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Its Just a Panel … Its not Rocket Science Shannon Long, MT(ASCP)SBB Lead Reference Technologist LifeShare Blood Centers.

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Presentation on theme: "Its Just a Panel … Its not Rocket Science Shannon Long, MT(ASCP)SBB Lead Reference Technologist LifeShare Blood Centers."— Presentation transcript:

1 Its Just a Panel … Its not Rocket Science Shannon Long, MT(ASCP)SBB Lead Reference Technologist LifeShare Blood Centers

2 2 Methods - Tube Disadvantages Subjective grading Increased hands-on tech time Washing problems Advantages Flexible Available equipment Relatively inexpensive Multiple phases of reactivity Use different additive solutions

3 3 Methods - Gel Disadvantages Special incubators Special centrifuges Special pipette and tips Advantages Sensitivity Smaller sample size Less hands-on tech time Stable reactions Automation

4 4 Tips For Gel Users 1.Screening cells positive panel negative 2.Screening cells positive crossmatch negative 3.Auto control

5 5 Methods - Solid Phase Disadvantages Sensitive pipetting Questionable interpretation Special equipment Pos and Neg control Advantages Smaller sample size than tube Stable reactions Pos and Neg control Automation

6 6 Tips For Solid Phase Users 1.Screening cells positive panel negative 2.Screening cells positive crossmatch negative 3.Auto control

7 7 Antibody Identification Age? Sex? Race? Diagnosis? Medications? Transfusion history? Pregnancy history? Patient History

8 8 Antibody Identification (contd) Exclusions Exclude based on negative reactions to cells having presumed homozygous expressions of antigen Exclude with one negative cell Exceptions

9 9 Evaluation of Panel 1.In what phase(s) and at what strength(s) did the positive reactions occur? 2.Do all of the positive cells react at the same phase, or do any react at different or multiple phases? 3.Does the serum reactivity match any of the remaining specificities? Tube Testing

10 10 Evaluation of Panel (contd) 1.Are all commonly encountered RBC antibodies ruled out? 2.Is the autologous control positive or negative? 3.Is there sufficient evidence to prove the suspected antibody? 4.Is the patient lacking the antigen corresponding to the antibody? Tube, Gel, Solid Phase

11 11 Cost-effective Methods Use of outdated reagent red cells Use of diluted antisera for screening Use of unlicensed antisera for screening Use of outdated antisera Use of proper controls for outdated or unlicensed antisera

12 12 Summary No matter what test method you use in your Blood Bank, the approach to antibody identification should always be the same. No test method is perfect, so use the one that works best for your facility.

13 13 Case Studies

14 14 Case 1 70 year old Caucasian female Admitted with cellulitis of right leg Transfused 3 months ago Three units of blood ordered STAT Blood type: O Positive DAT: Negative Rh Phenotype: C+E-c+e+ Antibody screen 4+ positive (all three screening cells) using automated solid phase testing

15 15 Case 1 – Initial Panel Results DCcEeKFy a Fy b Jk a Jk b Le a Le b P1P1 MNSsRT37AHG 1++00++0++00++0+0+1+ 2+ 2++00+0+00++0++0++001+ w 3+0++00++0+0++++++003+ 4+0+0+000+0+0+0+++000 50++0+0+++00+0+00+000 600+++00w+00+++0++001+ 700+0++0+0+0++++++ 2+ 800+0+0+0+0+0+++0+000 900+0+00+0+0++0+++001+ 10++00+00++00++0++0000 11+0+0+000+000+++0+000 A/C 000

16 16 Case 1 – Selected Cells DCcEeKFy a Fy b Jk a Jk b Le a Le b P1P1 MNSsRT37AHG 1++00+00+++00+0+++001+ 200+0+0+00+0++++0+00 3++00+00+0++000+++001+ s 4+0++00+00+0+0++++00 500+0++0++00+++++001+1+ s

17 17 Case 1 – Additional Selected Cells DCcEeKFy a Fy b Jk a Jk b Le a Le b P1P1 MNSsRT37AHG 100+0+000+00++0+0+000 200+0+00++0+0+++++000 3+0++00+0+00+0++++001+ s 4+0++00+++0+00+0++002+

18 18 Case 2 34 year old Caucasian female Admitted with abdominal pain and bleeding Hemoglobulin: 8.9 g/dL History of transfusion (> 3 months ago) History of pregnancy Blood type: AB Positive Rh Phenotype: C-E+c+e- Hospital reports 2+ using Gel (SC-I)

19 19 Case 2 – Initial Panel Results DCcEeKFy a Fy b Jk a Jk b Le a Le b P1P1 MNSsRT37AHGPEG 1++00++0++00++0+0+01+01+ s 2++00+0+00++0++0++01+01+ s 3+0++00++0+0++++++0000 4+0+0+000+0+0+0+++000mi+ 50++0+0+++00+0+00+01+mi+1+ s 600+++00w+00+++0++0000 700+0++0+0+0++0+++0000 800+0+0+0+0+0+++0+0000 900+0+00+0+0++0+++0001+ w 10++00+00++00++0++001+mi+1+ s 11+0+0+000+000+++0+0000 A/C 0000

20 20 Case 2 – Selected Cells DCcEeKFy a Fy b Jk a Jk b Le a Le b P1P1 MNSsPEG 1+0++00+0+++0++0+00 2++0+000+++0+++00+0 3+w0+00+++00++++0+0 4+0+0+000++0++0+001+ 500+0++0+0+0++++++mi+ 6++0+00+0++0+0++0+0 PT+0++00+++++0+++0+ NT

21 21 Case 2 – Ficin Treated Panel DCcEeKFy a Fy b Jk a Jk b Le a Le b P1P1 MNSsIS37AHG 1++00++0++00++0+0+2+2+ s 1+ 2++00+0+00++0++0++2+ 1+ 3+0++00++0+0++++++000 4+0+0+000+0+0+0+++ 2+mi+ 50++0+0+++00+0+00+2+ 1+ s 600+++00w+00+++0++1+2+1+ 700+0++0+0+0++0+++ mi+ 800+0+0+0+0+0+++0+1+2+1+ 900+0+00+0+0++0+++2+ s 1+ s 1+ 10++00+00++00++0++01+ 11+0+0+000+000+++0+1+ 0 A/C 000


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