Hello,

We use tube testing for DAT's and as back up to Gel for antibody detection and ID.  We use Biorad anti IgG and polyspecific.  We have always examined DAT's microscopically and tube testing at AHG (LISS and ALBUMIN).   The package insert for BIORAD state that "microscopic examination is not recommended."

I am looking into switching to IMMUCOR anti IgG and Poly whose package inserts just state that an optical ais may be used for examination but does not refer specifically to microscopy.

I'm not sure if elimination microscopic examination on DAT's  and tube antibody detection and ID is a good idea.  Does anyone have any advice or insight?  Thanks so much.

Julie Anderson

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Many years ago, Peter Issitt stated that microscopes should be banned from Transfusion Laboratories (I think it was in the orange edition of his book) except for such tests where cells are being counted (such as the Kleihauer).

Many years after his wise words, I still follow his advice, and have not (yet) been involved in a missed weak antibody that has caused a clinically significant haemolytic transfusion reaction (43 years in the job), and many of those tests were performed in opaque tiles and then, as we "modernised", tube techniques.

The use of the term "Optical aids", in this sense, is almost certainly referring you to an agglutination viewer.

The only time we use a scope is to verify the presence of that pesky rouleaux.

Scott

I agree with the previous responses. I would cease and desist with routine microscopic reading - you don't read the gel tests microscopically. Perhaps keep the microscope around just in case there's an odd case where it MIGHT be useful, but I suspect that it will just collect dust.

Thank you all.  Your responses are greatly appreciated!

The only caveat I would add...consider your staff. I have all generalists. I require them to use a microscope because they are not all equally skilled with shaking off and seeing weak reactions in the mirror. Without the scope, we would miss some things we need to see. If I had a dedicated blood bank staff, I would give you a different answer.

I stopped requiring microscopic examination of AHG testing many years ago but we kept the microscope for KB testing.  Consequently I had a few "more experienced" techs who refused to stop using the scope routinely for AHG testing.  The battle was not worth the effort to try to get them to stop.  Most of the "less experienced" techs had no problem with not using the scope.  As is the way of nature I'm pretty sure none of the "more experienced" folks are still testing patients, especially since they were more experienced than I and I am long gone as well.  

Wow, I'm getting far to diplomatic for my own good!  

20 hours ago, AMcCord said:

The only caveat I would add...consider your staff. I have all generalists. I require them to use a microscope because they are not all equally skilled with shaking off and seeing weak reactions in the mirror. Without the scope, we would miss some things we need to see. If I had a dedicated blood bank staff, I would give you a different answer.

Agreed.  Not only rouleaux, but also mixed field reactions.

sandra

Just be careful.  As Julie pointed out in her original post, Biorad, for one, specifically recommends to NOT use a scope.  Since we have to at least  follow manufacturer's guidelines, a lab using Biorad reagents would be up for a citation if an inspector catches someone using a scope.

 

Scope

18 minutes ago, SMILLER said:

Just be careful.  As Julie pointed out in her original post, Biorad, for one, specifically recommends to NOT use a scope.  Since we have to at least  follow manufacturer's guidelines, a lab using Biorad reagents would be up for a citation if an inspector catches someone using a scope.

 

Scope

I think that signature should, possibly, have been Scott???????!!!!!!!!!!!!!!!!!!!!!!!

Maybe its time for ME to retire!

Scott (aka Scope)

 

58 minutes ago, SMILLER said:

Maybe its time for ME to retire!

Scott (aka Scope)

 

Not for an absolute AGE yet young man!

I had a tech tell me one time (long time ago) that he could not find K neg units. All of the units of RBCs he tested were K antigen positive. He was reading his tube typings microscopically! Probably a trace of another antibody in the antiserum (human).

On 2/24/2017 at 3:21 PM, tricore said:

I had a tech tell me one time (long time ago) that he could not find K neg units. All of the units of RBCs he tested were K antigen positive. He was reading his tube typings microscopically! Probably a trace of another antibody in the antiserum (human).

Definitely have to take note of manufacturer's instructions, especially important for antisera and special tests. Using a scope when testing with antisera is a strong compulsion in students and generalists that has to be weeded out. Not sure why that worries them more than the antibody screen or crossmatch, but it does.

 

Thank you all so much!  Awesome responses!  Humorous as well!

Very good point about shaking the tubes to examine for agglutination.  Some techs will shake too hard.  I also am worried about Gel to tube method comparison.  I think I'll stick with RH antibodies with PEG.

Julie

On 2/21/2017 at 0:33 PM, Malcolm Needs said:

Many years ago, Peter Issitt stated that microscopes should be banned from Transfusion Laboratories (I think it was in the orange edition of his book) except for such tests where cells are being counted (such as the Kleihauer).

Many years after his wise words, I still follow his advice, and have not (yet) been involved in a missed weak antibody that has caused a clinically significant haemolytic transfusion reaction (43 years in the job), and many of those tests were performed in opaque tiles and then, as we "modernised", tube techniques.

YAASSSSS! Dr. Issitt said that to me many times when I worked under his direction at Duke.