Reverse typing shows agglutination with both A1 and B cells in a patient with a markedly increased total protein. Microscopic examination shows stacked coin-like aggregates. What is the appropriate next step?
1Prewarm the sample to 37 degrees Celsius
2Perform a saline replacement technique✓ 정답
3Perform an autoadsorption
4Repeat with a new lot of reagent cells
해설
Markedly increased total protein with agglutination in both reverse typing cells and a stacked-coin appearance on the smear indicates rouleaux. This is not true agglutination but red cells adhering because of excess protein, so it disperses with saline replacement. Prewarming addresses cold antibodies and autoadsorption addresses autoantibodies.