MOBB

I'm looking forward to the seminar. I'm also curious about the missing serum reactivity. Will this eliminate babies where there is no expected serum reactivity Malcom, How does the UK handle computer crossmatches and missing serum reactivity? Are computer crossmatches allowed for babies with no reverse type? I remember you stating at one point that our accredditing friends from the US and UK were comparing notes and picking the stricter ones from each side of the pond?

I completely agree. However, Amy from CAP did not.

That's why I was confused and asked more than once to verify. The majority of our MF patients have received blood from us and have a history of multiple types. The only thing I can think is to prevent hospitals from not really resolving a MF and just assuming an O or rh neg transfusion is causing the MF.

The 2017 revisions were released this week. The computer crossmatch section was revised to align with the FDA guidance. "If ABO typing discrepancies exist, you should not rely on a computer crossmatch.This is particularly important if there is mixed field red cell reactivity, missing serum reactivity, or apparent change in blood type following hematopoietic stem cell transplantation.Under those circumstances, your procedures should provide for compatibility testing using serologic crossmatch techniques." I called CAP to verify that this included resolved ABO discrepancies. Our hospital had been allowing computer crossmatches for ABO discrepancies that are resolved, and I'm not sure that our BB LIS could prevent a patient with a resolved ABO discrepancy from receiving a computer crossmatch. Does your LIS prevent computer crossmatches for patients with MF reactions or weak reverses?

How is it worded in your policy? And does staff call the medical director at all hours or is the unit refrigerated until review and then gram stain and/or cultures collected?

I heard last week that there is another method some of the US ref labs are either using or want to start using for the Dara patients and Kell isn't affected, but I can't for the life of me remember what they said and I haven't had any luck with google. Has anyone heard anything similar?

I think it depends on your process. If the hospital is performing a non-crossmatch setup, then not required is appropriate. Our pediatric hospital usually performs electronic crossmatches on neonates-the expiration date corresponds to the date the neonate is 4 months old.

Are you using tap water? You could switch to distilled water.

The forward type and D control are on the same gel card-so same manufacturer. The DAT was tested at our reference lab as part of their warm auto work up. I believe the anti-complement reagent is monospecific, but I couldn't say for sure.

We have a patient that is O neg with a positive D control in gel and a positive screen due to a warm auto-antibody. Why is the D control affected by the warm auto, but the anti-A, anti-B and anti-D weren't? Also how common is it to have a positive IgG DAT and positive complement DAT? The initial work up from our ref lab showed the warm auto and 4+ IgG DAT. Multiple days later, both the IgG and complement DAT were positive and the eluate showed an auto anti-e.

Why do you say it might mitigate poor technique? My blood bank experience is mainly gel with 2 cell screens.

Which does your facility use and why?

I think the qualifier "as appropriate" covers the blood bank's lack of normal ranges.

Any idea on when it'll be available?

How does the Eflexis vary from the wadiana or eytra? Is it just missing the middle module with the gel cards?

Our pediatric hospital orders 150 mL and 300 mL bags and 30 mL and 60 mL syringes. Since they are pediatric, they do purchase cases at a time. At our facility, we issue the whole unit. Nursing can run it with a pump and toss what they don't need. We never split units and wouldn't have a use for a partial unit. Maybe you could cost share with another hospital or two and split the case?

We test the DAT IgG on our Erytra and chose not to QC it since all the reagents and processes are already QC'd. There's really no need to QC the DAT itself. What do you do for poly DAT?

David, Thank you so much for your reply. I have seen that 2+ in gel are also usually negative in tube. I've been amazed at the number of patients that have changed Rh types and since we've switched gel manufacturers we've had at least one patient/month change from A to A2 and B to A2B pos, each one confirmed by our IRL. That's so weird that someone would f/u with a less sensitive method. Has anyone ever explained why to you? I had a very frustrated employee who works in another blood bank tell me that they will repeat a positive polygel DAT in poly tube to try to make it negative and that blew my mind too. All this brings me back to my original concern, I may be missing clinically significant reactions in tube. This is hopefully a temporary switch until Ortho can fill my backorders. We are kicking around the idea of running tube poly along side gel IgG to ensure we don't miss something. However, this could cause confusion when reporting a negative poly with a positive IgG.

How did your validation work out?

You can create your own QC sample and use check cells or override the DAT QC altogether since you don't need to do it. the IgG cards and diluent are already QC'd.

We're correlating gel and tube poly DAT. All of our 2+ or less reactions in gel were negative in tube. I'm worried that if we test in tube, we'll miss things we don't want to miss. Do most blood banks assume they are junk or not clinically significant? Otherwise, it seems odd that so many hospitals just do tube for poly.

Here's the Bio-Rad gel cards: http://www.bio-rad.com/en-us/category/direct-ahg-test-dat I believe it just received FDA approval and requires it's own card centrifuge or can probably be used in their new gel analyzer.

How did the complement+buffer card work for you? My ref lab said they couldn't get it to correlate with tube so they quit.

I just found out that Bio-Rad has a poly DAT card that tests IgG and complement. Plus one that tests the different immunoglobulins. Does anyone use their poly card? How do you like it?

Congrats on your go live! We had a bumpy start and a possessed analyzer, but it's much better now. I really like the analyzer and I really like our TAS and FSE. They do feel like an immature company in that they are newer in the US and seemed to struggle with supporting their staff as they've grown, BUT they seem to hear us and resolve our issues. We've been working with them a long time and I've seen dramatic improvements and growth, I don't think other hospitals or systems would experience the same rockiness. We had a few learning curves too. I'm happy to share, if it helps anyone else avoid some of our self-induced problems. 1. People kept throwing away the service racks when emptied-not understanding they were service racks. The Erytra would dump the cards ok in the service rack space, but when it went to get one, it couldn't find them. 2. If it freezes on you, DON'T hard reboot by pushing the start button. Use a mouse to right click, click global settings-not to use the global settings but to access the windows start menu and shut it down that way. 3. You'll save yourself a lot of headaches if you turn it off every night instead of letting it go to sleep for 20 minutes for your daily maintenance. 4. GENTLY shut the doors. We had to slam our Provue shut-so gentle touches have been difficult. Not being gentle can cause reagent splashing and possibly even splashing in gel cards too. 5. Don't let the Wash bottles get too low. We'll easily go through a full wash A container/day. Staff would get busy and not realize it would get super low or empty and start to cause issues. I ordered back up bottles and always have one ready to go on so they swap them when needed and clean and refill the container at their leisure. 6. Make sure your staff knows if there is a red triangle that they need to investigate and resolve the issue, not modify or accept. We allow some hemolysis as long as the gel card isn't more hemolyzed than the original sample. ANY other red triangle means there an issue and the test MUST be repeated. I'm sure there lots more that I'm not thinking of at the moment. If you have any questions, I'm happy to answer and share our experiences.