This is a very good question. We see this in the lab more often than we want. There are a few scenarios. 1. Pan-reactive in solid phase with negative DAT a. Gel screen; if not pan-reactive, continue to rule out using Gel Method. b. If pan-reactive, perform screen using Tube Method. c. If not pan-reactive in Tube, continue to rule out using Tube Method. d. We can perform alternative methods (PEG, LISS, SAGT), to rule out common clinically significant antibodies. e. If we cannot rule out, we would be leading toward Antibody of Undetermined Significance (AUS). AUS is when there are unexplainable reactions, but all clinically significant antibodies have been ruled out, and verify that these cells are not reactive on low-incidence antigens. f. AUS is considered an antibody. We would do a full crossmatch for a patient with AUS. 2. Pan-reactive in solid phase with a negative DAT a. The gel screen is negative. b. The tube screen is negative. c. Some hospitals may require you to do gel or tube panels. d. We suspect Solid Phase interference (SPI) if we only have reactions in solid phase method. In some hospitals, we would also require solid phase DAT and solid phase crossmatch to be negative before calling it a Solid Phase interference. e. We would also perform a full crossmatch for a patient who needs blood. 3. Pan-reactive in Solid Phase with positive DAT a. We would go through the same steps as the first scenario, except we would also perform DAT using Tube Method. b. If the DAT in the tube method is positive, we will perform a DAT differential. c. If the IgG in DAT differential is positive, we would perform elution. d. If we still cannot ID with elution, we would use other methods to rule out common clinically significant antibodies. If all alternate methods (PEG, LISS, SAGT) are still positive, we send the sample to the reference lab for absorption studies and molecular testing. e. In this case, we would suspect Warm Auto Antibody (WAA). f. Once we have the molecular typing of a patient on file, we would give phenotype-match blood if required. Note: If all cells are reactive on all methods and the autocontrol is nonreactive, alloantibody to high-incidence antigen should be considered especially if the strength and test phase of reactions are uniform for all cells tested. Antibodies to high-incidence antigens can be identified by testing red cells of selected rare phenotypes.
Plz tell me how to rule out alloantibody in pan reactive case
This is a very good question. We see this in the lab more often than we want.
There are a few scenarios.
1. Pan-reactive in solid phase with negative DAT
a. Gel screen; if not pan-reactive, continue to rule out using Gel Method.
b. If pan-reactive, perform screen using Tube Method.
c. If not pan-reactive in Tube, continue to rule out using Tube Method.
d. We can perform alternative methods (PEG, LISS, SAGT), to rule out common clinically significant antibodies.
e. If we cannot rule out, we would be leading toward Antibody of Undetermined Significance (AUS). AUS is when there are unexplainable reactions, but all clinically significant antibodies have been ruled out, and verify that these cells are not reactive on low-incidence antigens.
f. AUS is considered an antibody. We would do a full crossmatch for a patient with AUS.
2. Pan-reactive in solid phase with a negative DAT
a. The gel screen is negative.
b. The tube screen is negative.
c. Some hospitals may require you to do gel or tube panels.
d. We suspect Solid Phase interference (SPI) if we only have reactions in solid phase method.
In some hospitals, we would also require solid phase DAT and solid phase crossmatch to be negative before calling it a Solid Phase interference.
e. We would also perform a full crossmatch for a patient who needs blood.
3. Pan-reactive in Solid Phase with positive DAT
a. We would go through the same steps as the first scenario, except we would also perform DAT using Tube Method.
b. If the DAT in the tube method is positive, we will perform a DAT differential.
c. If the IgG in DAT differential is positive, we would perform elution.
d. If we still cannot ID with elution, we would use other methods to rule out common clinically significant antibodies. If all alternate methods (PEG, LISS, SAGT) are still positive, we send the sample to the reference lab for absorption studies and molecular testing.
e. In this case, we would suspect Warm Auto Antibody (WAA).
f. Once we have the molecular typing of a patient on file, we would give phenotype-match blood if required.
Note: If all cells are reactive on all methods and the autocontrol is nonreactive, alloantibody to high-incidence antigen should be considered especially if the strength and test phase of reactions are uniform for all cells tested. Antibodies to high-incidence antigens can be identified by testing red cells of selected rare phenotypes.