Blood Bank Automation

[S.Hunt]

We are a 150 bed hospital with limited space and have looked at the Echo and ProVue. The Echo is currently our first pick because of the faster turnaround time; ease of use; ability to put first panel on and run; it is a walk away bi-directional interphased machine that will interface with our MEDITECH IS; uses less reagent to run testing (and we all know that second to Gas prices blood bank reagent prices have been skyrocketing); and the ease of repair and service. The one concern we do have is that the ABO/Rh cards do both ABO and Rh and they do not have just an ABO card for doing RBC retyping of units from our supplier.

The ProVue was considerred because we currently use Gel technology and we ferlt the transition would be easier for our crosstrained staff - especially the evening and night Techs. However, the space necessary for it, and the sensitivity of it's reader requiring many cards to be visually checked kept us in the Tube ABO/Rh and Gel Antibody screen - ABID technologies.

Edited May 28, 2008 by S.Hunt

[Franklyn]

What did you see in regards to sensitivity and specificity?

I apologize for not responding to this earlier as I assume the question was aimed at me.

The gel and solid phase methods have very similar specificity and sensitivity. They each have their weak spots but, overall, we went with the solid phase and switched to PEG as our backup methodology. We submitted an abstract on our validation back in 2005, rather than try to paraphrase, I have attached a PDF of the submission.

2005 Validation Abstract.pdf

[D.C.]

Hi, I am new to the forum, but wanted to chime in on this topic. We have an ABS2000 that is being sunsetted on March 1, 2009. We use tube testing as our alternate method. We are a county hospital with about 100 beds. We went with automation purely due to staffing concerns, we needed to free up our Blood Bank tech's time to help more in the general lab.

Now we are considering going all gel, or tube and Echo. My preference is to stick with tube and get the Echo, then maybe consider gel in the future as our volume grows. My biggest concern with gel is the cost. I have also recently heard that the gel technology is not owned by Ortho and that it's future is uncertain. The Provue is also rather "old" and there's nothing being developed to replace it by Ortho. At least this is what I'm being told by our Immucor rep. If anyone knows anything different, please advise.

[John C. Staley]

I'm pretty confident that if you went to an Echo with a tube back up you would never need to worry about your work load out growing it. We are a 300 bed facility and have only rarely over whelmed our Echo, maybe twice since December and then it was only for a short period of time until things settled down, maybe an hour or two.

:pcproblem

[L106]

I agree with John's response. Our situation is very similar (340 beds, using an Echo with PeG tube back up), and we also went with an automation for Blood Bank strictly because of the "not uncommon trend" of increasing difficulty in procuring staff.

I suspect that an Echo would meet your needs nicely for quite some time. We have been "LIVE" on our Echo since September, it handles our volume well, and we have had very few problems. (P.S. Also, it's a breeze to throw an Antibody Identification Panel on the Echo!) I would be happy to respond to any questions anyone might have about our experience with our Echo.

Donna Brandis Ehler, MT/SBB

[Ann Viernes]

I have seen a comparison of the various automated instruments, provided by the Tango sales rep for the Chicago Area. I don't know if this is an official BioTest document or one compiled unofficially by the sales rep. It was not completely accurate, so if you are able to obtain it from the sales rep, be careful to confirm the accuracy of the statements with either current users of the other instruments or with the respective reps.

Mable's suggestion about reviewing the summary reports of CAP's automated instrument survey is a great idea and will give an idea of how many users are out there and the sensitivity and specificity of the instruments.

[LAS]

We are looking to automate so as to gain efficiencies in operations, as well as standardize procedures for float, cross-trained, and pool personnel. Our volumes have increased, but our staffing levels have not. We have been fairly lucky with cross-training, however the Bb skills/knowledge possessed by these staff members is broad, but shallow.

[DANDERS]

We've been using the ProVue for over 3 years and love it. I was sold on automation by the Immucor sales rep and the ABS 2000. By the time I convinced upper management, Ortho had the ProVue out. We had

on-site visits with each and preferred the gel technology over the Capture method. We have never been sorry. We've had rare down times - only one probe crach. All of our techs took to it quickly. We use the gel for back-up, but kept the reagents to type in tube if necessary. We do everything on the ProVue. The only thing it does not do is Fetalscreens.

[Kathy3171]

We've

[redwiner]

I may have posted my original question in the wrong place. So I will rephrase & ask it here in the automation section.

Has anyone else had repeated problems with the Galileo missing antibodies? Ours is very inconsistent. Our most recent issue was with a Kell. It gave a 2+ reaction on the screen, but when we ran the panel it had all negative reations except one ? (which was a Kell+) When the panel was looked at visually, the other 2 Kell positive cells were at least as positive looking as the cell the Galileo interpreted as ?

The specimen was repeated in Gel and showed a perfect Kell. 2+ reactions on the heterozygous cells.

We have had similar issues with other antibodies.

[John C. Staley]

We've seen nothing like you describe with the Echo in the 6 months we've been testing with it.

[LAS]

That is good to know; we are leaning toward it.

[jcoburn]

I have had a couple of instances of inconsistant antibody ID's with the Echo. One, an apparent Jka, could not be confirmed by our reference lab, but could not be ruled out, either. Another that I just encountered yesterday had a 2+ pos on one screen cell, but the ReadyID had no reaction at all. Extended panels had several cells positive, but no panel. I've asked for more sample (outpatient) but I suspect our reference lab will not find anything! I've also had 2 other samples which "screened" positive, but ID'd negative. Reference lab screens were negative in both cases.

[Franklyn]

We have noticed that the Galileo will pickup anti-cardio lipin antibodies in certain patient populations and we frequently pickup an antibody very early in its development. While we do not consider these to be "inconsistent" reactions they do add some noise when you have a positive screen on the Galileo and nothing on a panel. We created a code to identify these types of patients and I expect my medical director will publish an abstract on it sometime in the future.

[Likewine99]

We have been using the ProVue for 3 years and have been very happy with it. It facilitates crosstraining technologists and techs that have worked with analyzers in Chemistry and Hematology caught right on to it.

We use it for everything except donor confirmations and cord bloods. We put panels on it 3 months after go live and the evening and night shifts like it because it frees them up to sign out blood, work another dept, etc.

Our backup is manual gel at the bench. We only use tube testing procedures for prewarm XM and LISS is our backup antibody ID method.

[MediaMan369]

We have had our TANGO for approximately 2 months and are having a BLAST.

[NedB]

OK this may be kinda long.

We used the Capture R along with Gamma's Stat-Spin ABO/Rh for donor processing for many years. When Gamma stopped making the Stat-Spin available, we looked around for something else and evaluated Ortho's gel as well as Gamma's gel. The Gamma gel was easier to perform but it missed an Anti-Fya, so we opted for the Ortho gel and have never looked back. With the Capture R we would get approximately 3-5% of the run Positive and would then do a 3 cell screen in tube (LISS or PeG) and most of these would turn out to be negative. About 1% of our tests were a true Positive. When we switched to the Ortho gel we only saw the 1% true Positive. We seldom see anything on gel that is not a true and significant antibody. We got rid of our cell washers and went thru a process of validating antigen typings that require an AHG phase on gel, beautiful; and the technique uses only 25 mcL per test. When the ProVue came on the market, we bought the first one in Louisiana. To clarify some of the points in this thread. Yes you can add new samples to the ProVue without waiting for the incubation phase of the preceding test to complete - it's what the 'Emergency Stop' is for (a misnomer in that it really is only a 'Stop'). Why would anyone want to put an Immediate Spin crossmatch on a machine. If you use a screen with high sensitivity like the gel or the solid-phase, the only thing the crossmatch does is verify ABO compatibility - 2 drops of plasma and a drop of donor cells will cost you less than 5 cents, can be done in seconds, and will give you a visual of what will transpire in the transfusion. We have had very few problems with the gel system or the ProVue - but you should have a maintenance contract for the machine. The big reason to automate is cross-training blood bank and main lab staff; but to me this is also a big reason to use the gel. No one has mentioned this aspect, but with the gel dual populations with differing specificities separate on reaction with the corresponding antiserum. Mix Rh Positive and Rh Negative cells and react with Anti-D and you see both populations. This has come in handy more than once.

[Cornelia Kuehn]

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

[gbrown]

Cornelia, can you send me your data regarding Tango as we are considering the instrument. My email is GBrown@stamhealth.org or my address is Stamford Hospital 30 Shelburne Road Stamford, CT 06904. Thanks

[Melanie]

We have chosen the Tango to replace our sunsetted Rosys. A team from the lab investigated each and toured facilities to see them in operation and decided that for our workload and flow the Tango will meet our needs. We are getting three of them and they should be here in September.

[John C. Staley]

Melanie,

Once you have them up and running and testing patients let us know a little about them. I'm curious to hear how they work out for you.

John:juggle:

[clai01]

Cornelia,

I would like to have those comparison data if you would so kindly to send them to me. My e-mail address is chlai@mhs.net or address it to:

Harriet Chung-Man Lai

Transfusion Service

Memorial Regional Hospital

3501 Johnson Street

Hollywood, FL 33021

USA

I've seen both the Galileo and Provue at work. Galileo has continuous feed, but a higher number of "false positive", and it takes more physical space. That particular facility use the Galileo for type and screen, antibody ID, and DAT, it could finish a workload of about 340 type and screen in less than 8 hr.

The Provue is a counter top instrument, smaller in size, do not have continuous feed. But could be interface with a bloodbank system. Reason for this particular facility to choose the Provue is to have the same methodology for their manual method and automation.

[js0097]

Cornelia,

Could you send me a copy of your comparison? My email is j.simmons@novanthealth.org or it can be mailed to:

Julie Simmons, Manager Blood Bank

Forsyth Medical Center

3333 Silas Creek Parkway

Winston Salem, NC 27103

Thank you so much.

[Hi-Freq]

Cornelia,

I would like to have those comparison data if you would so kindly to send them to me. My e-mail address is chlai@mhs.net or address it to:

Harriet Chung-Man Lai

Transfusion Service

Memorial Regional Hospital

3501 Johnson Street

Hollywood, FL 33021

USA

I've seen both the Galileo and Provue at work. Galileo has continuous feed, but a higher number of "false positive", and it takes more physical space. That particular facility use the Galileo for type and screen, antibody ID, and DAT, it could finish a workload of about 340 type and screen in less than 8 hr.

The Provue is a counter top instrument, smaller in size, do not have continuous feed. But could be interface with a bloodbank system. Reason for this particular facility to choose the Provue is to have the same methodology for their manual method and automation.

The numbers that you quote above, the Galileo finishing about 340 type and screens in less than 8 hrs. is just about what we are seeing - excpet that we are starting to get "centrifuge read error 2 second delay" error codes, invalidating between 2 and 3 plates per day. According to Immucor Tech Support, we could be overloading the instrument. We're still using version 10 software, and we were thinking that SP 11 would correct this problem, but were told that while 11 will allow more time, it will not correct for this particular error. We're thinking we need a second Galileo.

[galvania]

Dear Cornelia - and to me please. My e mail adress is a.galvani@freesurf.ch

Thankyou