“It’s Just a Panel … It’s not Rocket Science”

Shannon Long, MT(ASCP)SBBLead Reference Technologist

LifeShare Blood Centers

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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

Methods - Gel

Disadvantages

Special incubators Special centrifuges Special pipette and

tips

Advantages

Sensitivity Smaller sample size Less hands-on tech time Stable reactions Automation

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Tips For Gel Users

1. Screening cells positive panel negative

2. Screening cells positive crossmatch negative

3. Auto control

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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

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Tips For Solid Phase Users

1. Screening cells positive panel negative

2. Screening cells positive crossmatch negative

3. Auto control

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Antibody Identification

Age? Sex? Race? Diagnosis?

Medications? Transfusion history? Pregnancy history?

Patient 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

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

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Evaluation of Panel (cont’d)

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

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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Use of outdated reagent red cells Use of diluted antisera for screening Use of unlicensed antisera for screening Use of outdated antisera Use of proper controls for outdated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 + + 0 0 + + 0 + + 0 0 + + 0 + 0 + 1+ 1+ 2+

2 + + 0 0 + 0 + 0 0 + + 0 + + 0 + + 0 0 1+w

3 + 0 + + 0 0 + + 0 + 0 + + + + + + 0 0 3+

4 + 0 + 0 + 0 0 0 + 0 + 0 + 0 + + + 0 0 0

5 0 + + 0 + 0 + + + 0 0 + 0 + 0 0 + 0 0 0

6 0 0 + + + 0 0 w + 0 0 + + + 0 + + 0 0 1+

7 0 0 + 0 + + 0 + 0 + 0 + + + + + + 1+ 1+ 2+

8 0 0 + 0 + 0 + 0 + 0 + 0 + + + 0 + 0 0 0

9 0 0 + 0 + 0 0 + 0 + 0 + + 0 + + + 0 0 1+

10 + + 0 0 + 0 0 + + 0 0 + + 0 + + 0 0 0 0

11 + 0 + 0 + 0 0 0 + 0 0 0 + + + 0 + 0 0 0

A/C                                   0 0 0

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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 RT 37 AHG

1 + + 0 0 + 0 0 + + + 0 0 + 0 + + + 0 0 1+

2 0 0 + 0 + 0 + 0 0 + 0 + + + + 0 + 0 0 1+

3 + + 0 0 + 0 0 + 0 + + 0 0 0 + + + 0 0 1+s

4 + 0 + + 0 0 + 0 0 + 0 + 0 + + + + 0 0 1+s

5 0 0 + 0 + + 0 + + 0 0 + + + + + 0 0 1+ 1+s

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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 0 0 + 0 + 0 0 0 + 0 0 + + 0 + 0 + 0 0 0

2 0 0 + 0 + 0 0 + + 0 + 0 + + + + + 0 0 0

3 + 0 + + 0 0 + 0 + 0 0 + 0 + + + + 0 0 1+s

4 + 0 + + 0 0 + + + 0 + 0 0 + 0 + + 0 0 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 + + 0 0 + + 0 + + 0 0 + + 0 + 0 + 0 1+ 0 1+s

2 + + 0 0 + 0 + 0 0 + + 0 + + 0 + + 0 1+ 0 1+s

3 + 0 + + 0 0 + + 0 + 0 + + + + + + 0 0 0 0

4 + 0 + 0 + 0 0 0 + 0 + 0 + 0 + + + 0 0 0 mi+

5 0 + + 0 + 0 + + + 0 0 + 0 + 0 0 + 0 1+ mi+ 1+s

6 0 0 + + + 0 0 w + 0 0 + + + 0 + + 0 0 0 0

7 0 0 + 0 + + 0 + 0 + 0 + + 0 + + + 0 0 0 0

8 0 0 + 0 + 0 + 0 + 0 + 0 + + + 0 + 0 0 0 0

9 0 0 + 0 + 0 0 + 0 + 0 + + 0 + + + 0 0 0 1+w

10 + + 0 0 + 0 0 + + 0 0 + + 0 + + 0 0 1+ mi+ 1+s

11 + 0 + 0 + 0 0 0 + 0 0 0 + + + 0 + 0 0 0 0

A/C                                   0 0 0 0

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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 PEG

1 + 0 + + 0 0 + 0 + + + 0 + + 0 + 0 0

2 + + 0 + 0 0 0 + + + 0 + + + 0 0 + 0

3 + w 0 + 0 0 + + + 0 0 + + + + 0 + 0

4 + 0 + 0 + 0 0 0 + + 0 + + 0 + 0 0 1+

5 0 0 + 0 + + 0 + 0 + 0 + + + + + + mi+

6 + + 0 + 0 0 + 0 + + 0 + 0 + + 0 + 0

PT + 0 + + 0 0 + + + + + 0 + + + 0 +  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 + + 0 0 + + 0 + + 0 0 + + 0 + 0 + 2+ 2+s 1+

2 + + 0 0 + 0 + 0 0 + + 0 + + 0 + + 2+ 2+ 1+

3 + 0 + + 0 0 + + 0 + 0 + + + + + + 0 0 0

4 + 0 + 0 + 0 0 0 + 0 + 0 + 0 + + + 1+ 2+ mi+

5 0 + + 0 + 0 + + + 0 0 + 0 + 0 0 + 2+ 2+ 1+s

6 0 0 + + + 0 0 w + 0 0 + + + 0 + + 1+ 2+ 1+

7 0 0 + 0 + + 0 + 0 + 0 + + 0 + + + 1+ 1+ mi+

8 0 0 + 0 + 0 + 0 + 0 + 0 + + + 0 + 1+ 2+ 1+

9 0 0 + 0 + 0 0 + 0 + 0 + + 0 + + + 2+s 1+s 1+

10 + + 0 0 + 0 0 + + 0 0 + + 0 + + 0 1+ 1+ 1+

11 + 0 + 0 + 0 0 0 + 0 0 0 + + + 0 + 1+ 1+ 0

A/C                                   0 0 0