SandyR

Audrey - We also were doing ab screens in gel and ABDs in tube until now (ABD in gel was not available when we started) and when you do not learn these together it does seem cumbersome. (I felt your pain.) Too many variables or something. We did validate using saline as our diluent instead of adding yet another reagent so that helped a little. We are only calling 3+ & 4+ reactions for D as positive on routine patients and any reaction positive for cord bloods. That will more closely parallel our tube testing where we only did weak D testing on cord bloods. We're using John Judd from the University of Michigan as our reference. He's written and spoken on the D issue many times.

We have several hospitals and one blood center currently reviewing our audit policies. Thank you so much

I would love to use a proprietary Rh control but I don't see that Ortho offers one for their BioClone Anti-D tube test. If I'm missing something please let me know

Thanks for all the input - very informative. Sandyr

What type of labels are available for facilities interested in having the product tag adhere to the product bag? What about printers for these tags? If you are using stick on product tags now do you like them? Any input would be appreciated. We're considering changing our current tags to something that sticks on the units. Thanks, SandyR

Do you dilute your own 6% albumin or can you buy this product? Thanks

Could anyone share what they use as an Rh control when doing tube testing? We only incorporate an Rh control when we have an AB person. Thank you

Could someone please tell me what SIDAT stands for? It appeared in the antibody investigation procedure that was so kindly posted last year. Thanks

For anyone going to AABB in Miami in October, Wyndgate always has a really nice area at TXPO. Prospective customers can test drive whatever product they are looking at and current customers can chat with high level Wyndgate people who can offer solutions or look at implementing ideas. I don't know about the demo. We went live in April, 2003. When we purchased SafeTrace we had an intense training period as part of the deal. We opted for onsite training and our trainer was excellent. We've had awesome tech support ever since. Our purchase price would probably be considered proprietary at my establishment but there are multiple levels of involvement each with its own price. So, you would have to decide what you would need the Wyndgate people to do and what you could handle with your own IT people. Bottom line the price is pretty customized.

We use SafeTrace TX and love it. We were never computerized in blood bank and with SafeTrace being windows based (as was our homegrown LIS system) the transition was easy. Anyone that could work a computer at home could feel comfortable with it. It's parent company is Wyndgate out of California. There is a QC module so you can record QC but at this time it doesn't function as a check - that's for future versions..... There also is a donor side to this (SafeTrace) so if you also are a donor center you could track vein to vein (sort of Wyndgate's motto). Good luck!

We just had a JCAHO inspector who did have an issue with this but only verbalized it. Our solution, which was acceptable to the inspector, was to keep the blood products on the top shelves and anything else on the lower shelves. Since blood bags are somewhat permeable this would ensure that if anything spilled before it froze it wouldn't contaminate any blood product.

We still have the Lui freeze procedure in our manual but haven't done one in probably 2 years. Our pediatricians don't particularly care for proof when they know there is an ABO discrepancy so they just treat the baby and don't order any follow-up to positive DATs. We talked about eliminating this test but it's pretty easy to do so we decided to keep it around since physicians seem to change their practices when any new journal article comes out recommending something. I'm surprised the cord blood wasn't positive but medicine is not an exact science so we'll always have those peculiar results around. Unfortunately I can't think of any articles that I've seen that touch on this. Hopefully someone else has. Sandy

We're currently evaluating a new blood supplier contract and would like some input on pricing. I realize many hospitals' blood supplier contracts are confidential but I'm just curious about price and location so no supplier or hospital would have to be named. I believe blood prices are much higher on either coast than in the midwest so if you are willing to share the price per leukoreduced RBC please include your area of the country so I have some context. Thanks for any help anyone can give. (We currently pay $181.00 for a LR RBC and we're in the midwest.)

We didn't really get into cold panels until we were using gel. The first 2 years we were using gel the antibody that we seemed to send to a reference lab the most was just anti-M. Now if we get a reaction pattern that doesn't fit anything we run a second panel in the refrigerator and compare results. It's easy and it's really helped ID anti-Ms and anti-Ps that were just mucking up the works.

Our problem is with the negative control often appearing too pink with some cells bordering on looking "postive". What made you think to use the MTS diluent instead of saline?

Is anyone else having problems with the Simmler Fetal Cell Stain kit? Are there other methods that forum readers like better? Thanks for any input

We have also seen positive reactions become negative when we've reused the card for another patient. When we first started with gel (1998) the Ortho trainers had said a respin was acceptable. Later they changed their tune so I'm guessing real antibodies had spun away. We didn't specifically track what we found because I believe it's been a mixed bag - both antibodies and rouleaux.

Thanks for the input. Since we're no longer doing weak D testing on moms we were looking at reflexing any positive fetal screen to a weak D test before moving on to a K-B. Are there many folks out there using flow cytometry? And if so what kind of instrumentation? Thanks again.

If the trend is away from Weak D testing on OBs so they are reported as Rh negative based on an immediate spin reaction, how are other facilities handling the fetal bleed screen after delivery? Thanks for any ideas.

We looked at Softbank 4 years ago and went with SafeTrace instead. At that time Softbank wasn't really "Windows" and they couldn't support a multiple site situation. I've heard they've improved. Good luck!

bbbirder - We did not test any of our patients with a LISS tube method. Our freshly diluted 3% to 0.8% selectogens picked up "something" and then a freshly diluted 3% to 0.8% panel or a PeG panel was needed to identify it because the prediluted 0.8% panel was either negative or weakly reactive. Conceding that not every technique picks up every antibody, we're talking about the same technique here - gel. Fresh dilutions work better than the current prediluted dilutions. The PeG tube method that we were able to run in parallel with some of our patients just verified our freshly diluted gel results. To help those considering the risks involved we found 8% of our workups were affected. Those facilities that use prediluted 0.8% screening cells will never see this anomaly.

As an addendum, 2 of our weakly reactive Anti-E's are now 4+ reactions. One patient received blood at another facility and came back to us for more. The other patient was given E positive blood, reacted, and after the hemoglobin dropped 3 days after surgery we could only identify the Anti-E with freshly diluted 0.8% cells. So these seem to be clinically significant. I'd also like to add that when the sensitivity studies were done in the early days of gel there were no prediluted 0.8% cells available. Using the current prediluted product seems like taking a step backwards.

Orhto is referring to their prediluted 0.8% cells. We did a poster at AABB on the discrepancies we found between freshly diluted 0.8% cells and the prediluted 0.8% cells. In our case we found the reactions with freshly diluted cells matched our PeG reactions when we had enough specimen to run both. The 40 minute incubation didn't help the few times we tried it. We do a daily dilution of our Selectogens (from 3% to 0.8%). If our screen is positve we run a prediluted 0.8% Panel A. If the reactions do not match the strength of the reactions we saw with our Selectogens we dilute a 3% Panel B to 0.8%. I'm sure we missed a few before we adopted this process. We saw mostly Anti-E's being affected but we also had an Anti-K and an Anti-Jka. An Ortho researcher met us at our poster in Seattle and said Ortho is working on a new diluent for their diluted cells. Since then other members of the Ortho group have said that all antigens are affected and hopefully a new 0.8% product will be out in 2006. Ortho would like to hear from anyone seeing these problems and would like specimens to test.