JustaKIDD

Ensure your acid eluate kit is approved for use in the specific gel you are using- Immucor eli kit is not approved for use in gel. Ortho has a kit specifically approved for use in their gel( not others)- gel is not all the same- different matrix’s/ composition.

Yes, this is a known limitation of automated analyzers in blood bank.

The challenge becomes as a few have mentioned the scarcity of some homozygous cells in certain situations, ie)presence of anti-D in a rr patient It is impossible to find homozygous cells for E, C , etc in this situation. I am having a " debate" of sorts :)(!) regarding the need to run 2 hetero in this situation, as it appears most of you have mentioned. The bigger questions is what do you require In these situations? Would love BBtalk to start a new voting grid as has been done here- to address the questions of ruling out E, C in presence of anti-D)-how do you approach the homozygous challenge in this instance? 2 hetero? (Btw-bloodbank talk, the grid above should have included 3 homo-I have had blood bankers in my past insist on this)! Impossible often with multiple antibody situations.

Sounds like you need a new rep, as ours has been very open about the ability to make up your own QC...

Has anyone every been cited by using 2 hetero rule out for rare (or with anti-D not too rare:) situations (ie-anti-D presence and trying to rule out E or C)? How about citations with keeping expired panels (as some in this string do)? I know for awhile some insepctors liked to cite on expired panels (typically inspectors that don't understand the qualitative world we live in:)! Would love to get a global US perspective on this (not intended to incite our luckier ExUS collegues:)

what was the question? all i see is a ppt...?# Lost in kidd land!

Yes, you can use any partially used cards on manual work station.-they are easy to retrieve off the manual review rack at any time. I would call your Ortho rep, to see if your software setting can be modified. Ours were and it helped immensely. There has been one software upgrade a few months ago, that is possibly what you/they were referring to. I was told all along the final software upgrade was coming out 4th quarter of this year. I have found Ortho has devli vered and been upfront on everything they have said and promised. We looked at other instruments, and this pales in comparison to the other gel instrument that has been out 2 years and still haven't fixed the periodic 15 minute downtime flush that occurs and locks you out of the instrument-now that is a REAL nuisance,- occurs if instrument isn't "fed" samples hourly ! Requires babystiing if you don't want it to happen! Getting STATs off in 28 +/- 1 minutes has been awesome, as well overall TAT in under 30 minutes.We are very happy,

The unused wells as described in dansket scenario will be retained on instrument and used with next sample within 4 hrs.- currently.i am told as well Orthos upcoming next software upgrade will fix this issue and retain card until expiration of card or next sample, whichever comes first.

No-but would love to see some if anyone can track some down! Ive looked for them too! Grifols gel is manufactured and shipped from overseas, and was approved aprx a yr ago in U.S. Ortho has manufactured theirs in US for over 20 yr. Grifols uses 8 well cards vs 6 well Ortho. Ortho has more choice in cards. I've heard have to use 2 cards for ABO reverse with Grifols or test for Kell on their single card. Ortho has 1 card for ABOrev.

Why would you want to switch from gel? If you go to solidphase, you don't have a mirror back-up to run on the bench. Furthermore, its quite the learning curve to move from gel to reading/reviewing solidphase, particularly with the '?' and NS the plaques solidphase (search on this site to see all the posts) Staying with the same vendor will minimize new vendor qualitfacation, validation (on bench), etc. Gel historically has been the easiest to read, interpret and train-particularly when you have generalists as you mention that are more used to pipetting (bench method at least). Check out the MDBuyline data, it has given the VISION great reviews recently.

I completely agree with the variability of Bg antigens on the red cell, as the most common cause of these types of reactions. Even though Ortho screens for these- they can come and go on the red cell in terms of their expression strength. We must not forget a strong 'I' expression; a strong cold agglutination w/ 'I' specificity -can be a common causal issue for these type of reactions-and something manufacturers don't routinely type for. Changing manufacturers will not solve the problem, as you'll note by doing research on this site- they are all plaqued by this sometimes .... The joys of blood bank- and the need for knowledgeable techs!!!

That is interesting about Grifols stating they do not require an IS xm-it is my understanding that it is a regulatory requirement to detect ABO isogglutin compatability, which does not come through at IgG phase. With that said, AABB has recently blessed the EC to fulfill this need (anyone else confirmed this)? But to say it is not necessary I believe is misleading, unless it was expounded on to address how to satisfy the regulations.

Does Grifols have IS crossmatch available on Erytra or Wadianna

Hope this helps to clarify the muddied waters! Ortho had exclusive distribution rights for the past few decades to the Diamed gel cards-Ortho never manufacturered them. They also did not manufacturer the Provue. They were a part of JNJ that has been divested as of last year to a private equity company. Bio-rad purchased Diamed in 2007 (see link below), and now that the Ortho distribution agreement has expired, you are seeing new competition in the gel market. Diamed (now Bio-rad) ,the worldwide leader in gel technology, has gel cards and product in front of the FDA since Feb 2014. Has anyone seen a change in Orthos gel cards in the past year or so since the distributioin right expired? http://www.marketwired.com/press-release/Bio-Rad-Completes-the-Purchase-of-DiaMed-776352.htm

Karrie61-in addition to gel- you may want to consider the other solidphase method (not sure why you mention you do not want solidphase). If it's due to the AUS problem with your ECho-the two solid phase automated methodologies ( capture R used on Echo/ Neo vs SSll on TANGO) are completely different in the detection of non specifics. Since TANGO uses intact red cells- not antigen coated ( stroma) micro wells- it does not have the false positive issue that CAPTURE R does. You may want to consider– although both the Vision and the TANGO are going to be bigger than your Echo. Anything smaller , will be a manual or semi automated platform nearterm.

I disagree as well that it is not picking it up b/c its IgM. If it titers out to 1:8 in tube with IgG-I would absolutely expect it to be picked up by a system that is purported to be more sensitive then tube. Hopefully you get another redraw in 3-4 weeks (or pt. delivers at your facility) so you can follow the titer and reactivity.

Ask and you recieve;) Malcolm IS coming the West next month! Bio-rad is sponsoring him at SCABB in Las Vegas the first week of June. Go to the website and you will see the information- or contact your Bio-rad rep.

Bio-rad gel products have been in front of the FDA for over a year. Since they brought Dia-med 6 years ago, which is the leading manufacturer of gel, (manufactured Orthos gel), they have strong and extensive gel experience and expertise. In addtion to gel cards, the submission included a floor model automated platform, and I believe a bench top centrifuge/reader and incubator. Their gel products and automated platforms are available outside the US, and a google search should pull them up.