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“It’s Just a Panel … It’s not Rocket Science”
Shannon Long, MT(ASCP)SBB Lead Reference Technologist LifeShare Blood Centers
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Methods - Tube Advantages Disadvantages Flexible Subjective grading
Available equipment Relatively inexpensive Multiple phases of reactivity Use different additive solutions Disadvantages Subjective grading Increased hands-on tech time Washing problems
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Methods - Gel Advantages Disadvantages Sensitivity Smaller sample size
Less hands-on tech time Stable reactions Automation Disadvantages Special incubators Special centrifuges Special pipette and tips
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Tips For Gel Users Screening cells positive panel negative
Screening cells positive crossmatch negative Auto control
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Methods - Solid Phase Advantages Disadvantages
Smaller sample size than tube Stable reactions Pos and Neg control Automation Disadvantages Sensitive pipetting Questionable interpretation Special equipment Pos and Neg control
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Tips For Solid Phase Users
Screening cells positive panel negative Screening cells positive crossmatch negative Auto control
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Antibody Identification
Patient History Age? Sex? Race? Diagnosis? Medications? Transfusion history? Pregnancy history?
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Antibody Identification (cont’d)
Exclusions Exclude based on negative reactions to cells having presumed homozygous expressions of antigen Exclude with one negative cell Exceptions
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Evaluation of Panel Tube Testing
In what phase(s) and at what strength(s) did the positive reactions occur? Do all of the positive cells react at the same phase, or do any react at different or multiple phases? Does the serum reactivity match any of the remaining specificities?
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Evaluation of Panel (cont’d)
Tube, Gel, Solid Phase Are all commonly encountered RBC antibodies ruled out? Is the autologous control positive or negative? Is there sufficient evidence to prove the suspected antibody? Is the patient lacking the antigen corresponding to the antibody?
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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
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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.
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Case Studies
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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
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Case 1 – Initial Panel Results
D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s RT 37 AHG 1 + 1+ 2+ 2 1+w 3 3+ 4 5 6 w 7 8 9 10 11 A/C
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Case 1 – Selected Cells D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s
D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s RT 37 AHG 1 + 1+ 2 3 1+s 4 5
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Case 1 – Additional Selected Cells
D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s RT 37 AHG 1 + 2 3 1+s 4 2+
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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)
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Case 2 – Initial Panel Results
D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s RT 37 AHG PEG 1 + 1+ 1+s 2 3 4 mi+ 5 6 w 7 8 9 1+w 10 11 A/C
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Case 2 – Selected Cells D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s
D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s PEG 1 + 2 3 w 4 1+ 5 mi+ 6 PT NT
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Case 2 – Ficin Treated Panel
D C c E e K Fya Fyb Jka Jkb Lea Leb P1 M N S s IS 37 AHG 1 + 2+ 2+s 1+ 2 3 4 mi+ 5 1+s 6 w 7 8 9 10 11 A/C
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