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Posts posted by jayinsat
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Just make sure that you can still have a high speed internet connection to Immucor for your remote diagnostics. HCA Meditech (not the same as Meditech controlled directly from Meditech) has been fussy in the past about allowing any connections like that on a instrument that interfaces to their system. They wanted us to only have a dial-up connection and the remote diagnostics will not work with that slow of a connection.
Our system is an HCA partnership. This has been the most frustrating thing! :mad:
I don't understand why our Chemistry department with their Seimens analyzers can have network access but Immucor can't.
The dial up connection does not work. -
Hi Everyone,
Just have a question about Echo interface... BB lead tech before me did not want to interface our Echo for fear of techs just accepting what the Echo said without really looking at the results. She put it off for 3 years. Our IT guy thinks he heard stories of things not crossing correctly from Echos??? Now my director wants me to get this up and going. What is your experience with your Echo interface?
Thanks in advance for your help,
Jackie BS MLS (ASCP)
My hospital system, with 5 campuses, has a total of 9 ECHO's all interfaced with MEDITECH 5.6.4. It works flawlessly. Only GROUP/SCREEN AND DAT requisitions upload to the ECHO and only GROUP and CONFIRM testing export to MEDITECH. This is because of how our SCREENS are set up in MEDITECH. The reactions for the antibody screens are resulted as a sub screen and it would have required us to build all new tests, etc to make that work, or something like that.
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Oh James you will give me nightmares talking about in-vivo crossmatches....
Tell me about it! I had to splash cold water on my face after typing that.
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In the states we typically do as your reference lab suggested and give phenotypically matched PRBC's. We normally DO NOT send the original sample we discovered the reactions with. I highly suggest you redraw and send new samples so you have something left to use.
We perform our crossmatches on the screened units and label them "Least Incompatible". The physician is required to sign an emergency release form acknowledging that the units are phynotypically matched/least incompatible. We have done this many times without incident.
At one facility I worked, we performed In-Vivo crossmatches. This is where you give a 10cc aliquot of the unit and measure pre/post haptoglobin levels.
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This is from the Rhophylac insert:
"Rhophylac can contain antibodies to other Rh antigens (e.g., anti-C antibodies), which
might be detected by sensitive serological tests following administration".
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This is from the Winrho package insert:
"After administration of WinRho® SDF, a transitory increase of various passively transferred antibodies in the patient’s blood may yield positive serological testing results, with the potential for misleading interpretation. Passive transmission of antibodies to erythrocyte antigens (e.g., A, B, C and E) and other blood group antibodies [for example, anti Duffy, anti Kidd (anti JKa) antibodies]5 may cause a positive direct or indirect (Coombs’) test."
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I have seen actual cases (or journal articles-too long ago to remember when/where) where Rhogam, Rhopylac and WinRho have contained Anti-C. I believe the package inserts of all three state that they can contain C,D and/or E.
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Unfortunately, I think these are common issues in hospital blood banks of your size. My situation mirrors yours ALMOST EXACTLY! We have the same issues. I'm not in charge but am the one responsible for most of the work and the one who catches all the errors. Communication is a huge problem. Doesn't seem how many notes I post, messages I send or people I talk to, the problems persist. Real continuing education is resisted by my superiors, therefore, training is always wanting.
If I had your authority, I'd handle it the same way, but I would implement a mandatory monthly proficiency exercise that focuses on the prevalent problems.
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I'll leave this to my friends and colleagues in North America, as I am not certain at what level the SBB is pitched. Is it BSc, MSc, PhD, or something else?
Once I know this, I'll try to suggest a few things.
SBB can be achieved at the Bachelors level by challenging the exam from ASCP (American Society of Clinical Pathologist). Any registered Technologist having met the time in service requirement can challenge the exam. Alternatively, a registered Technologist may complete a SBB program offered at a University that MAY lead to a Masters degree. Some regional donor centers and Universities partner and offer a program that prepares the Technologist to challenge the SBB exam without conferring the degree.
Hope that clarifies.
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Your electronic crossmatch is essentially a computerized ABO check.
Understood. But the situation presented by the O.P. would be missed by the electronic crossmatch.
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GEL and Solid phase (ECHO) crossmatchs are designed to detect IgG AHG inompatibilty, not ABO incompatibility.
For sites that only do Electronic Crossmatches, how do you address this possibility of ABO incompatibility?
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I always seem to miss a few when swiping. Going left to right is even worse.
It's slow here on christmas eve. :tongue: Merry Christmas.
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Hello everyone,
My name is James and I am a smash-the-lights-aholic. It's been 10 seconds...oops...1 second since my last destructive light episode. I can't seem to stop myself. I refresh the screen multiple times/shift just to pop those little buggers. If only the filled the entire screen.
Anyway, Merry Christmas
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This made my brain hurt and gave me nightmares of Chemistry and College Algebra.
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The issue with performing PEG or manual testing is that the comparison is not "apples to apples". Time and time again, the ECHO has proven to be a much more sensitive method versus other methods. The problem with the "three" panels available is that you are limited to IMMUCOR's selection. To match the automation's sensitivity, I chose selected wet cells and perform a crossmatch using the automation.
Ah! Now I understand.:ohmygod:At first I was like: "what is this guy talking about?"
That's an awesome way to run select cells on the ECHO to help i.d. antibodies without wasting a bunch of plasma doing full panels. I don't know how often I'd use this technique though as it is easier to do in Gel or tube as backup.
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Remember ABO antibodies are primarily IgM. The ECHO crossmatch is IgG and CAN miss IgM incombatilbity. This is why the results upon completion state:"IgG Comp (Check ABO Comp). Your installation Tech/Trainer should have explained this to your super users. When we validated our ECHO, we experienced this as well. It is the Techs responsiblity to ensure the units placed on the instrument are ABO compatible.
Hope that helps.
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Thats another problem.. The unit was mis labelled as B+. On rechecking the group it was found to be A+
And yes the grouping was done from segment attched to blood bag.
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No didn do an immediate spin. No H/O bone marrow transplant.
And QC of machine and reagents was done
This is the problem. The automated methods are set up to detect IgG incompatibility, not ABO (IgM) incompatibility. That is why the immediate spin crossmatch is still important (unless you do Electronic crossmatch). However, the bigger issue of the mislabeled unit of blood scares me to death!
When we validated our ECHO, we had a crossmatch that was ABO incompatible test IgG AHG compatible on the analyzer. I don't believe this is wholly uncommon. That is why you must select compatible groups to perform crossmatches on automation. The ECHO actually reports "SEROLOGICALLY COMPATIBLE: VERIFY ABO COMPATIBILITY".
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Doggonit! I haven't had this problem in quite a while. I read this thread yesterday and guess what? Came in this morning to a wasted unit because the nurse lost I.V. access and couldn't get it restarted. Thanks for the jinx!
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I have a new echo and have had this same problem. By looking at the picture of the individual well, there appear to be cells still present causing the false positive reaction. When we had install we were told to take the qc from the fridge and allow to warm to room temp, then spin, that is when I had the problem. If I remove from the fridge and mix them by inversion 3-4 times then spin them (cold) for 5 minutes I do not have qc failures. Also, I was told to store them laying flat every night, there again I have found that storing them in a rack standing up then mixing them just prior to centrifugation helps.
They told us to do that after we were having issues with one particular lot of WBCORQC. A week later they issued a product recall on that lot. It didn't help one bit! Other than that bad lot our issue has always led back to contaminated reagents due to splashing.
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I had the same issue. It turned out my Anti-A was contaminated. I performed postive and negative controls on the in use bottle of Anti-A, in tube, and got weak 1+ reactions. My guess is that someone removing the reagent rack was too aggresive, causing splashing of the Anti-B into the Anti-A. My off-shift techs are real bad about "yanking" racks of and catching that guard, causing splashing.
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I use the BBK History Backup Status routine to monitor patient history backup. We have it configured to back up to two different PCs in the Blood Bank. These PCs are always powered-on.
I backup our files to my pc and upload it as a .txt doc to our lab portal on our intranet. That way it's on an offsite server and accessible from any network terminal by any authorized user.
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My IS person is not here to double check but I can't find this on my screen. Could this be a custom report?
It is a custom report for us.
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It could be. My lab LIS coordinator is also off. I'll try to remember to check with her next week.
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Effective November 1, 2012. But the 27th edition states the same: Pooled in an open system: 4 hours
16th Edition is the highest I have. I guess my powers-that-be don't see the necessity in keeping up to date since we are not AABB accreditied.
The dial up connection does not work.
Echo interface
in Equipment
Posted
This has not worked for us! HCA continues to balk at our attempts to get IMMUCOR a high-speed connection. :mad: