jalomahe

We do our cord bloods DATs by on the Immucor Galileo (Capture solid-phase). We are switching to Immucor Echos (Capture solid phase also) in the next month or so and will move them to Echos at that time. This might be a silly question but what reagent you using for your tube methodology, anti AHG or anti IgG. I only ask because it was an issue here at the beginning because the Galileo DAT is an IgG method and the techs would occassionally, mistakenly use anti AHG in the tube and end up having a discrepancy in the results. We have since corrected this issue and now our results correlate quite well.

Thanks to all who have responded to this post. The information is invaluable. My query was based on a request from my new lab director who thought this was relevent data we should be collecting. Her background in blood banking unfortunately is little to none. Although I have tried to explain blood bank concepts....no one method....sensitivity vs specificity....and just because it's not identifiable (at the time) doesn't mean that there's nothing there.... the director wanted to hear what others are doing. Basically I was hoping for exactly the responses I received, that this is not a good way to spend time and effort. So thank you all for giving me the ammunition to shoot down this project.

We want to track our "FALSE POSITIVE" antibody screen rate as part of our QA Statistics. Currently our definition is the Antibody Screen is POSITIVE but the Antibody Identification shows no specificity or is negative. Does anyone else track this data? If so....... What is your definition of false positive? What antibody screen/antibody id methodology are you using? What type of percentages are you seeing? I'd like to come up with a benchmark to use for management as to when we are statistically too high. With just three months data we currently show an average of 1.0% that fit the above criteria. Thanks for your input.

For anyone out there with electronic charting -- how are you handling documentation of uncrossmatched blood? We still issue our uncrossmatched units with a hard copy form for the MD to sign. The form is supposed to be scanned into the patients electronic chart and the hard copy returned to us. Unfortunately the scanning rarely occurs so then there is no documentation in the chart and the return of the hard copy is not 100% which then takes time to track it down. Our LIS receives orders and sends results to the HIS but other than that we have no access to the HIS for entering or scanning information.

We have both OB and trauma services and we perform KB stains for other facilities. We do about 4-6 KB stains a month. The test can be ordered STAT with a TAT of 2 hours. KB stains are usually a test that is not ordered off the cuff....If docs are ordering it they are interested in the results and do look at the results. The results do influence their clinical decision making. Their clinical decision may be no additional intervention is required (Negative KB); monitor fetus and mom (Postive KB indicating low volume of fetal blood) with repeat of KB stain after several hours to see if there is a change; to intervene in the pregnancy up to and including delivery of the baby. Additionally we have performed KB stains to investigate why an infant is born with a low Hct when there is no overt signs of bleeding in the infant. Recently we had a full term infant born with a Hct of 20. Both pre and post delivery specimens from the mom showed a high volume of fetal blood in the mother's circulation. The conclusion from the neonatologist was that there had been an ongoing fetal-maternal transfusion occurring.

Does anyone know of an alternate vendor for Thermogenesis Plasma Thawer POCKETS? Thanks Jan

What CPT code would be used to bill a patient for RBC Antigen Typing by DNA Analysis i.e. BioArray?

I've been doing my correlations and I've only had the one lot number kit but so far I think the reactions are easy to read. My POS control is consistently strong with multiple (5-10) agglutinates PER FIELD.

The usual reason.....push from upper management for cost savings. Our phlebotomy staff evaluated Greiner blood collection products 2 yrs ago and were sufficiently dissatisfied so that the process did not even make it to the testing area. Now the push is on again.

We currently use BD EDTA tubes in our transfusion service and are considering switch to Greiner tubes. Just wondering if anyone has experienced any positives/negatives with one manufacturer's tube over the other whether it be in manual testing or with automation.

Sunquest users.... We are currently using PrintTek 850 printers to print the crossmatched unit labels. They are big and noisy and I'd really like to get rid of them. I was wondering if anyone has found any other printers to use for this SQ function? Ideally I would love a ribbonless printer like we use to print specimen labels because I would eventually like to add the patient id barcode to the labe but I've been told by our LIS manager that the unit labels/label printer are "special" and thats why we're stuck with the PrintTek:confused: or I'm wondering if its just about $$ which comes out of the LIS budget. We are preparing to upgrade to SQ v7.1 so maybe there's more/better options for this version? Thanks Jan

When patients are admitted to your facility does nursing ask/chart answers to questions about previous transfusions, antibodies, transfusion reactions, etc as part of the medical history? What about if the physician orders transfusion are questions asked/charted then? Possibly as part of the order? Maybe as part of consent? Reason for question. Recently had patient with multiple antibodies identified by another facility 10 yrs ago. Only one of the antibodies was still detectable. Patient was transfused, had a strong delayed tranfusion reaction requiring readmission. Found out while doing transfusion reaction workup patient had an "Antibodies Present" card from the former facility. Just trying to figure out a way to lessen the possibility of a repeat error. For all I know this has happened before and we didn't have a problem because the antibodies were still detectable. Thanks for your input. Jan

Tony-- You need to request the free validation kit. If you have not received the request info from your Business Manager contact them or contact Immucor Customer Service directly and they will help you. I'm not sure how your facility is set up but at mine it frequently happens that this type of info ends up going to the purchasing department and not directly to me. Purchasing then forgets to tell me about the new stuff . If you haven't signed up with Immucor for electronic notifications I highly recommend it, that way you are much less likely to miss new/important information that they are sending out. You can sign up on their website.

I just received an email from my Immucor Business Manager with instsructions for how to create appropriate postive specimens. The document is titled FMH Conversion Protocol. Evidently they have been receiving a lot requests for guidance from their customers. If you have not received this you should contact your Immucor Business Manager.

We have the result patterns set up in our BB LIS to not allow an interpretaion of AB+ unless the D control is resulted as negative. This has stopped our generalists on several occassions from not doing the D control when appropriate. The bulk of our work is done on the Galileo and it automatically runs D control. So we only had to worry about those times the testing was being performed manually i.e. traumas or when the analyzer down for PM

Make sure you are looking at the correct CAP survey. I'm thinking you are looking at the J survey which is not the one used for automated testing. The most recent (2012) JAT (Transfusion Medicine Automated Testing) survey had the following number of participants. Ortho ProVue = 524 Immucor Galileo = 106 Immucor Echo = 466 Immucor Neo = 21 Biotest Tango = 62 So in essence thats 524 Gel; and 593 Capture Solid Phase; and 62 Solid Phase. Originally JAT only had participants report ABORh and Antibody Detection. In 2011 they upped it to include Antibody Identification. This year they also have included Compatibility Testing. If you can get your hands on copies of the Participant Summary, especially over the past couple of years, it can give you a bit of an overview of how the various analyzers are doing. Wastage with solid phase automated analyzers can be an issue especially if you run low volumes however as stated by others it can be managed by using routines to pair up with STATs so you are leaving empty wells on your strips. But, don't forget to figure in all of the other consumables you won't be using with i.e. tubes, pipets, etc PLUS your valuable hands on tech time between the various methodologies whether manual or automated and whether that offsets the wastage issue.

We are a level 3 trauma center but we do get our fair share of "Does". Our admitting registration of a Doe patient is the same as yours. When they come in they have they are assigned a medical record number along with the Doe name. Obviously there is no point on doing a history check at this point since we know that a) the MRN is new and the Doe name is not the patient's real name. Once the patient is identified by registration (anywhere from a few minutes to several hours later depending on the situation) the blood bank staff performs a history check on the patients actual name. If a significant history of an antibody is found as in your case we immediately notify the physician caring for the patient at that time and our medical director of the situation. With any luck, if the patient was bleeding profusely, they'll have bled out most of any antigen positive units that were given and we can "fill them up" with antigen negative units as they get the bleeding is under control. Once we have identified a that we have multiple MRNs on a patient with previous blood bank histories on file, our LIS (Sunquest) allows us to "link" the MRNs together so that the information is available to the blood bank staff from that point forward no matter which MRN is being used.

At our institution, once a patient is deceased, we keep the record based on the state's statute of limitation for filing of a medical malpractice lawsuit. So check with your legal department and see what they say.

Our nursing service currently use a paper Transfusion Record (their form although the Transfusion Service/Med Director give input whenever it is up for review). On the record it gives the intervals for recording vitals. Pre-infusion; 5 min, 15 min, 1 hour, 2 hour, 3 hour, and then Post-infusion. There are also questions they need to answer post-infusion "Infusion completed? Yes No" and "Did patient display symptoms of possible reaction? Yes No. If yes, Transfusion Reaction form initiated Yes No. Name of MD notified: _____________" This is a 2 part form so one copy goes for the chart the other goes to the unit's QA nurse for review. Periodically our hospital's Blood Management Co-ordinator (also and RN) will do an audit of the forms also. We are currently in the process of moving to a new/improved HIS that will allow this information to be documented electronically. The plan is for the information currently on the form will be duplicated in the electronic version.

How do you handle incompatible crossmatches due to the patient having a Warm Auto (work up performed by reference lab so you only have neat plasma to do the xm with) or a HTLA? How do you report the crossmatch interpretation? Do you make any special notification to the MD? Do you require the MD to sign a form stating they understand that the blood is incompatible? Thanks for any and all input.

Did you check the patient's medication history. Is there any chance that the patient was started on any immuno-suppressive drugs between the two specimens?

You can find the information you are looking for: IFU's, MSDS's, COA's, Master Lists etc by logging into Immucor.com and clicking on Users Group and then File Downloads.

Our lab is having a discussion concerning what constitutes a SUBSTANTIAL/SIGNIFICANT change to a policy or procedure that would then require the director to review and approve the change. If you have defined these terms for your lab would you be willing to share. Are your definitions included in a procedure concerning document control. I've seen several document control procedures on various websites that mention the terms but no where do I see the terms actually defined. Thanks for your help

now that the Galileo Neo is FDA approved I was wondering if anyone has started looking at it? If so what platform are you currently running on and why are you looking at Neo. Also has anyone seen any comparison studies on it yet (compared to Provue Tango Galileo manual methods etc)? Just trying to keep up with the times.

We are all familiar with detecting passively acquired anti-D due to RhIg administration. But as methods become more sensitive, has anyone experienced detecting other Rh antibodies in patients who have received RhIg? How would you know if it was passively acquired or an antibody being actively produced by the patient? How would you explain it to the physician if the patient had an anti-E at the end of her last pregnancy but then never has it during the current pregnancy? Anyone using TANGO, Galileo, Echo ever experience this?