Proficiency testing for autoadsorption

[Sandy L]

Is anyone performing proficiency testing for warm autoadsorption? In our procedure we state "Samples prepared by this method are tested using antibody detection and/or identification procedures which are verified 3 times per year using the CAP Transfusion Medicine Survey". At a large academic hospital in town, which had previously taken the same stance, the facility was cited by during an AABB/CAP inspection for not having an alternate proficiency for this procedure. The supervisor suggested sharing samples between our facilities to accomplish this, but this would require drawing extra specimens from an anemic patient. In view of the volume of specimen that may be required to complete this test, I do not believe it would be right to set up split sample analysis with another facility or reference lab or duplicate blind testing. Before I suggest to the supervisor that she challenge the deficiency, I wanted to see if others have set up an alternate proficiency test.

[John C. Staley]

Personally, I say challenge the deficiency. I'm beginning to think that this whole proficiency thing is a good idea mutating into a monster.

[David Saikin]

Once again the spectre of ignorance appears to rear its ugly head. Come on, all you are doing is an antibody id. I agree with you . . . there is no call to over bleed someone in with a hemolytic anemia. Some inspectors just can't see the forest for the trees . . . I would challenge it, in fact, I would have called the inspecting agency while the inspector was there and got some clarification if they felt this was worth the effort of a response.

[MicheleKay]

I agree with David! All it is is an ABID. Why would an alternate proficiency be needed. At my facility we used to perform a warm adsorption 3x (depending on strength of reaction 3+,4+) before we decided to send it out to a bigger reference lab that had alternate procedures we didn't have. Majority of the time it was drug induced and no underlying AB's were present...but of course in BBing we can't always assume these things!! Why involve another facility and set yourself up for more SOPs and blah.. blah.. blah....

[Lcsmrz]

There are some special procedures in a lab where no QC exists -- autoabsorption sounds like one of them to me -- and interpretation is subject to the technologist's discretion, with respect to the other data from the patient sample.

CAP comments that the Lab Director is charged with the responsibility to define such alternatives AS APPLICABLE. So, I would put the matter on the agenda of a BB or QA meeting and document the decision NOT to pursue alternative PT, based on "good clinical and laboratory practice."

[kelliott]

I would ask your assessors for the reference to the regulation they are citing and where it specifically states proficiency testing is required for autoadsorption.

[sgoertzen]

I agree with everyone else. We can't have a PT for every kind of antibody ID technique we use in blood banking. How about things like prewarming, adsorptions, neutralizations, or enzymes??? I work at a pediatric hospital, so getting enough specimen to do all of the investigational testing just once is a challenge. There is no way they are going to let me get another set of tubes from those little anemic patients to send to another facility just to reverify the established techniques that we use are working.