Posted January 11, 20214 yr comment_81403 Our Blood Bank is having trouble locating a lab to perform KBK when our Fetal Screen is positive because so infrequently done now. Does anyone else have this problem and any other options?
January 11, 20214 yr comment_81404 Is there someplace local that can do flow cytometry for you. I never understood why everyone thought KBs are so difficult. We were forced to stop doing KBs and send out for flow cytometry by the corporate transfusion service medical director. I have my suspicions why but I won't voice them here. We never had any issues with doing the KBs and we really didn't do all that many.
January 11, 20214 yr comment_81405 We used to perform KBs in blood transfusion, but we finally got rid of them to haematology. The reason for this was because it was so unusual for us to come across a true positive (apart from the positive control, of course) that we felt that we were no longer able to guarantee competency, whereas, in those days, haematology were used to performing manual reticulocytes, and so could almost guarantee competency. Nowadays, of course, retic counts are performed by automation, so their competency can no longer be guaranteed either (but we never accepted the KB's back!!!!!). Since 2009 (I think it was 2009?), UK Guidelines mandate that, if the estimated FMH is 2mL or greater by KB, the estimation MUST be performed by flow cytometry.
January 28, 20214 yr comment_81514 Hi All! I am trying to follow up on this topic as my hospital is currently trying to bring this test in-house. My concern is keeping techs caught up on competencies and the amount we would actually do to justify this. They do not want to bring in flow so that option is out. I have read several articles that state "the KB test should only be done to determine the amount of additional Rhogams needed, and not to be used as an actual determinate of a FMH". In 10 years, we have sent out 12 KB test to our reference lab (they use flow). So I suppose my actual question here is if you do perform your KB test by acid elution is there a kit that is recommended? Also, after reading Malcolm's response of the mandate over 2 mLs requiring flow is this a guideline in the US as well?
January 29, 20214 yr comment_81521 We haven't done Kleihauer Betke stains in our lab for years. When we did, I was the only tech who could consistently match the expected results on the CAP survey. Everyone else tended to over count fetal cells (which is better than under counting and under dosing RhIG I suppose). If we had a patient sample on my day off or during an off shift, the stain was reported out as a preliminary, then I recounted and sent out a final report the next shift/day. If I was on vacation, a preliminary report was issued and the sample was sent out. I tried and tried to improve performance - we sat at a double head scope and counted cells together, I watched them stain, etc. etc. Our patient volume was 1 or 2 a year with 6? or 9? survey samples. By the time we paid for the kit, paid for the survey and worked to maintain competencies for those 1 or 2 patient samples a year, it didn't seem to be a good decision to keep the test in house either from a $$$ or quality point of view. The reference lab we use now can give us less than 24 hour turn around. When we did do them in house, we used the kits from Sure-Tech (below). I see they have some nice controls now - when we used the kit we had to make our own controls. The controls could help with training/competency. They also have a reference manual that I would recommend that has nice photos of stained cells. I used it for training. Are you an ARC customer? I think that their reference services might do K-B stains. Edited January 29, 20214 yr by AMcCord
January 29, 20214 yr comment_81525 We send our KB's to another hospital in our division and get nice 2-4 hr turn around time. They use flow. We started using them because the local ARC does not perform KB's, and with only 6 or 7 a year we couldn't justify the cost for performing them inhouse.
February 9, 20214 yr comment_81562 i used to use Simmler's kits. Worked well. CAP actually has a kodachrome of a KB stain as part of the FMH survey. You could have all your techs give you a result using that and then wait to see what the consensus is. When we did these here i had all techs read slides after we had reported.
February 11, 20214 yr comment_81566 Thank you all for your help. We do not use ARC. We have located a hospital that is willing to do them for us it is just a matter of getting it approved by our higher ups. This facility actually does them 24/7 so our turnaround time would be great. They also perform KBs for other hospitals as well, so I suspect they would be far more accurate than we would just starting out
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