D.C.

Donna, thanks for your comments! It's nice to get some positive feedback from someone; this issue has been a real thorn in my side. I'll keep your thoughts on the Echo Ab ID's in mind. It will most likely be after Jan. 1st as we're in the middle of converting our computer systems and I'm in charge of building and validating the blood bank dictionaries; yikes!

Donna, we don't do antibody ID's on our Echo yet, though because of this scenario, we're looking into it sooner than we had planned. What we get is a positive initial antibody screen that comes up AT LEAST 2+ on SI and SII (lot #R099 Capture-R strips) and most often 3 or 4+. We use ImmuAdd as our enhancement. If the doc orders an antibody ID, most often it comes back negative because our reference lab uses PEG and it won't pick up Rhogam-induced Anti-D most of the time. By reporting when the patient got Rhogam and the results of BOTH methods, we're hoping to cut down on how many ID's are ordered on these patients. Our comment that we send with the reports does also state that the automated screen shows "presumptive Anti-D patterning".

We've had our Echo for coming up on two years. In March of this year, we started seeing a new phenomenon. When we get Rh negative OB patients, very frequently they come up with an Anti-D pattern of at least 2 to 4+. The problem is when we do these manually (tube), they come up negative. If we send them to our reference lab, ALMOST always they come up negative for Anti-D. In ALL cases, these patients have gotten Rhogam. I've tried to find a good way to handle this; we used to do the screen manually and report as negative, but because of those few Antibody ID's that were coming back positive, I felt we were not giving the docs the entire picture. So what we do now is to run the screen on the Echo, if it is positive, we run it manually. If it's negative, we report both workups WITH a comment saying when the patient got Rhogam and that manual testing methods showed no reactivity. It also asks the doctors to notify the lab if they want an ID done. Sometimes they do and sometimes they don't order one; I felt addressing it this way gives the docs all the information they need to make an informed decision about ordering an antibody ID, putting the ball in their court. Since we send these out, it's a significant extra cost for the patient. I have some techs who hate doing it this way (they liked the other way that didn't involve as much work and thought), and some who think it's great; oy vey! But I should mention I'm the only "official" blood banker in my lab as well as being the supervisor; everyone else rotates in and out. Any thoughts, suggestions, anyone else having this problem??

We have all our antibody identifications sent to our Community Blood Center. They bill us, we pay them, and then we charge the patient or insurance, etc. My supervisor wants us to break their charges down into specifics so we can get more reimbursement. The problem I'm running into is that while I have found CPT codes for all the testing, some of those codes have no reimbursement fees listed at all, nor are these same codes listed in the 2008 Clinical Diagnostic Fee Schedule at all; they're just not there! All these codes have to do with elutions, pretreatments, antibody titrations, incubation w/inhibitors, auto-allo-adsorption, etc. Are prices of these "unusual" tests simply set by each hospital or performing entity? Is there a list somewhere of transfusion medicine CPT code prices? If anyone knows what I'm talking about, I can provide the CPT codes I'm having troubles with. Thanks! Debbie

We do the weekly flushing as well with the 10% bleach, then water, then back to saline. The last thing I do afterwards is wipe off the excess liquid left on the lid and around the top; this prevents salt buildup on the lid, hinges, etc.

Hi, I am new to the forum, but wanted to chime in on this topic. We have an ABS2000 that is being sunsetted on March 1, 2009. We use tube testing as our alternate method. We are a county hospital with about 100 beds. We went with automation purely due to staffing concerns, we needed to free up our Blood Bank tech's time to help more in the general lab. Now we are considering going all gel, or tube and Echo. My preference is to stick with tube and get the Echo, then maybe consider gel in the future as our volume grows. My biggest concern with gel is the cost. I have also recently heard that the gel technology is not owned by Ortho and that it's future is uncertain. The Provue is also rather "old" and there's nothing being developed to replace it by Ortho. At least this is what I'm being told by our Immucor rep. If anyone knows anything different, please advise.