dbarding13

Hi AMR, I too am trying to go Route 3 and pass the SBB. I have been studying the Technical Manual, AABB standards, and Denise Harmening's text. Is there any chance you might share how to find the most recent Last Chance Review materials? I have only been able to obtain some from quite a while back. Thanks and BEST OF LUCK!!

This is also how we do pre-ops, with the Type and Screen being done immediately, then the units set up the the morning of the surgery once the patient arrives and the armband is verified. We were having too many canceled or rescheduled surgeries, and having units tied up in crossmatch needing to be released when they were crossmatched the day before the scheduled procedure. Does anyone know of any regulatory standard that states we have to actually have the units "set up" prior to them being needed in surgery? Specifically, can we do the type and screen, and as long as the antibody screen is negative, wait to actually crossmatch the units until they are requested? (As long as we make sure there is product available, of course.) The physician's order is for a type and crossmatch, and we would still be able to provide crossmatched units when they are actually needed in OR. If they are never needed, then we don't crossmatch at all. Thoughts on this?? We set up so many units, only to have to release them when not needed. I am just trying to figure out if there is a better work-flow for this.

Hi Barb. Can you email me the pdf for the SBB review class? Thank you so much!! You are an angel! dawn.barding@hshs.org

We have been using the Echo for just under 1 year. Some of the most important information I have learned in dealing with equivocals is to be sure the washer manifold is clean, keep an eye on the indicator cells' expiration date (If it is close to the expiration of the lot, the cells tend to be more fragile, and they are not stable for the 24 hours on-board with the stir-ball beating them up.), and last but most important-we use the Technical communications from Immucor for interpretation questions and examples. It is very helpful in deciphering all the strange little quirks solid phase exhibits. (halos, etc.) I attempted to attach those Technical Communications, but keep getting errors when uploading. They are PDF files. If you e-mail me, I will send them to you that way! Print them on a color printer, and they will become your new go-to. They have helped our techs (all generalists) IMMENSELY! : ) dawn.barding@hshs.org

Yes, like Quality Guy, this is why we still have the procedure for the cold screen. We test the patient auto along with screen cells at IS, and 4 degrees. As far as the rouleaux not being an issue with the reverse typing, the Echo testing platform cannot reliably detect hemagglutination reactions that are graded as 1+ or less in test tube methodology. The IS XM reactions with the example above were graded as W+ by the tech. There may or may not have been something "funny" about the reverse on the Echo, but it did not trigger a NTD (no type determined) flag. If it had, the type would have to be performed in tube. We do see NTD fairly often when the reaction strengths are very weak in reverse typing.

OK-thank you both so much! Happy Easter!!

Agree, Malcolm. But if the antibody screen is negative through AHG, but IS crossmatches are rolling off questionable, aren't we obligated identify cold agglutinins, if all other possibilities have been excluded? Or can we just deem a probable cold agglutinin not of clinical significance? If "everything else" has been excluded, rouleaux, alloantibodies, etc., but the IS is still "chunky" weak macro or microscopically, would you just do a prewarm crossmatch through 37 degree and AHG phases, and call it good if negative? Thank you, Scott, for your very valuable input, also!!

Thank you, Scott. I was afraid of that. But you wouldn't just pre-warm an immediate spin crossmatch without any other conlusive evidence of a cold auto, would you? I guess I am just very leery of prewarm in the hands of the inexperienced in an attempt to just get rid of bothersome reactions they aren't expecting. I can see the logic in the case I sited above, because the screen was negative, but you have to exclude other possibilities for the imcompatible reaction, not just assume it is a cold and try to warm it away, right? Or am I being too strict and old school here?

Hello All! I know this subject has been discussed extensively. It continues to be a source of confusion in my TS, due mostly in part to the lack of solid Blood Bankers (all generalists who rotate through). Currently, our SOPs for working up suspected cold agglutinins include a "cold screen" at 4 degrees using Immucor Panoscreen I and II, and patient autocontrol. If Cold Screen is indicative of a cold Autoantibody, a Tube Pre-warm screen is performed, and subsequent panel, if warranted. This is so confusing to my techs. Last night I received a call at home from my 2nd shift tech, saying she had a patient coming in for transfusion for one unit of red cells, with no prior history with us, was found to be A+, Negative antibody screen in solid phase on Echo, BUT positive Immediate spin crossmatches. She then proceeded to tell me she "prewarmed the crossmatches and then they were fine." She wanted to know how to result the Cold Auto!!!!!!!!!!!!!!! After swallowing to remove my heart from my throat, I explained that this was not a conclusive "work-up" for a Cold auto. I talked her through the possibility of Rouleaux (She said she only saw "clumps" not "coins" microscopically); the possibility of an A2 or subgroup, but she assured me the reverse reactions were consistent with A. I then told her the series of procedures to follow for a suspected cold agglutinin, all of which are in our SOPs. I suspected Rouleaux, and asked her to follow the saline replacement procedure, explaining that if it was true agglutination, saline replacement would not "correct" it. She performed saline replacement and the IS crossmatches were as smooth as silk. I guess my question is, does anyone have any suggestions for making this more clear to our staff? Also, what are your procedures for identifying a cold agglutinin, or autoagglutinin, both specific and non-specific? How about a flow-chart to make it easier for techs to determine what to do next? Any info, SOP, chart anyone is willing to share will be so appreciated right now, and worth its weight in GOLD!! Dawn

We were doing ours quarterly until our last CAP inspection, whereby the inspector told me it was overkill. Our Path approved going to every 6 months now.

I am having trouble locating the actual transcript to the CMS webinar that DebbieL has referenced. Can anyone shed more light on the reason that CMS said "NO" in short, when asked specifically if an IQCP was required for antibody ID panels? Our primary method for antibody ID panels is on an Echo, which incorporates a positive and negative control with each test. It is our back-up method of tube panels with Panocell-10 and PeG that concerns me. THANKS IN ADVANCE FOR EVERYONE'S KNOWLEDGE AND FEEDBACK!