Two new CAP surveys

[Cliff]

There are two new CAP surveys that we will be subscribing to.

They are Eluate and Antibody Titer.

Is anyone else subscribing to these? They sure aren't cheap. Our total order is now $4510!

[KathleenSL]

We are subscribing to both. After talking to CAP (4X over 6 weeks) I found out we need ABT and ABT1 surveys in order to report anti-A titers using 2 different methodologies (DTT treated method used for kidney protocal and untreated method used for all other patients).

[Jane]

We signed on for both. I figured if we didn't we'd get slammed on our next CAP inspection.

[Laura Mc]

We only signed up for the titer survey. We had called CAP last year to inquire whether eluates were considered a test that required internal proficiency testing. CAP told us that eluates were considered a special method and therefore did not require a proficiency test. So we decided to save a few dollars.

[ANORRIS]

We perform the titer survey. If anyone has the procedure for the "Uniform Procedure" for Anti D, please email it to anorris@georgetownhospitalsystem.org

Thanks

[JMunden]

We have been performing the ABT for anti-D, and the Eluate CAPs for some time.

Be sure to perform the eluate when specimen is fresh, I have assigned CAPs to techs who waited until near due date and found specimen to be hemolyzed with spurious results. If result is not evident, we result as "would sent out to reference lab"-which is what we would do with a patient with similar reactivity patterns.

[Likewine99]

Because of the price we discontinued both of these survey about 2 years ago.

We also discontinued testing eluates in house because of the price of the reagent and lack of expertise in the dept.

Is there a theme here???$$$$$

[L106]

We subscribe to both ABT Antibody Titer and the ELU Eluate CAP Surveys.

Laura Mc: That's interesting that CAP told you that Elutions were a "method" that did not require a survey. Has anyone else been told similar information? (I'd love to drop it if we could, mainly because of the cost.)

[Eagle Eye]

we have been doing both survey....i guess > two years now. We subscribe anti-D & anti-A titer and also subscribe Eluate.

We are not using their uniform procedure.

[bbbirder]

We only get the Titer survey. We had a discussion with an inspector who agreed that elution is a method, and not a 'regulated analyte', so no proficiency testing is required.

Linda Frederick

[dgibaud]

We tried "it's a technique and not a procedure argument" with the last CAP inspector to no avail. So now we subscribe to the eluate AND titer surveys.

Don Gibaud

[kslaforce]

I do not currently subscribe to either as we send these tests to our donor center reference lab, but at my previous place of employment we subscribed to the anti-D titer and the eluate. We had been told by one inspector that eluate was a method but another one said we needed it. Last I heard, that institution dropped doing eluates to save cost and also there were only two techs who could do the procedure well and they were tired of always getting called in to do them!

[adiescast]

We do both the anti-D titer and the eluate surveys. I don't know how anyone could define elutions as a "method" not requiring proficiency. It is a unique test protocol.

[Susan Patti]

We subscribe to both CAP surveys. I have not implemented the uniform procedure. Is anyone elso doing this?

[Trek Tech]

Here is the original article.

We use this procedure and we also use the CAP ABT survey.

Uniform Procedure.pdf

[AMcCord]

I order the elution survey but dropped the titer survey and started sending all titers out. Makes me real sad to pass up doing titers...Boo Hoo!

[adiescast]

We also implemented the uniform protocol.

[dgibaud]

Regarding the uniform procedure: It looks like it call for R2R2 cells (e-) cells, which make it problematic for me.

[estiner]

This question was brought up at the AABB Assessor Meeting in 2007 and the CAP representative stated that elution did not require a survey. We dropped our subscription for elutions and we do a repeat titer by another tech whenever we get an antibody titer - which is very rare. Both surveys are very expensive.

[L106]

A couple weeks ago I wrote to CAP and asked if the Elution survey was required to maintain our CAP accreditation. A CAP Specialist replied: "The ELU survey is not required for your lab to participate in. It can be used for alternative assessment."

I didn't feel this gave a clear-cut answer, so I wrote back to CAP again and ask them to elaborate or restate their response in different terminology. The CAP Specialist then replied: "If you will go on-line and look at your laboratory's activity menu, you will see that each activity is marked as requiring PT, requiring alternative assessment or not marked for either. Activity 3361, Antibody elutions, is marked as requiring alternative assessment. The alternative assessment requirement can be satisfied by doing something in-house, or by purchasing a PT product if available."

This answer was clear to me: "If you don't do an official survey sample, then you have to do some time of alternative assessment" (as far as CAP is concerned.)

Donna

[Ellen Zeigler]

These two CAP proficiencies have been around for a while. While expensive, you need to consider what testing you perform and how you will accommodate regulations on proficiency testing without them. Elutions at minimum may be part of your antibody identification process and subject to CLIA requirements, i.e. 42 CFR 493.857, 493.865. Titers may be necessary for treatment or determination of organ transplant eligibility, eg, kidneys

[ANORRIS]

For CAP Activity ID 2949 Cold Agglutinin, what alternate assessment is being used, if any at all?

[estiner]

To Donna - I just checked with both CAP and AABB accreditation departments and both agreed that the surveys for Elutions and Antibody Titers are not required but are available to fulfill the requirement that these procedures be assessed every 6 months. A much cheaper way is to use check cells to perform the elution procedure and repeat the titer with a second tech.

[L106]

Thanks, estiner. Yes, I understood that we could asses these tests by alternative ways (instead of purchasing the CAP Surveys). If my Lab Director is agreeable, I would like to drop our Elution Survey.

However, I'm not sure about the Antibody Titration. If you have a second tech repeat the titer (and he/she gets the same result), that proves that the results are reproducible, but that doesn't assure you that the test procedure is really doing what it is supposed to be doing.

As an example (although an unlikely one, I admit), let's say I have a sample with an antibody, but my Antibody Screening Cells are near their expiration date. I do an Ab Screen and my results are Negative. Another tech repeats the Ab Screen and her results are Negative. Summary: Our results were reproducible, but they were not the results that we should have obtained. (Now, if we shared a sample with another lab and got the same test results, I think that would give more reliability to the proficiency testing.)

[BloodBank]

We also for the last two years subscribe Eluate and Anti-D titer survey from CAP. I would also like to drop Eluate survey if not required. Cost is again the issue. Also would like to mention to JMundon regarding testing near due date. One place I went to inspect, somebody cited the facility because CAP survey was not done like routine patient testing. Normally you don't keep patient testing pending for so many days. Just a thought.