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Microscopes in the Blood Bank


johna

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:D Some time ago I posted a similar question on the AABB website and the consensus seemed to be that for the most part microscopes should be kept out of the blood bank. Personally, having \"grown up\" with a microscope by my side through years in both transfusion services and reference laboratory, it's difficult :cry: to break the bond. I guess my feeling is that if my staff is well trained using a microscope we should not have the \"overreading\" problems which tend to complicate matters.

Basically I was wondering what the general opinion is as to whether scopes should be used to read Coombs reactivity, whether for direct or indirect Coombs testing.

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We do have a microscope in the blood bank. We use it to look at DATs for transfusion reaction workups. Our fetal bleed screen test also has to be viewed under the microscope. Sometimes it just makes us feel better to look at something under the scope! :)

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We allow the use of the microscope in three situations:

1)DAT's

2)As a confirmation to a very weak reaction at AHG

3)When rouleaux is suspected

However, there are those who cannot let it go and use it to look at all of their negative reactions at AHG. In some cases the microscope has caused significant delays in providing blood due to chasing non-existent antibodies.

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  • 2 weeks later...

I think I responded to this on the AABB website, however . . . I think this depends on the training and comfort level of the techs. At my small institution we use the microscope routinely. The reason being all the techs are generalists. I have met very few technical personnel who can competently call w+ reactions macro. Granted, most reactions of this strength are not clinically significant, but THEY CAN BE. I would rather have my staff find all that they can. IF this turned out to be a big problem, i.e., over-reading, I might change my tune, but it is not.

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  • 4 weeks later...

I stopped using the scope for routine tube testing years ago (DATs are the exception). I have not see a dramatic increase in patient deaths because of it. The problem I have is, we use a manual PEG technique and the package insert recommends against microscopic reading. Many of my "more mature" techs can't seem to let go of the scope and they spend an awful lot of time chasing unicorns. :twisted:

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  • 2 months later...

I agree and I have a tech who not only scopes everything and reads at every step but also holds the tubes over his head and looks toward the light to read them as he shakes them off. I've spouted safety, time and regulatory constraints to no avail. How do you get them to change?

Lu :?:

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  • 3 weeks later...

We also limit the use of the microscope to DAT and rouleaux. Our other use of the microscope is to aid in determining if a weak reaction is mixed field. Many techs are not comfortable differentiating between a weak mixed field and a weak reaction based on macroscopic viewing alone.

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  • 3 months later...

We use Ortho/MTS gel system for antibody screens, panels, AHG crossmatch. That takes care of scoping.

We still scope tube DATs - adult broad-spectrum Coombs. Cord DATs (anti-IgG) are agglutination viewer only.

Fetalscreens are scoped per package insert.

It is way too easy to overread non-reactions with a microscope. Red cells can look like they are agglutinated if not fully resuspended before viewing. If you use plasma instead of serum the increased protein can enhance rouleaux. Sometimes it is difficult to differentiate rouleaux from true agglutination under the scope. The novice general Med Tech (or the OCD Med Tech) tend to see two or three red cells "holding hands" under the scope and call this a W+micro reaction.

I prefer test systems that maximize ab-ag reactions with clearcut macro reading endpoints, e.g. gel, PEG.

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