“It’s Just a Panel … It’s not Rocket Science” Shannon Long, MT(ASCP)SBB Lead Reference Technologist LifeShare Blood Centers
Mar 28, 2015
“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
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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