ABQ bloodbanker

I have used quite a few of the systems: Sunquest - not very good - not logical for a bloodbanker's mind... eProgesa - the donor side only - not too bad SafeTrace (or Horizon Blood Bank) - very cumbersome, but has good features. No QC module to speak of and the reports are terrible though HCLL - not too bad - easy to learn Meditech - Loved the older version - haven't had the opportunity to use the window's based one. HemoCare - basically good for a DOS system - no longer supported. I think they are all better than doing everything on paper though:)

We QC our antibody panels before use with a diluted anti-D and just confirm that all cells that should react do and those that should not react don't. Once the panel expires and we use it for selected cells, I require a positive cell to be run to ensure the cells are still reacting. I figure if the entire panel is being stored the same, and one antibody reacts, they all should... Not the perfect system, but there is no way to test everything...

I would do a prewarmed XM for a cold or clin insign cold.....

In regards to perfoming both an IS and GEL XM, I built a new XM test in our computer that has both reactions and only one interpretation, and it crosses the interface only once and bills for only the GEL XM. Still haven't gone live with it yet, but reading all of the responses, I reckon we will soon....

That's what we do too! Of course, I learned from the best! PS. Hi Lu!!

Once per admission and we verify the consent when we perform audits. The nursing dept is responsible for making sure every patient receiving blood has the consent form signed. We do require a physician's order "to transfuse" before we issue though.

Howdy Blood Bankers! I am wondering what everyone is doing regarding the CLIA regulation change that happened last Sept, saying that IgG gel crossmatches do not detect IgM antibodies (i.e. anti-A or anti- and that you must also perform an Immediate spin XM, electronic XM in addition to performing the gel XM. This has just come up in our laboratory, and before we implement a change in how we perform our crossmatches for our patients with antibodies:cries:, I would like to see if there is any alternatives out there. We are currently inspected by CAP and AABB, but I'm sure the CLIA regulations are somewhere in there. I personally performed a "mini" validation of the IgG gel cards, and yes, they do detect ABO incompatibility, but I've been told that that may not be relevant. Any ideas???

I would like to remain as "BloodBank Talk", but if we have to change, I like LabTalk and then have sections: Blood Bank, Micro, Hematology, etc...

Liz, We only have one type of anti-D, and it is used for all of the above. Supposedly does not detect DIV....

We did not perform a formal correlation, but when we had known weak D's or when we do get a 1-2+ reaction, we repeat it in tubes and it is negative at IS and 3-4+ at IAT phase. We've probably seen over 20 of them in the last 2 years.... not a whole lot, but enough to add to our procedure that if you see a weak anti-D reaction in gel, call them Rh Negative...

We use both gel and tubes. Gel on the ProVue and tubes when performing any testing manually. Gel IS more sensitive than tubes, but if you know that, you will be fine. If we get a 2+ or less in gel for the D, the patient is considered Rh Negative. (Usually they are a weak/partial D when that happens). Gel does cost more and takes more time, but you can definitley see mixed field and can save the results for someone to look at later. (And that's a good thing when you have generalists in the BB!!) Denise

You are correct: it does not correlate gel to liss to peg to enzymes to Prewarmed or using adsorbed plasma. The answers would vary too much, depending on what antibody you were testing. Denise

Congrats Heather! I will be taking the exam around October.... Denise

I like it! We have McKesson too! But it does seem too logical to actually work!

I still like the "shoot the nurses" response!

Here is the parity worksheet I use. parity worksheet.xls

We correlate all of our tests that are performed using different methodology. Blood types, we get one of every ABORH (8 total) and run in tubes and gel, for example. We also correlate the same methodology (Antibody screens, for instance) that we run manually and on the ProVue. And then, we have 3 ProVues, so we correlate all 3 ProVues. I have attached my parity procedure with a nice form I document all results from all locations/instruments. We do this every 6 months. Denise HBB PARITY CHECKS.doc

We also do NOT reidentify known antibodies....just look for new ones! Denise

We repeat the entire workup with every new specimen..... 3 days for those that have been transfused within 3 months, and if the patient qualifies for a "Pre-Op" specimen, then it is good for 7 days. Our patients like to hospital hop - so finding accurate transfusion history is difficult. I would rather do the extra work instead of missing a newly forming antibody and deal with a hemolytic transfusion reaction later.... Denise

We just validated it last week and are live now. It's pretty awesome! Not only is it helpful for the techs, but also we use it when we review all antibody panels - it is very helpful to see quickly if all alloantibodies got ruled out. The only thing I would like to see with it is to be useful with enzyme panels..... But I definitely recommend it! ABQ BB'er

SuperMT, I am not sure I'm understanding your reply, but do you perform immediate spin crossmatches on a patient with a previous known antibody if it is currently nonreactive? Once a patient is known to produce an antibody, our facility, and every place I have ever worked at, always require a gel (IAT) crossmatch for the rest of that patient's life..... Just curious...

We re-identify with each new specimen - using select cells to make sure nothing new has formed, which is usually every 3 days.

Help Blood Bankers! Last week, I reviewed a panel that a tech performed, and I wanted to run a few more cells to prove an Anti-Fyb. (A non specific antibody was also identified). I decided on running a ficin panel, so the Duffy would be destroyed, so I could maybe identify the non specific. The entire panel was negative. I ran the same panel with untreated cells, and that too was totally negative. I then repeated the panel that the tech ran on the ProVue (she had run it manually first), and got totally different results. :eek:Yikes! The Fya was ruled out so we only had the non-specific antibody. Before I could pull the tech in to retrain, I had another tech get basically the same senario of results, so it made me think I didn't have a tech problem, but a ProVue problem. Ortho came in and did a complete analysis on both of our ProVues, they were fine and reading/grading with no discrepancies. I now have all techs running panels both manually and on the ProVue. I am terrified :eek:because I am seeing lots of discordant results! However, they are only on the non-specific antibodies. Any "real" antibody (Anti-D, E, K, etc) we are getting results that match perfectly. According to Ortho, I am the only one seeing this. It is happening on both of our ProVues, with all 3 panels that Ortho has, so it isn't a reagent problem. This is a new problem, because everytime we run parity studies, all results have been great. Any ideas????? Denise - lost in Albuquerque:confused:

Hi guys, I may be just having a bad day, but I can't seem to figure out the Quality Control procedure on the package insert of Immucor/Gamma's W.A.R.M . Auto Adsorption... It states that "the activity of WARM may be deemed sufficiently active if it can be shown that treated red cells show enhancement of Rh antigen and denaturation of a Kell system antigen. It is recommended that a reagent red cell of known phenotype be treated with WARM to demonstrate enhancement and denaturation with appropriate antibodies." So what I am getting from this is to take 2 different cells (screen cells, one K+ and one E+ for instance) and treat them with the WARM solution, along with the patient you are treating, and once done, use Anti-K and Anti-E on those screen cells to see if they are enhanced and denatured??? Does that mean you need to test them before you treat them and record the reactions to see if they changed? Most antisera give a 3 -4+ reaction, so it may be hard to tell if it was enhanced. I am writing the procedure for this and I need specific instructions in performing the quality control. Thanks for your Help... ABQ Bloodbanker

We use the AlbaQ-C for our ProVues. We actually take Vial 4, sensitize the cells with Anti-D, and use that vial for our positive control for our IgG/C3d gel cards. This is what was recommended by our Ortho BB Specialist when they can and got us set up.