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nziegler

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Everything posted by nziegler

  1. nziegler
    When I started with the DDHS500 line a few years back I had a horrible time with controls. That 30 day claim is junk - and I thought they were going to work on changing that wording in the package insert. I could only get 3 days out of mine. They did seem to work out the issue I was having, though. I believe it was a combination reagent stability AND qc stability. (We ended up switching to BioRad controls simply because in NYS I have to have a "negative" control, and IL doesn't make one that low yet.) But in all the years of using IL, that is the ONLY problem I've had. The TOP analyzers are rock stars! (and I just got my new 550's in!) The best thing to do is document EVERYTHING. I had a log at the instrument where I had the techs write down every time they changed reagent or made up new qc and why (empty vs. qc trouble). And then I would print the Levy-Jennings and send them in. Do you submit monthly to the AccuTrak? If everyone else is running high, that is in your favor.
  2. nziegler
    Scott - you aren't located in NYS, are you? Definitely a requirement for us, and have gotten cited for it. I asked my apps person what other people are doing and she indicated they are doing the same thing I am. Some can be done by concentrating the normal control. Others I have to hope to come across a patient that reaches the higher levels.
  3. nziegler
    to anyone that performs special coag testing - what do you use to perform the require cal ver / linearity? I looked into George king, they only have material for clot based assays, but most of mine are chromogenic or immunoturbidimetric. I have to run Protein C Activity, Free Protein S, von Willebrand Activity, von Willebrand Antigen, and ATIII Activity. The manufacturer just recommends using a different lot of control material, but that doesn't go anywhere near the upper linearity. I've been trying to catch high patients and serially dilute, but I always end up missing one or two tests (especially Free Protein S). Any help is appreciated! Nicole
  4. nziegler
    We've been working up the Alcor iSED. Unfortunately, I am not the one in charge of it (for once) and have only ran one sample on it. It takes 3 minutes for the first sample and then 30 seconds for each additional sample (up to 20). So in my view, anything that takes less than an hour is a win. Plus it reads a sample barcode and provides a printout. Too bad we don't have the $$ to interface it. Apparently if you're in a nursing home here a weekly sed rate is a necessity - so we get ALOT. And don't forget the STAT ERs - because they are waiting for the result to discharge the patient. *sigh*
  5. nziegler
    very well written! I'm going to save this for lab week. the public only hears when bad things happen with the lab, and most nurses seem to think our job is to compromise samples so they have to be redrawn. they don't realize that we do know patients by name, bad results have an effect on us, and we often wonder how patients are doing.
  6. nziegler
    yes, SMILLER! it's true! the kit is VERY easy to use - all liquid ready-to-use reagents. I don't remember if the controls are liquid or not. It will be a great test to quickly rule out HIT, but I'm pretty sure in order to diagnose you will still need to send a confirmation to a reference lab. Our friends at the FDA have made them change it to a qualitative pos/neg instead of reporting actual values. This is why it will take until 1st quarter of 2017 before it becomes widely available in the US - they need to reprint all the package inserts to reflect that change. Start saving correlation samples!
  7. nziegler
    We perform dRVVT testing for lupus-like anticoagulant/antiphospholipid testing. We automatically run both the screen and confirm, then report a normalized ratio. For any ratio >=1.20 a comment is added to the report saying, "Evidence of a lupus anticoagulant (antiphospholipid antibody) is detected ... blah blah blah." Our new hematopathologist would like for us to change the wording because it sounds too definitive - ISTH guidelines recommend performing at least two methods and to have testing repeated at 12 weeks to definitively call an antiphospholipid antibody. I agree with her, so I'm wondering what (if any) comment any of you that perform this testing attach to the result?
  8. nziegler
    i have a DM96 Cellavision and Soft. Hemo instruments are DxH800. We have to manipulate 2 separate interfaces in order to get the cellavision results into the CBCWD order. it's really crappy because we have to make sure to clear the diff pad before going into the cellavision interface to post those results. if you want more details, let me know....
  9. nziegler
    It would be surprising if that were actually true. But I live in NYS, so even if JC gets rid of it, NYS never will! Regarding Fib cal verification - we use the TOP500, but I'm pretty sure there is wording in the regulation that states if it is a clotting based test (versus chromogenic), you don't need to do the cal ver. Just like you don't have to do it for PT or PTT...
  10. nziegler
    I do the exact same thing. Patients in cells/uL (or mm3), but CAP for some ungodly reason requires the 10^3 and 10^6. It's really kind of silly. Curious to see if ANYONE reports patients that way ...
  11. nziegler
    Scott Miller - if you like your LH's you will LOVE the DxH's!!
  12. nziegler
    I know this post died out a few years ago when Clinitest became available again - but they are taking a break from manufacturing again. The last time it happened we discussed retiring the test and then NYS made a new regulation specifically stating we need to have something in place to screen pediatric urine for reducing substances. I noticed someone mentioned Benedict's reagent form sciencelab.com - any other recommendations out there??
  13. nziegler
    We perform automated and manual retic counts. we have a pretty significant sickle cell population and we cannot discontinue the manual (sickle cells interfere too much with the automated count). While I'm not sure what JC requirements are, I know NYS definitely requires correlation between methods (I tend to only remember the more stringent regs - which is usually NYS). Since we run a patient as our control with each manual count, this isn't a problem for us. But from what you're saying, it seems like you could get away with doing away with the manual all together. If you no longer offer the manual method, then you don't have to correlate to automated. You only have to correlate methods you currently have in use.
  14. nziegler
    For anyone else that may be interested, this is the Rumke Table. The easiest way to correlate differentials that I have found. Rumke Table.pdf
  15. nziegler
    Rachel - NO - you cannot bill for both.
  16. nziegler
    ooh. you're going to love them! their HIT assay is coming very close to FDA approval. I helped them with some testing for reproducibility and precision a few months ago and am doing another round in the fall. I'm REALLY hoping it's approved first quarter of next year. I spend $70k a year sending those out! FYI, they're also working on anti-Xa calibrators for the new oral drugs but once again the FDA is giving them a hard time. the reason: the DRUG COMPANY says they don't need to be monitored. *smh*
  17. nziegler
    This is the calculation Beckman gives users to determine their "Lab Limits" (aka: SD) taking 10 months of data (6 would be fine), average your %CV for each measured parameter avg %CV x package insert mean (usually roughly the same lot to lot) / 100 * 3 = 2 SD limit I have no idea how they came up with that calculation. The only parameter the calculation won't work for is MCV because of the upward trend as the control ages. The ranges will be tight, but like you said, you WILL catch shifts/trends/poor reproducibility easier. I've caught diluent problems based on high MPV %CV and random low hgb results that wouldn't have been seen with a wider range. For my mean lot to lot, I run about 10 runs of the new lot while finishing up the old lot. After eliminating the outliers (usually due to an empty vial) I set my target as my observed mean, and tighten the ranges to my "lab limits". Hope that helps!
  18. nziegler
    Wow. that was a lot of information, Alan! Thank you everyone for sharing their experience! Unfortunately for me, our purchasing department tends to tell us what products we're allowed to use - which translates to the cheapest thing out there. We currently use Azer Scientific clipped corner slides, but they want us to change to some Cardinal product (I think). I'll keep my fingers crossed they work...
  19. nziegler
    next question: what brand methanol do you use?
  20. nziegler
    Anyone out there using Beckman's SlideMaker/Stainer for the DxH's: -what manufacturer of slides have worked best for you? -what slide manufacturers should I avoid at all costs? Thanks for the input! Nicole z
  21. nziegler
    We have this happen occasionally, too. Because it doesn't happen very often, we simply use the tan and report. We've never validated.
  22. nziegler
    we got rid of any kind of delta checks for PT/INR years ago. our logic was that it is not improbable for the results to vary one week to the next (even one day to the next) depending on the dose, the time, and what the person ate that day. we were easily repeating about half our samples due to the delta check. (we have also gotten rid of that policy - repeating delta's)
  23. nziegler
    Thanks guys! Next question: how did you go about getting both tubes from patients who would be at the higher end for PT, fibrinogen, and DDimer? We are not allowed to simply have the phlebs draw and extra tube on patients. PTT and anti-Xa I plan on just spiking with heparin.
  24. nziegler
    Our system currently uses the glass 4.5 mL fill 3.2% BD Vacutainers for our coag samples. Because BD will be discontinuing the glass pediatric tubes and replacing it with the plastic 2.7 mL fill 3.2% tubes, we have decided to switch completely to the plastic. Best practice (and CLSI recommendation) is to validate to prove there is no difference in results between the two tube types. Has anyone actually done this? How many samples? What was your range of results (CLSI mentions a difference may only be seen with prolonged samples)? Did you validate your entire test menu, or just PT/PTT?
  25. nziegler
    If there is no platelet clumping, we simply review the slide to confirm the count is low (and report with the comment "Platelet count confirmed with peripheral smear review). If there is clumping, we obviously ask for citrated tube. There have been instances when our slide review disagrees with the automated result - either due to giant platelets or platelet satellitosis. IF the instrument is reporting something <100 OR the result is much lower than historical results, we will replace the result with our manual estimate. This requires supervisor approval and review. It is pretty rare we do that.
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