Ruling out using ABID Panel

Ruling out using ABID PanelPlease print Antibody Panel 1It will be helpful to have

Panocell for ABIDPANEL1RhKellDuffyKiddLewisMNSPRESULTSPanelDCEceKkFyaFybJkaJkbLeaLebSsMNPIS37AHGCCCell # 10+0++0++0++0+0+++0002+2++00+0+0++00++0+++0003++00+++0++0+00+0++001+4+0++0+00+0+0++++++002+500+++0+0+0++0+0+++0006000++0++++000+0+0+0007000++++0+++0+++++0002+8000++0++00+0+0+0++002+9+00++0+000++00++00002+Pt000

ABIDLook at the panel and checkPhases that have positive reactionsPhase that do not have positive reactionsAre there different reaction strengths recorded?Are there reactions at different phases?Patient auto controlIs it negative or positive?These are all clues to help with identification

Look for CluesRhKellDuffyKiddLewisMNSPRESULTSPanelDCEceKkFyaFybJkaJkbLeaLebSsMNPIS37AHGCCCell # 10+0++0++0++0+0+++0002+2++00+0+0++00++0+++0003++00+++0++0+00+0++001+4+0++0+00+0+0++++++002+500+++0+0+0++0+0+++0006000++0++++000+0+0+0007000++++0+++0+++++0002+8000++0++00+0+0+0++002+9+00++0+000++00++00002+Pt0001Reactions are all at AGHReaction strength is different at cell 3Different reaction strengths can indicate: dosage and/or multiple antibodiesPatient auto control is negative, indicating a possible alloantibody

Begin Ruling OutUse only panel cells that have no reaction recorded in any phase.Begin with cell #2Follow with cells #5 and #6

What is left?

Ruling OutWhen ruling out Use only cells where no reaction is recordedGo one cell at a time and mark out antigens that are positiveWatch out for antigens that show dosageKidd, Kell, Duffy, MNS, LewisIf both are present on the cell then can not be ruled outLook for a pattern to show up especially if only one antibody is present in patient serum

Lets begin!RhKellDuffyKiddLewisMNSPRESULTSPanelDCEceKkFyaFybJkaJkbLeaLebSsMNPIS37AHGCCCell # 10+0++0++0++0+0+++0002+2++00+0+0++00++0+++000The first cell with a negative reaction is panel cell 2.Go across cell 2 and mark out all antigens that are positive.

Panel Red Cell #2RhKellDuffyKiddLewisMNSPRESULTSPanelDCEceKkFyaFybJkaJkbLeaLebSsMNPIS37AHGCCCell # 10+0++0++0++0+0+++0002+2++00+0+0++00++0+++000All positive antigens for panel cell #2 have been marked out except for M and N.M and N travel together and therefore show dosage. In order to mark out antigens showing dosage, one antigen must be positive and the other negative.

Continue Ruling out AntigensContinue ruling outUse only panels cells where no reaction occurredAfter all antigens are marked out look and see what is left.

What is left?After ruling out:Check what antigens are not marked outIn our example Antigen s and K are not marked outWhat are we testing for?Patient serum/plasma for unexpected antibodiesAntibodies react with: antigens on red cellsConsider the Rule of Three when interpreting results

Rule Of ThreeThere must be three antigens that react positively with the patients serum/plasma.There must be Three antigens that react negatively with the patients serum/plasma.If not, use selected cells with or without the antigen in question to meet the Rule of Three

What About our Example?Antigen K Meets the rule of threeDoes not match the reaction patternCannot rule out yet

Antigen s Meets the rule of threeDoes match the reaction patternCannot rule out yet

How to Resolve Phenotype the patient red cells for antigen K and sIf patient is negative for the antigen then the antibody could be presentIf patient is positive for the antigen then the reactions would not be from the corresponding antibody

Patient PhenotypeAntigen TypingAnti Serapatientpos controlneg controlInterpretationK++0positive for K antigens0+0negative for s antigenThe patient is positive for the K antigen; therefore will not make Anti-K.(Remember Landsteiners Rule!)The patient is negative for the s antigen; therefore the antibody is most likely Anti-s

Interpretation of ResultsBased on the panel reactions and the antigen test results:Our patient has a possible anti-s in his serum/plasma.

When you get a chance, ask if you might review some panels at your clinical site.