jlemmons

If you are using the ProVue, check with your Transfusion Technical Specialist (if you don't know who this is, ask your sales person, they'll let you know) about changing the way your menu is configured. When we first got our first of three ProVues, they configured them differently than they do now and the new way is meant to make your TAT better.

They will be at AABB in San Diego. The program is absolutely awesome for searching for cells to rule out. They've made some great improvements in it too.

I have worked with Ortho folk for several years and they work very hard at making sure problems are addressed. I assume that other companies do the same. I do know that the issue with Screen Cell II seems to be a problem with leaving the red cells out in the light and at room temp. If they are placed in a container in the refrigerator when not in use, there are less problems seen. And yes, I work for Ortho but am very new to the company. I speak as a customer not as an employee. It is very interesting to see both sides of the issue and try to work through the problems for the sake of the patients. End of soap box.

If you will rim your cord bloods to remove all of the clots (the nursing staff put them in there on purpose, you know ), then you do not have to wash them. We rim them until we find no more clots, then spin them so we have packed cells , place on the ProVue for an ABO and control (No back type obviously) and DAT IGG. With the new softward Ortho has just put in, there is a clot detection device in the software that will not run (and thus clog up) your ProVue if you have missed a clot. It works great on our cord bloods.

One time in our lab our ProVue was having problems and we were waiting for service and so were using the manual gel workstation and the belt broke on the manual gel centrifuge. We all looked at each other in horror and said" We have to go back to tube for everything now?" Luckily our Ortho person had a demo centrifuge he could loan us until we got the belt in. It was a very interesting thought process after so many years of using gel.

We found that if we kept out screening cells out at room temperature all day or on the ProVue all day, we got more of the Cell II positive issue. We have tried switching them out every 4-8 hours and that seems to have cut down on the problem. The cells seem to like the cold and the dark more than light and warm. (Maybe they were born in Alaska) Just a thought to try.

There is also the thought that washing the red cells with warm saline will keep the rouleaux away (is that like keeping the rabbits out of your garden?). I've tried it and it does work.

I found this an interesting subject. A sister hospital to the one I used to work for did a study using the Echo, the Tango and the ProVue. There were pros and cons to each but overall the ProVue and the Tango actually showed the best sensitivity and specificity. However, recently there has been a carry over issue with the Tango and some people are questioning whether the Tango is really a good machine for their lab. While the ProVue has on occasion missed an antibody, they tend to be very weak and found only on homozygous cell lines. I've worked with the ProVue for about 6 years, at least, and have really liked it. Ortho is also upgrading software on the machines and showing customers how to decrease TAT with a change in the way the menu is set up. I've not really worked with the Echo but I have taught the theory of solid phase in MLT classes. I've also read at least one study that shows problems with the solid phase method. So I guess it comes down to what will work best for you and your lab. I have also heard that there will be some interesting things to see at AABB in the vendor section this year if you are going. Not my year to go though so I just get to hear about it. Good luck with your decision making.

AntibodyCheck is a very useful product. I know the developers and they are working on some enhancements to the program. They will be at AABB in San Diego in October 2011 and you can easily check out the new enhancements. Or go to the web site and ask about the product. Very much worth the time and money spent in the time savings for your techs.

Has anyone wondered how to report a transfusion reaction if you have multiple products hanging? I've always wondered about that.

I would probably check something like this with poly AHG reagents as I have seen Anti-Jka that does not react in anything except poly. That could definitely hide and also cause a hemolytic reaction.

We actually have three ProVues in our lab that use the gel technology. Most of the time, everything is negative and the type and screen are out the door. Occasionally, we will get something strange and will run a gel panel and end up using LISS and PEG and Ficin and everything else known to Blood Bankers to determine the antibodies. We also have been known to get what we call a "gel" antibody, where some patients just react with the gel and nothing else is positive. We back up to tube on these patients and AHG crossmatch units to be double sure there is nothing there.

I'm curious if any of the audits include units that were given in surgery. Our forms that we receive from the floor after a transfusion has been given is supposed to be filled out completely with time, date, who verified, etc. but the ones from surgery come back with "See anesthesia record". Does any other place accept this as appropriate? We don't like it but haven't gotten anywhere in changing it.

We have run into this problem when testing was done at a laboratory that does all of their typing by tube. We have found that the Provue is more sensitive in this area and we will get a D positive when the other laboratory did tube typing without doing weak D testing (because it is not required) and we get to explain that the patient is really D positive and does not need RhIg. We do give the RhIg if the physician is insistent on it.

We had a situation where the nursing staff were misidentifying patients on an ongoing basis and nursing would not do anything about it. One of our techs reported it to CAP and I can tell you that our senior people were very unhappy. They were required to show documentation about the situation. CAP is probably your best bet and/or JCAHO. Both of these agencies take these types of errors very serioiusly.

There is a program that helps with rule outs called Antibody Check. It only rules out by homozygous cells and has a component in the program that allows for help in finding select cells. This might be something you would want to look into. I believe you can just go to www.antibodycheck.com and you will find them and they have examples on their web site. I would never rule out anti-M, anti-N, anti-Jka, anti-Jkb, anti-Fya or anti- Fyb with just heterozygous cells. I have actually also seen an anti-K that showed dosage like these previous ones that I have mentioned so I tend to be careful with just heterozygous. Given a choice, I like to have 2 or 3 homozygous to completely rule out an antibody but many times that is a pipe dream and not available. We are blood bankers and must use our knowledge and skill to make these decisions as to how to rule out but there must also be the rules in place that you are trying to make. Our facility actually uses 1 homozygous or 2 heterozygous with the exception of the above antibodies. Those must have homozygous only. Hope this helps.

We were told that as long as the plasma and the cells were in contact, it did not matter if there was or was not contact between the plasma/cells and the gel.

We use O positive pooled patients who have a negative antibody screen. We set up two tubes, one with Anti-D added and the other without anti-D added. We test both our IgG and IgG/C3d cards against this.

We only do weak D testing on Rh negative babies of Rh negative moms. And we actually do it on the Provue using Anti-D as the serum and the cord blood as the cells and performing an AHG crossmatch. I believe that AABB only actually requires Weak D testing on Rh negative units after they are drawn from the donor. We have had a fair number of moms who test at another lab, who use only tube typing, come to us for delivery and when we test them on the Provue, they test as Rh positive. We will tube type them and weak D test them and they have always tube typed as Rh neg Weak D positive. Now explaining to the doctors why we are calling the patient they know as Rh negative Rh positive is an interesting experience.

Sometimes women will be pregnant and not know it, then they miscarry and just think that they are having a heavier period. I've seen this several times at our hospital. They then will develop the Anti-D. And yes, it is possible for women to be pregnant and not know it.

On another posting here I have been hearing about problems to the patients when more than one vial of Rhophylac is given when the patient has a large fetal blood. Do you about any thing like this happening? We were given no input as to a change from Rhogam to Rhophylac and are concerned that this change should not have happened without further input. Thanks for your help.

We were switched to Rhophylac by our pharmacy without any input from us. We are gathering information regarding problems because of the lack of request for info from us. We are very concerned about the problems mentioned here. I too have noticed that there is nothing in their information regarding these problems. Any help along these lines would be appreciated.

Actually, Jean, you know how unstable us supervisors in blood bank are (do I really qualify?)

For years we said that they would renovate out Blood Bank "when pigs fly". Well, an AABB inspector gave us a phase 2 deficiency for space and we have just finished the renovation. We have hung a flying pig in our blood bank!

One of my first jobs taught me "if you have time to lean, you have time to clean."