incidence antibody? But the likelihood of non clinically significant "junk" with solid phase is much higher than a very weak (doesn't show up in LISS or PEG) high incidence antibody.

But the likelihood of non clinically significant "junk" with solid phase is much higher than a very weak (doesn't show up in LISS or PEG) high incidence antibody.

I don't look at it as the likelihood - I look at it as the consequence. Are you possibly going to give someone a DHTR?

I don't think I could live with myself issuing a negative result over a more sensitive, positive result...

We see this from time to time. No matter what path we end up taking to resolve the issue, we only report the end result. Putting more information on the patient's chart usually just ends up confusing the nurses and doctors. We also keep any pertinent information internal to help the next tech when the patient needs to be worked up in the future.

Thank you Elizabeth--you stated my thoughts better than I.

Here's a thought? Was the tube examined under a microscope? If not, it cannot be guaranteed that there is not microagglutination that cannot be easily seen by naked eye...

We check for rouleaux in the tube whenever we see all wells of

solid phase reacting 3-4+. I have seen rouleaux to cause this

false solid phase pan agglutination. Gel is our back up and we get negative with gel we report out negative results to the floor but

like others enter in comments to alert the next tech who would

get a future sample.

If we see a nonspecific pattern of reactivity in both gel and solid phase and everything is ruled out in one of the methods we report out "CSRO" : all clinicically significant antibodies ruled out.

Keep It Simple--if the end result is negative, report negative. This is what we do--however, we keep comments (so floors do not see) with all the pertinent info for the next guy to see.

Exactly what we do. If you call something positive you need to explain that. In my procedure I have a flow chart that if gel (we use gel and not solid phase, but same thing...often junk) is mixed field (or junky) we go to tube (backup method). Once we go to tube all further work is in tube and tube results are reported. If work done in gel (our primary method), all further work is done in gel and gel results are reported.

We see the same thing on our Echo from time to time, we will run a screen in tube and/or gel and it will be negative. Sometimes there will be a positive DAT or Auto with these.

Reporting out can be a problem, but I am wondering about the cause of this. Most of these patients that we have been able to get a clinical history on have some sort of underlying autoimmune disease. I have wondered if the creation of the red cell stroma exposes other phospholipids and the Echo reactions are related to this sort of auto antibody?

Long time no post from me...I hope I am not away again so long from this site, but I have a lot of catching up to do.

Linda Frederick

Good to see you back, Linda!

What is the general consensus of this discussion group on compatibility testing in these situations.....to AHG or not?

Yes, AHG crossmatch as long as there is a question mark.

Agreed Liz. Better safe that sued.

We have an Echo. We have had this sort of reactivity on the Echo and then negative on bench. Then, several months later, we found an Anti-E. We also had the same thing and then later picked up a Jka. Both specimens were sent to a reference lab and nothing was picked up. We had positive reactions that looked like an iffy E , sent to reference and they got negative reactions; only to receive information from the patients family that "years ago, he had something in his blood and he needed special units when he was in Florida. Calling the FL. hospital, he had an anti-E!  Immucor has a "teaching" section on their web site. Picking up anti Es before other methods was discussed. I have heard from other area hospitals that Jka is also being picked up by them. I certainly do a complete xm on any pts with a question. It's sort of funny as I have made an appt to review this with our pathologist and medical director this afternoon. jl

I've heard that some inspectors are not fond of the term "inconclusive". I guess it appears to them that you just gave up, but maybe should have sent it to a reference lab. I would suggest using a code like jill mentioned above: CSRO, or some other code that translates to all clinically significant alloantibodies were ruled out.

For this case mentioned above, I would result as negative.

This is what we would do. With the negative auto, it would definitely be a reference lab project.

Ditto

 

And we report all testing performed. I also agree with Liz and Malcolm AHG cxm.

 

I  had a work-up where Gel was 3+ with the screen and panel, AC 0. LISS, PEG, Saline was reported as wk. Prewarm was reported as negative, cold screen was reported as postive 1+-2+. Rest was negative x3 with LISS. When I saw the workup the "cold" didn't add up. So I ran high incidence (what we had in house) all reactive. Decided to repeat all previous techs work- prewarm was 1+, so sample was sent to IRL and ID'd as Anti-Coa, Anti-C, AutoAnti-I.

 

Sadly I doubt some people would have questioned the work-up and would have reported it as a cold.

Edited December 2, 201311 yr by Justina

This thread terrifies me...

Yes, AHG crossmatch as long as there is a question mark.

But, if the antibody is not reacting in tubes, a full AHG XM could read as compatible. Sorry to continue the scary thread.

Edited December 5, 201311 yr by EDibble

This thread terrifies me...

Yes. Same here.

Particularly when I see that gel/echo is reacting and tube is negative and you end up giving tube xm compatible!!! Yes scary.

I do not allow this practice unless on very rare occasion cold was confirmed and our MD approved to give tube full crossmatch compatible .