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jalomahe

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Everything posted by jalomahe

  1. 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.
  2. I just had this conversation with the CAP .... Here's may question and CAP's response: My question -- RE: COM.04250 Comparability of Instruments/Methods I need clarification on this for the Transfusion Service. Since antibody screen and antibody identification TESTS both use the same METHOD do you have to perform correlation on both TESTS or just on the METHOD? In other words do I have to do the CAPTURE antibody screen and compare it to the PeG screen and then also do CAPTURE antibody identification (which is the same method as the screen, just with more cells) and compare it to a PeG antibody identification (which is the same method as the screen, just with more cells)? CAP response -- If you compare the antibody screen methods, you are correct, that covers the antibody identification as well. Sincerely, Kathy Passarelli Technical Specialist, CAP The intent is to compare METHODS so if your antibody ID on the instruments are performed by the same METHOD as the antibody screen then you do not need to perform an antibody identification as part of your instrument/method comparison....just the antibody screen will suffice. Ditto for comparing your manual method, if your manual antibody identification is performed by the same method as your manual antibody screen then you just have to do the antibody screen and compare it to your instrument method.
  3. We had a patient in February of this year who had a negative antibody screen in January. They were subsequently transfused 5 pRBCs over a one week period. Nineteen days after the last transfusion he needed additional transfusions. His antibody screen was positive with the antibody panel showing Anti-Fy(a) and Anti-Jk(a). The DAT performed in tube showed WPOS (microscopic) with Anti-AHG but NEG with Anti-IgG and Anti-C3d. An elution was performed and the eluate was tested against the 10 cell panel in tube and it was totally negative. Being curious and knowing that other Echo users have validated eluates on their Echo's it was decided to run this patient's eluate on the Echo just to see if anything would come up. The result was a perfect Anti-Jk(a) reacting 2-3+.
  4. We changed ours to transfused within 3 WEEKS on the recommendation of our Immunohematology Reference Laboratory following the Technical Manual reference. However, in the case of a new ID'D Warm Autoimmune patient who is going to likely be a frequent flier we will do an elution prior to transfusion just to get a baseline to compare to if necessary after the patient is transfused.
  5. When do you perform an elution? (e.g. all positive DATs, all positive DATS within 3 months of transfusion, IgG positive only) DAT POS IgG and patient has been transfused in the previous 3 weeks. Will do for a baseline on a patient that has not been transfused but is going to be frequently transfused going forward i.e. Heme/Onc patient What method is utilized for the elution? Immucor ELU KIT II (cold acid) What method is utilized for testing the eluate? Testing performed in tube How is the eluate tested? (e.g. screening cells, full panel, specially selected cells) We run the last wash against screen cells to ensure the wash process was adequate. We run the eluate against a 10 cell panel initially and then if necessary, selected cells Feel free to mention any special notes/criteria for which I may not have though to ask. Thinking about performing validation to run the eluate on the Echo.
  6. At our lab, equivocal (?) reactions on the Echo are visually interpreted by the tech. As I tell the techs when training them .... just as a one tech would ask another tech to look at a reaction they are unsure of in tube or gel testing, the Echo will ask for a tech to look at result it is unsure of (equivocal '?' reaction). If they have not done so already, Immucor can provide you with pictures of equivocal reactions and what other 'experienced' facilities interpreted them as along with the rationale. This is in addition to the regular grading examples that they supply. The techs at our lab found these pictures very helpful when they first started on the Echos.
  7. We do not do lot to lot comparison on blood typing antibody screen or antibody identification reagents. These are FDA licensed reagents and had to be approved by the FDA prior to release from the manufacturer. We have never gotten dinged by inspectors for not doing it.
  8. We add it either by ordering the patient antigen testing on the patient and resulting it there so that if files under the Antigen/Antibody tab. In our system we would then have to issue a credit for the typings that were not done in our lab i.e. performed by a Reference Lab so that the patient would not get double billed. OR The supervisor/tech specialist can add it directly to the Antigen/Antibody tab by using function Blood Administrative Data Entry. This allows you to add/delete/change information in the patient's BAD file at any time without an actual test order. It is restricted to those who have been given that level of access to prevent inadvertent or unauthorized changes.
  9. Interesting! We also currently have a patient with a high incidence, ours is anti-Lub. Scheduled for elective surgery that's low risk for bleeding. Just enough time for the patient to do autologous donation (only 1 unit though) which was our and our blood center's recommendation. Still has us on pins and needles that nothing goes wrong.
  10. I may be confused but it sounds like we are talking 2 different scenarios. If I am reading the original post correctly the poster is concerned about an POS Antibody Screen ID'd as Anti-D (titered to 8) identified in Gel but when performed on Echo the Antibody Screen is NEG. Later posts seem to be referring to Rh typing of patients with Anti-D4 and D5 missing Rh+ patients, typing them as Rh-. We have been running with Echos for about 18 months (before that we had a Galileo) and I have not see this similar scenario. Like the first response, we tend to see the opposite, ABSC Pos on Echo and not by backup. We used to use Gel as our backup method and we did have some antibodies identified by Echo that were negative in Gel. Usually these were Anti-Kidds or Duffys. I don't think I've ever seen a discrepancy with an Anti-D. How long between the pos results in Gel and the neg result on Echo. Was this a fresh sample or an old sample that had been saved for performing validation? If it was saved, how long and was it frozen? I'm sure all of the usual clerical errors were excluded i.e. the same specimen was used for both the Gel and Echo testing. For Gel, there were no identification errors between specimen and gel card. Was the Echo Antibody Screen performed using the primary specimen or was an aliquot removed an run on he instrument. If it was a specimen that was saved for validation, there was not a labeling error. When it was performed on the Echo there were no bubbles at the top of the specimen causing it to pipet incorrectly (when we first started running our Echos the techs had a couple of times where they forgot to check and then came up with unexpected results) . Also, does the patient history indicate any trauma or procedure that could have resulted in bleeding. Is it possible she received RhIg-D and doesn't equate that to "Rhogam"? I had a patient in the not too distant past with Anti-D identified in her plasma at 28 wks who was asked if she had "received Rhogam" and stated no. Upon further investigation we found out she had fallen a month or so earlier and received RhIg-D (Rhophylac) in the ED at another facility but either didn't remember (not sure if she didn't get the card or lost it) or did not equate that to Rhogam. This doesn't explain the negative on the Echo but might explain the positive in gel with no history.
  11. jayinsat "When they come to pick up the units, the Blood Product Request form we use must have the physicians signature." It seems like you have a two-step process, one electonic and one paper. I like the electronic part where the order gets entered and must be acknowledged. How long do they have to acknowledge the order? Is it easy to find when an inspector wants to see your process? If they are having to sign the request form before they come to pick up the units then doesn't this duplicate the electronic order? What happens to the signed Blood Product Request form? Do you save it? Our physician and nursing staff want to get away from having to sign any hard copy/papers at all. They think it should be done as part of the electronic medical record (EMR). The problem is getting something that they (physician) can do quickly at the time or more likely something that can done retroactively once the crisis is past. What I want is something that is consistent so that it shows up in one place in the EMR so that when an inspector wants to see the authorization we don't have to look to see where the physician put their "signature".
  12. Has anyone set up a system where the physician documentation authorizing use of uncrossmatched blood is done via the electronic medical record instead of on paper? If yes: is done as part of the blood order, or as a specific physician patient care note or do you have another process? We currently send a form with the uncrossmatched units and the physician needs to sign and return at some point in time (does not need to be done prior to transfusion). When ordering uncrossmatched blood, sometimes an order is placed in the hospital system for units with special order, uncrossmatched. Sometimes it's placed in the hospital system with no special order but blood bank receives a "verbal" to send the blood uncrossmatced. Sometimes it is picked up as part of a trauma activation prior to the patient even being physically in the hospital or identified/registered. We currently use Epic as our hospital information system but have Sunquest as our lab/blood bank information system so feedback pertaining to these systems would be especially helpful but information from any system would be welcome. Thanks in advance for any input you can give.
  13. jalomahe

    Echo Problem

    But remember when you compare two totally different methods you are going to have discrepancies (Not all methods will detect all antibodies all of the time). While we would like to have 100% correlation, that's not going to happen. Would you be equally concerned if Echo detected the Jka but PeG "missed" it?
  14. jalomahe

    Echo Problem

    I don't know if this will help any of you with these reactions or not..... We have 2 Echos and recently saw an increase in non-sensical reactions on one of the Echos. I did all of the things you normally think of as in cleaning the wash manifold etc but then I checked one other thing. The probe rinse tower. Move the probe off to the right so it is out of the way. Remove the cover from the top of the rinse tower. It's held on by one screw in the back left corner. This is a captured screw so no need to worry about dropping or losing it. When I did this I discovered that there was all manner of "gunk" in the overflow area around the white shallow rinse cup. Enough that it was managing to intermittently get back into the white cup and, I'm assuming, contaminating the probe. After I thoroughly cleaned the tower with RelyOn I did probe rinse and then ran known true positive and true negative specimens and got the expected results. Repeated a couple of the specimens that had problems and they were negative. We have not had a problem with non-specific reactions on this instrument since (it has been about a week). This instrument had just undergone monthly PM less than 48 hours before I checked the probe rinse tower. Obviously the monthly PM does not seem to address this problem in the rinse tower. We are now adding this cleaning of the rinse tower to our monthly PM.
  15. CAP COM.30450 Do you perform lot to lot verification on Fetal Bleed screening kits?
  16. We used Galileo previously and are using Echos currently. While the panel is running on the Echo perform a DAT in tube. Our feeling, if the auto is positive, what's the next step to investigate? Do a DAT. So we just skip the auto step.
  17. Have you talked to Immucor about this patient? If you have specimen available there's a good chance they would investigate this for you. We recently had a patient, Rh negative who shows a perfect anti-c on the Echo (multiple specimens from different draw dates and multiple panels). When we contacted Tech Support they had us send specimens to investigate including, if necessary, molecular genotyping all at their expense. You are not going to get quick turn around but may give you some anwers down the line.
  18. The suspicion is that the patient might be a c variant, again this would be very rare. The results we are seeing repeat consistently with multiple specimens drawn on different days. We have contacted Immucor and are sending them specimens to investigate.
  19. Has anyone else come across this scenario? Pt is 74 y.o. caucasian female. Pt has been pregnant but has no history of blood transfusion. Dx: Colon tumor Echo Ready ID and Extend I show perfect Anti-c reacting 2-3+. DAT on Echo is negative. Patient is AB Negative C-c+E-e+. Testing repeated with PeG and all cells negative except 1 cell that Immucor identified as Dantu+. Repeat DAT in tube also negative poly, IgG and C3d. Since Anti-c in an Rh negative patient is exceedingly rare the specimen sent to Reference Lab and they report Rouleaux (we did not obseve this in our tube testing) and "Unidentified antibody to low frequency antigen" detected by both PeG and Gel. Tech asked and their cell(s) were not Dantu+. We went back and checked using new specimen and had similar results. We performed crossmatch on Echo using 2 AB- c+ donor units and both units were compatible. I understand seeing non specific reactions or all cells reactive on Echo due to method specific issues but does anyone have any thoughts on why we would see such a clear-cut Anti-c on Echo panels but not demonstrable by other methods?
  20. The ER doc has a patient bleeding profusely so he clicks a button in the computer and voila, blood will magically appear at the patient bedside. This might be fine for non-emergent cases but what about the patient that needs blood right now? How is the blood bank notified of this order? Does it pop up on a screen somewhere? audio alert? print on paper? Wherever/however the notification occurs is there someone present 24/7 to take immediate action? We are a 400+ bed hospital with a level 3 trauma ED. When blood orders are entered in the computer a copy of the order prints in the blood bank HOWEVER there is not always someone in the blood bank to see that printout, especially on off-shifts where techs cover multiple departments. For that reason ANY time there is an emergent need for blood/components whether ED or inpatient, the blood bank must be notified by phone because: 1-we have an open concept lab and there is always someone in earshot of the phone and 2-it gives the tech an opportunity to ask for clarification of needs i.e. your ordering 4 uncrossmatched O- pRBCs? Do you want FFP to go with that? You'd be surprised how many times the call for uncrossmatched pRBCs ends up being more components when blood bank asks the questions and how many times we have been able to anticipate additional need for product or staff (pt is being moved to OR for leaking AAA) because we asked the right questions. The ONLY exception to the call rule is when there is a Trauma patient brought in by squad, then the blood bank is alerted by a text pager (audible throughout the lab) with information about the type of trauma and patient conditions as observed by medics i.e. male, mvc, +loc, gcs 10, multi fx bilat legs. In these cases we immediately prepare a trauma cooler with 2 O- pRBCs for pickup by the ED runner. Any additional blood/components require again require a phone call. So in the long run, what may seem like an easy fix to the ED director may not be the best fix for patient care. If the ED director/staff has no idea of your lab layout and your processes then it might be a good time to invite them down for a visit and for everyone to go over how the process works from the time the patient arrives to the time the blood they requested gets to the patient. This is what we did when we started Trauma services and it can be eye opening for everyone.
  21. Thank you all and I agree that for transfusion purposes it may be a "moot point" when there are procedures in place for the blood bank staff to set up antigen negative units for all current and previously identified antibodies. MDs are perhaps not concerned because they know when it comes to transfusing the patient the blood bank will have their backs. My other concern is with the prenatal patients. Antibody Screen Negative but previously id'd antibody. If you add a note/comment indicating this history, do you include in this note any comment as to whether patient should be monitered for HDFN? Do you handle it as a "critical call" and document notification of the MD? I worry that even with the previous history comment that it doesn't click with the OB that this is an issue and instead just focuses on the "Antibody Screen Negative" result.
  22. When resulting antibody screen or antibody identification, how do you result antibodies previously identified but that are no longer at detectable levels? Do you add chartable comment to the effect that there patient has history of antibody? Do you include any comment such as a transfusion recommendation or, in the case of pregnancy, recommendation for repeat testing or ... ? Example 1: Prenatal patient has previously identified Anti-E but now the antibody screen is negative? Example 2: Pre-surgical patient has previously identified Anti-C and Anti-K but current antibody identification shows only the Anti-C. Blood bank of course honors both the C and K and provides C-, K- units but how would you report the undetectable K at this point (or do you)?
  23. Currently using Sunquest 7.1 with an old PrinTek 8600 series dot matrix printer for printing the blood unit tag. It is big and it is noisy and is starting to require repairs on a frequent basis......Just wondering what printers other Sunquest users are using? Hopefully I can find something smaller/quieter? I would really like to switch to a laser printer but I've been told that it can't be done.
  24. We do the same as BBCLS, exact volumes for neonates, default volume for adults. Most of the time the units are being given through IV pumps that track the actual volume given, granted it is total volume of blood plus saline but the nurse is still documenting fluid volumes which is what they really want to know for I&O
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