Blood Bank Automation

[RR1]

Hi Liz,

You need to consider the type of reagents used by whichever automation, also look into your external QA schemes to see the the type of problems you could encounter. Diamed have a new analyser coming out next year(?) which handles larger batches and has on board card storage similar to the Ortho Autovue, but many other good features too.

I am not a Diamed automation user ( but would definitely go this way if I had the choice).

[Liz]

Thank you Rashmi.

[sbenson]

We are about a 260 bed hospital transfusion service. We got the Echo because our "mother" hospital signed a contract to receive the best rates for reagents. We do anywhere from 10 to 25 samples a day. I think there will be alot of waste for us, and the biggest advantage will be for the night shift because they can load the sample and walk away. We won't use it for crossmatch because we are required to also perform an immediate spin for all crossmatches. We will probably not use it to do donor reconfirms because it is easier to make the cell suspension with a quick squeeze of a segment instead of trying to get the cells all out of 2 segments with a segment cutter and then letting the cells settle. Since I only get no more than 40 units at a time, I can be almost done by the time I'd be loading the tubes with the cells on the Echo.

In other words, for a small volume TS, I don't think it is of value over manual methods. For a blood bank with a donor room and a high volume, it would be great. Maybe will get bigger.

[DANDERS]

We are about a 100-125 bed hospital using the ProVue and LOVE it. It's generalist-friendly; if down (rarely), the manual get is great; you can have continual flow; IS and IgG xmach; donor reconfirmation is very easy. The only thing we don't put on the ProVue is Fetalscreens.

[bbbirder]

We are about a 260 bed hospital transfusion service. We got the Echo because our "mother" hospital signed a contract to receive the best rates for reagents. We do anywhere from 10 to 25 samples a day. I think there will be alot of waste for us, and the biggest advantage will be for the night shift because they can load the sample and walk away. We won't use it for crossmatch because we are required to also perform an immediate spin for all crossmatches. We will probably not use it to do donor reconfirms because it is easier to make the cell suspension with a quick squeeze of a segment instead of trying to get the cells all out of 2 segments with a segment cutter and then letting the cells settle. Since I only get no more than 40 units at a time, I can be almost done by the time I'd be loading the tubes with the cells on the Echo.

In other words, for a small volume TS, I don't think it is of value over manual methods. For a blood bank with a donor room and a high volume, it would be great. Maybe will get bigger.

We are not a large volume hospital, but automation is well worth it to us. We have an Echo, and yes, we have some waste due to STATS that we run singly, but this allows the tech to do other things. Plus, getting the T&S done in 21 minutes is wonderful. And if you have a positive screen, the quick loading of the Ready ID strips allows you to get the panel out in 21 minutes. We also don't XM on the Echo, because we do IS only.

We run our donor retypes on the Echo. It may not be the most cost effective, but I did a little time study and found it did take less hands on time. Plus, if you are interfaced, you have good tracing of all results. We may revert to doing tube tests on these again. I haven't made up my mind entirely on that.

Bottom line... find what works for your facility.

Linda Frederick

[AMcCord]

I agree with Linda 100%. We also are small volume and will be running anything on our Echo that it will do. It's a tremendous help to evening/night shifts and it gives us more time for paperwork, etc, etc on the day shift.

[sun]

i am also have a similar query. Do any body use the Autovue? why could not it be approved by the FAD to be used in USA?

[sun]

Dear Rashmi

Hi,

It seams that you have experience with Autovue. Can you kindly give me a breif idea about its advantages and disadvantages . Is it giving really giving false positive coombs tests and overdiagnosing non required benign antibodies

[djmdjm]

Hi Kate,

I noticed that you have your SBB certification. I am interested and was wondering if you attended any SBB program. Any info would be of great help.

Thanks,

Drew

I have not seen any review that compares the 3 instruments.

When we were deciding which instrument to buy, both Ortho and Immucor showed us the instrument in a hospital. I thought it was important to talk to actual users - how automation fits into their workflow, how they did training and validation, what good points and bad points they have found.

We choose the best fit for us - our volume, workflow and staff.

Our needs might not be your needs.

[RR1]

Dear Rashmi

Hi,

It seams that you have experience with Autovue. Can you kindly give me a breif idea about its advantages and disadvantages . Is it giving really giving false positive coombs tests and overdiagnosing non required benign antibodies

Hi Sun,

I don't have much experience with the Ortho Autovue. From what I have seen it is a very nice analyser. There have been various EQA results from the UK that show staff misinterpreting Rh D types if the sample was DAT positive, but this is due to the potentiated reagents used in the Ortho cards in the UK.

You have to bear in mind that the Ortho cards in the U.S for the Provue are the equivalent of the UK Diamed cards (gel based), whereas the Ortho UK cards are the glass bead matrix.

The problems we have been experiencing in my lab with over sensitivity and missed antibodies has only been with the Immucor Galileo and ECHO analysers using Capture-R serology. This is what most of my posts regarding equipment problems have been about.

[redwiner]

Rashimi

Have you had the same problems with missed antibodies with the Echo as you do with the Galileo.

We continue to have numerous problems with our Galileo. Missed antibodies, false positives, etc.

redwiner

[RR1]

Rashimi

Have you had the same problems with missed antibodies with the Echo as you do with the Galileo.

We continue to have numerous problems with our Galileo. Missed antibodies, false positives, etc.

redwiner

Hi redwiner, the problems seem not to be as pronounced with the ECHO, though we have had some. Our latest was a missed/ inconsistent detection of an EQA sample and when this was repeat run on each analyser gave various results from Negative, ?, +.

The EQA lab had no problems detecting the anti-K by capture using a manual technique, which could mean that there may be issues with the wash process itself. Our EQA body is now in investigating these problems.

The ECHO is definitely a better instrument, but not good for large batch processing.

As always Capture does have a higher rate of false positive reactions overall.

Edited January 7, 2010 by RR1

[mjshepherd]

I installed and validated the Echo in my facility about a year and a half ago.

Overall the Echo is a good instrument, the mechanical operation is relatively simple with quick and easy maintenance. For facilities with moderate to large volumes of routine testing it does free up a lot of bench time.

However, the data station does seem to be underpowered. When attempting to perform multiple operations, such as loading additional patients for testing, it will freeze and crash. Many times an easily correctable error will cause one of the boards to crash resulting in lost tech time powering down and rebooting the analyzer.

The patient data organization is cumbersome as well, especially for facilities that are not computerized. Having multiple reports on patients is asking for errors. The results area would be much easier to maneuver if the data were organized by patient rather than batched by test.

The functionality of the analyzer is also somewhat limited to ABO, RH, Antibody Screen, and ID panels. While it is capable of running other functions such as forward typing of donor units and crossmatch testing they are more complicated and time consuming than manual testing.

We did have some issues with validation. The analyzer will only detect IgG antibodies, which led to us removing the crossmatch option from our testing due to incompatible blood types being reported as compatible. This also prevents the analyzer from detecting cold reactive IgM antibodies, which could be clinically significant in cardiac surgery cases. Immucor removed the option for patient phenotyping during installation.

I would recommend this analyzer for any facility with moderate to high volume of routine testing that could be batched, and had the ability to have an interfaced computer system.

[silverblood]

My hospital is attempting to decide between the Echo and ProVue. Could you be more specific about your statement that the crossmatch option was removed due to incompatible blood types being reported as compatible? I am aware that the Echo does not detect IgM antibodies-specifically which ones could be clinically significant in cardiac surgery adn why? Thanks in advance for your reply to my questions.

[bday]

I have just went thru the decision of the Provue and the Echo...to me they both had their pros and cons...the Echo, I was concerned that we would go back to tube for backup method (we are currently on Gel) and the waste; the Provue, I was concerned with the Stats (even though you can load in the middle, the locking door makes it more of a batch analyzer) and the wastage of panel cells, if you were to run a panel on the Provue. I had previous experience with Immucor's Rosys and ABS2000, and had seen false positives in both gel and solid phase. In the end, we went with the Echo, due to it's stat capabilities, the panel capabilities, and the overall functionality. Plus, Immucor specializes in blood bank equipment and reagents! Unfortunately, we didn't look at the Tango.

[mjshepherd]

During validation, there were several times when an A patient crossmatched to a B unit would report out as compatible. When this was reported to Immucor they stated that it was a known occurence with B units, and that the crossmatch function on the ECHO was only to detect IgG antibodies. While the risk of mistransfusion was low I and my pathologist still felt it was significant enough to pull the function off the analyzer.

As for the ability to detect cold reactive IgM, for us it is not an issue as we use the tube method at IS for crossmatching and this picks up any cold reactives. Due to core temp cooling for several types of cardiac surgery cold reactive IgM antibodies that are normally insignificant can become very significant.

[John C. Staley]

We never used the crossmatch feature on either the Echo or the ABS2000 before it. We were an IS crossmatch facility and thought that going back to IAT crossmatching, even automated, was a step backward. Besides we felt that the instrument time was better used with the Type and Screen testing than tying it up with crossmatching.

I don't imagine this has changed since I left.

:bored:

[mignone]

We currently have the Provue and are trying to interface with Cerner Mill. If you plan on interfacing your instrument do consider your computer system.

[jcdayaz]

Yes, you can interrupt both instruments to run a STAT, for example. HOWEVER, it seemed that on the Provue, you cannot physically load the specimen until an instrument-determined time when access to lift the lid is allowed.

Heather

No, actually this is not a true statement. You can do an "Emergency Open" pretty much anytime. Well, not within the first few minutes of beginning testing, but other than that you are typically good-to-go.

I do have issues with the Provue on the length of time it seems to take to check all the reagents, scan the gel cards, etc before beginning testing. I LOVE it in some ways, and maybe not so much in others.

[jcdayaz]

We currently have the Provue and are trying to interface with Cerner Mill. If you plan on interfacing your instrument do consider your computer system.

I FEEL SO SORRY FOR YOU!!!!!!! We have 2 Provues and switched from Meditech to Cerner Millenium @ 2 years ago. (Not our choice). It has been a nightmare ever since!!!!!!!!!!!!!!! GOOD LUCK!!

[mignone]

I FEEL SO SORRY FOR YOU!!!!!!! We have 2 Provues and switched from Meditech to Cerner Millenium @ 2 years ago. (Not our choice). It has been a nightmare ever since!!!!!!!!!!!!!!! GOOD LUCK!!

. We finally have everything interface except xm's. The engineers are currently trying to make this available. Provue sent two results for xm and it's a known issue for them. If I can help let me know

Maria:chainsaw:

[sun]

Dear All, Hi

What is your experience with Qwalys3 analyzer please ? Any validation study? advantages and disadvantages ?

Thanks

[jalomahe]

hello

I am from Germany and here in the University of Erlangen they have made a direct comparison between Galileo and Tango optimo. If you want to have these datas I can give it to you

Cornelia

Would it be possible for you to email me the information also?

Janet_Helton@Trihealth.com

[jcdayaz]

. We finally have everything interface except xm's. The engineers are currently trying to make this available. Provue sent two results for xm and it's a known issue for them. If I can help let me know

Maria:chainsaw:

Are you saying your Provue results automatically cross-over (for lack of a better word) to your Cerner computer system? If that is what you are saying, any and all information would be greatly appreciated.

We have 2 Provues and still have to manually print the results of each specimen and enter into our lovely (NOT) computer system! We have been told, if my memory serves me correctly, that there is no interface available.

Any information you can provide will be greatly appreciated.

[sun]

Dear Cornelia

Please do. Thanks alot