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Edit function on Immucor Neo


ChrisW

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We are considering using the edit function on Neo to manually review and interpret equivocal reactions on antibody screen tests performed on Neo. We have been getting many, many equivocals over the past several months and all instrument and reagent solutions are temporary. We are repeating a significant number of tests which is requiring extra resources of reagent and time, not to mention delay to patients. All of the antibody screen repeat test results are negative so we are looking into thoughtfully editing the Neo result.

Is anyone routinely using the Edit feature and what is your algorithm for interpretation?

Thanks!

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We've done visual interpretation since we got our Echo, probably about 8 years. Immucor has a visual aid for the interpretation of questionable results which I use to train techs. In a nut shell:

  • If the cell button is reduced in size, if the the cell button is ragged, if there are 'freckles' (agglutinates) around the button, if there is an obvious halo around the cell button or if the well background looks pink (and the cell button is probably going to be smaller in these cases) - we consider it as positive or potentially positive. If none of that is true, then we call it negative. Sometimes the edge of the cell button looks 'soft' or 'fuzzy' or looks like a red color has stained the area around the cell button - those wells are reported as negative. It's worth mentioning that there are a few wells occasionally that the Echo calls negative that we call positive after visual inspection. We can't edit those results in, but we do document them and perform additional testing to ID the antibody/rule out the antibody.
  • At that point - run a Ready ID panel. If it's an antibody, perform additional testing as needed to ID it. If you can rule out all clincally significant antibodies, consider an AHG crossmatch.
  • If all cells are uniformly 'positive' or suspicious, then we repeat the antibody screen with tube/PeG and perform an auto (which you can do on the Echo by 'crossmatching' the patient with their own red cells in the donor rack). You may be dealing with an auto antibody or a 'solid phase only' antibody. Tube testing with PeG or LISS may be non-reactive because of the sensitivity of the test system.
  • If the tube screen is negative, report it as negative but make a note in the patient record that solid phase was reactive. You might want to consider a policy to perform an AHG crossmatch for these patients. We are currently doing that selectively, using our best judgement.

The visual review cuts down repeat testing significantly and we have not seen an increase in missed antibodies. All my techs are generalists and it doesn't take them long to become comfortable with visual reviews.

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We also have Echoes for more than 2 years and the Galileo before that.

We do the same as AMcCord. The techs are trained that an equivocal '?' is like a new tech asking a seasoned tech what they think of a reaction in tube, Gel etc.  It's the Echo's way of asking the more knowledgeable tech what they think.

The techs are trained using Immucor's images of positive and negative results. They also have some good ones where they took '?' results and circulated them to seasoned Capture users and had them interpret them and give reason why they called them either Pos or Neg. The techs found these sets of images particularly helpful. If you don't already have these, check with your Technical Specialist to see if you can get them.

We also put together flow sheets for the techs to follow when working with positive reactions on the Echo to help guide the generalists through less than clear cut antibody ID's. That seemed to help also.

 

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I do sometimes look at the values. If I'm seeing 1s and 2s, it's probably not a positive. If the numbers are close to the cut off it could still be a negative, it could be a positive - this is where the tech's best judgement comes in to play.

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The techs just interpret by visually looking at the test wells under the Edit function. When in doubt they are told to go ahead and run an appropriate Capture panel based on what they are seeing and follow up in accordance with the flow sheets. The new techs usually get an experienced tech to look at the wells with them the first few times then they get comfortable fairly quickly.

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