I check microscopically when I believe I see rouleaux.  I was seeing a lot microscopically, but think I was overcalling it.  

I think that can be dependent on:

1.  Your patient population (protein concentrations)

2.  How you perform your testing

 

I worked 1 place where I was convinced the Techs. did not know what Rouleaux vs. Agglutination was because they were just reporting so much.  So I started asking to look at their tubes when they saw it....and it really was there.  I think it just had to do with our particular patient population.

We use GEL where I work now; and while we do get Rouleaux in GEL (and then confirm it in Tube), I don't think we see it as often as in Tube (but again, could just be our patient population.

If you think you see something macroscopically, you should check it out microscopically.  If you are looking microscopically on ABO/Rh Typing when you don't see anything macroscopically, you are going to create your own problems.  

 

Brenda Hutson, CLS(ASCP)SBB

Perhaps it also depends on what kind of specimen tube you are using. When I did my clinicals, the blood bank there would use the long pink tops with EDTA. In my four weeks there, I saw rouleaux 10 times. However this was a city of 200,000 people. When I got my first job at a different hospital, the blood bank there was still using red tops. Out of the whole year, I saw only two patients with rouleaux. But this is a city of only 99,000 people.

rarely see it at immed spin (tubes).

We see it quite often, but almost always in elderly or oncology patients...which (coincidentally) is the majority of our patients with crossmatch orders. It's definitely population dependent.

 

Call it like you see it.

Do you use saline replacement to help clarify the situation?

Yes, we do saline replacement.

We see (or saw) it in tube from time to time, and sometimes with a negative antibody screen. There must be some differences between fresh donor cells in saline and old reagent cells in alseavors (our techs call the phenomenon "anti-saline"). It is virtually always rouleaux or a cold, but annoying when you really want to get the blood out the door but have to stop and investigate. That's a very nice thing about electronic crossmatches - you should not get any serologic surprises.

 

Do you use saline replacement to help clarify the situation?

 

Yes - saline replacement.

We used to see it "occasionally", maybe once a month when we did ISXM. We use gel for absc so if I see something "hazy" I suspect rouleaux right away.  Rule it in using saline replacement.

 

We now do electronic XM so it's dropping off of our radar screens.

Evilwaring is correct with the comments about EDTA vs Serum.  Many years ago when we made the transition we did see an increase in detection of rouleuax.  It seems that centirifuging the samples hard enough to achieve platelet poor plasma reduced the incidence in tube testing as well as avoiding problems in gel.  Now that we do Electronic XM for qualified patients we encounter it less frequently.

Where I worked before we did IS xms using EDTA samples (pink tops) and often found rouleaux.  We had not found that much when we used serum.  We also found that a strong spin of the specimen helped some.  Where I am now we did IS xms before we switched to EXM and we almost never found rouleaux.  Here we used K3 EDTA rather than the pink tops which are K2 EDTA.  Not sure if that matters or it is our patient population here or what.

I have noticed that we have a few more when either the platelet count or white blood cell count is increased (large buffy coat), with the room temperature maybe a little cooler than usual. Saline replacement is always negative. Just some observations made this past year.

I have noticed that we have a few more when either the platelet count or white blood cell count is increased (large buffy coat), with the room temperature maybe a little cooler than usual. Saline replacement is always negative. Just some observations made this past year.

GOSBB, I can't  sure platelet or white blood cells agglutination is same as rouleaux.

Rouleaux can be a result of acute phase proteins like CRP or fibrinogen.  Along with WBC and platelet counts, they are often all elevated in inflammatory conditions.

 

Scott

We do saline replacement. 

New question:  Do you see rouleaux frequently in patients that are type AB?  My trainer said she sees this often.

I've never associated it with a specific blood type.

Neither have I.

If you are finding it in the reverse type you would certainly find more of it in AB patients than in group O patients. 

If you are finding it in the reverse type you would certainly find more of it in AB patients than in group O patients. 

 Aren't you the sly one!

How do rule out Rouleaux, when reacting positive in Gel? Do you only do tube screen with LISS and a saline rep technique? Do you run a panel in LISS? any comments would be greatly appreciated.

 

Thanks,

 

-Serafin