Kleihaur Betke Stains

[John C. Staley]

Mollymotos, sorry I don't remember!  That was 16 years, 2 jobs and retirement since 2015 ago.  If I were to guess we probably would have reported as positive or negative for fetal cells or possibly as no fetal cells seen or fetal cells seen.  We were really into waffle words when making such determinations.  

[AMcCord]

On 2/10/2023 at 5:28 PM, mollymotos said:

Hi! We are planning to do KB testing for traumas as well. Do you report it as fetal cells positive or negative?

We report the fetal bleed volume.

[Auntie-D]

My two pennies worth... I did measurement of uncertainty on KB - 47%. Shocking sensitivity... We changed our policy that any foetal cells required follow up by flowm while we were addressing the issue.

We solved it by requiring all staff to take part in each EQA session and following up any discrepancy of >10%. We also introduced scoring for our controls and required all staff to do a count before moving onto the patient ones. Any discrepancies in the control scoring or EQA resulted in retraining.

What actually happened was that because staff were required to do an actual count, rather than an eyeball, for every kleihauer, they organically became more proficient. We also were able to identify the staff member who was counting lymphocytes as foetal cells...

For anyone who is interested - there is a modified KB that I have developed (sadly I never published before leaving the labs) that has a counter stain for the white cells - makes the foetal cells ping

[AMcCord]

We used the Sure Tech kit when we were doing Kleihauer Betkes. They offered a 'training book' of KB stain photos, good and bad stains, that included info about troubleshooting the staining process. It wasn't terribly expensive. I found the photos very helpful in getting my eye 'calibrated'. After that I had zero problems hitting the CAP survey results. I tried to use it to educate staff, but I couldn't get them zeroed in - they always overcalled (better than undercalled). I think our major problem was that we did so few patient KBs that it just wasn't possible for anyone else to become proficient. That's when I approached our medical director about switching the test to a send out. We are able to get specimens to our reference lab within 24 hours, usually much less, so it hasn't hindered patient care. I still use the book for student education.

[applejw]

We refer our positive rosette screening test to Hematology for K-B stain. Results are reported as % fetal cells.