Immucor's ECHO machine

[John C. Staley]

It works kinda like a batch analyzer only not quite. I'll try to explain. If I put 4 group and screens on the Echo I can keep adding group and screens and it will start them in sequence as they are loaded but if I add an antibody ID it will, essentially, have to complete all of the group and screens before starting the ID. This is even more pronounced with the wD testing. If I have a group and screen and have it reflex the wD testing for an Rh neg. and I add another group and screen once the wD testing has started it won't start the G&S until the wD is completed which can take 30 min. from start to finish. The through put is very good as long as you keep loading the same test. The problem comes if you try to mix and match.

We had a case a couple of days ago where one tech put an ID on and a second tech loaded a stat G&S. The first tech did not say anything and the stat test was on the analyzer for about 15 minutes before the testing even started. That's still a 37 minute turn around time for stat which isn't bad it's just frustrating.

We are considering a 2nd Echo, the first for G&S and the second for everything else.

We are not computer interfaced. Our computer is a very old version of Lifeline/Western Star and incapable of such sophistication as an instrument interface. We are in the process of getting a new computer system and it will interface with the Echo. As that progresses I'll keep everyone updated.

[bbbirder]

John,

Are you using this analyzer for unit retypes?

Linda Frederick

[John C. Staley]

Morning Linda,

Yes we are doing donor confirmations / unit retypes on the Echo. They are much more user friendly on the Echo than they are on the ABS2000.

January was our 1st full month of testing and the numbers are pretty good for us.

472 Group and Screen

215 Donor confirmations

86 groups

29 screens

9 antibody ID's

89% of our antibody screens were run on the Echo.

So far so good!!

[Vaatha]

This is the second week we've had the ECHO-we just received our training for our "superusers" last week. We've had one software error that has shown up twice in the past two days. It's called Spool Subsystem App error, and Immucor says that it is a Microsoft error. They say it usually has to do with the printer, but we haven't been having any printer problems. If it keeps occurring, we may need service. I have not seen any software errors specific to the ECHO software.

[huntilla]

Did this error happen after a scheduled restart following weekly maintenance? Our Echo has been live for almost a month now and this error primarily occurs when cycling the power. My workaround is to power the printer off as well when turning the PC off. The error has not presented again since I started doing this about three weeks ago.

Good luck, let me know if this helped.

Barr Antilla, MT(ASCP), Blood Bank Coordinator

North Texas

[John C. Staley]

We have not seen this error. Hope you get it worked out.

Other than that, how are you liking the Echo so far?

[L106]

We have been live for a little over a year and have never observed this error. (Hmmm.)

[dingalls2]

Our Echo arrived last month, validations are done on it. We have manual Capture as backup. As training is progressing, we are finding manual readings seem to be weaker than the machine. Anyone else see that? I think it's partly that the machine mixes samples better than the tap tap tap that we were taught was adequate by the immucor trainer. Any thoughts?

[dingalls2]

Anyone?????

[n.peters]

Is anybody using the ECHO for very small volumes (10-20 xmatchs/week)?

[AMcCord]

I've been told by my rep that he has a client with one in a small volume hospital in Wyoming.

[John C. Staley]

I'm back for a minute.

I've always been of the mind set that there are many reasons to automate and test volume is, in my mind, probably not the most important. Consistency of testing is a big one. Reducing staff stress is another. If you have only one tech working the entire lab how great is an automated analyzer that can do a group and screen for you in 22 minutes while you are doing everything else!! Things don't over incubate or set in the cell washer for 20 minutes because you got busy and could not get back to the testing. I've always thought that the smaller facilities needed something like the Echo just to keep staff from burn out at a high rate.

With the ABS2000 Immucor was quite surprised that their initial customers were the small rural hospitals in Canada. That was where they were the most needed and appreciated.

[Linda0623]

Hi all,

We have just implemented the ECHO, and although we would have low use of the IGG crossmatch as it stands, what we are in the process of validating is using the IGG crossmatch assay to "prescreen units" for patients with antibodies. As an example, I just had a patient that had E, Kell, and Fya antibodies. When we needed to screen more for routine crossmatch, I ran the patient against 8 donor cells for IgG crossmatch. Only one was compatible. We then took the one donor and antigen typed it....negative for all 3 antigens....not too shabby for 1/2hour's ECHO time plus antigen typing.....not to mention the potential cost savings on antisera....we only phenotyped one unit instead of 3....(well, if we were validated....because I am in the process of validating, I did have the techs go back and determine which antigens the other 7 donor units had which caused the ECHO incompatibility......)

[John C. Staley]

Linda, that's a great use of the IgG crossmatch on the Echo that I had never really considered. This is the kind of ideas that really need to be shared.

[Linda0623]

Thanks John.....

I am actually pretty new to the BB supervisory realm, so it's nice to know I have some ideas to share that others might find useful, and not just feel like I have alot to learn......

To dingalls2: Yes, we did experience what I would call a two-fold difference in sensitivity when we validated the Capture manual workstation, and then proceeded to the ECHO.

I was very fortunate in that during my last AABB inspection, my surveyor was a Beta tester for both capture and then more recently, the ECHO. He gave me a "heads up" about the potential to see this, and I took his recommendation to validate the Capture workstation to validate the "method", which would be Solid phase Red Cell Adherence, to the reference standard, which for me was PEG in tube, and then validate manual method to automation when the ECHO arrived. When the ECHO arrived, the major validating was the ECHO itself, and their validation guide for that is very thorough in testing ECHO functionality, but I did parallel studies to validate the change in our Work Flow Processes. However, we did do an additional 40 samples, tube vs. Capture vs. ECHO, to cover all bases. All told, it took about 2.5 months, as the total validation was 10% of our monthly volume. It did show further sensitivity the further in the Process we went, especially with E's, Kidd, and Duffy antibodies.

[bgruber]

Hi,

In response to your search for information, I would suggest researching the 3 automated platforms available to determine the best fit for your lab.

[huntilla]

Hi all,

We have just implemented the ECHO, and although we would have low use of the IGG crossmatch as it stands, what we are in the process of validating is using the IGG crossmatch assay to "prescreen units" for patients with antibodies. As an example, I just had a patient that had E, Kell, and Fya antibodies. When we needed to screen more for routine crossmatch, I ran the patient against 8 donor cells for IgG crossmatch. Only one was compatible.

this is a great idea when you have an adequate amount of sample for screening units. Are you drawing extra tubes during the validation process for known antibody patients? Also, are you doing a full antibody panel on known antibody samples or are you only running selected cells for antigens not previously positive? We run a full panel on known patients using the Ready-ID and perform tube testing for selected cells in the event that the answer is not clear from the Ready-ID result.

Our Echo is currently down as there is a software glitch and the instrument QC is not recognized as a pass event even though no errors were displayed during initialization. Apparently this is a new issue and we are awaiting a call from a software specialist.

Barr Antilla, Blood Bank Coordinator

North Texas, USA

[Linda0623]

Hi Barr,

Wow---you packed alot in a paragraph...I'll do my best to keep this concise.....(I'm getting better at it the longer I'm a supervisor!!)

One way for me to keep this "simple" is that I am validating this process with "known" antibodies needing routine crossmatch. This allows me to request 2 tubes for the validating, as it is the lab phlebotomist who will be drawing the patient. This gives me plenty of plasma to work with. We are a predominently orthopedic specialty hospital, so I don't have as many "unexpecteds" as those of you in a general community hospital setting. So, for my patient pop. what we are doing is:

If patient has known history of antibodies (not Anti-D), they need to run the Ready ID panel with the Antibody screen. If they have a history of auto antibodies or one is suspected, I have them run the IGG DAT with the Ready ID to serve as the autocontrol. If the patient has history of Anti-D, they are to run Extend II only, to rule out anything else. If the patient is not known to be Anti-D, but is rh neg. with no prior blood bank hx, the rule is to do the Ready ID followed by the Extend II if anti D is proved but they need to rule out anything else. If beyond that more rule outs are necessary, or if there is the need for pre-warm techniques, as well as the full DAT kit, we have liquid cells and panels for rule outs.

I have been off for the Holidays, but I did receive via email the tech comm from Immucor regarding this QC issue and a possible resolution. Do you need them?? I would be happy to help......

Regards, Linda

[marisapete]

We recently received Echo's at four of my hospitals. I was searching the site for ideas, as I start to write the validation plans, and came upon this great thread. Is anybody willing to share their validation plan?

Marisa Peterson

Minneapolis, MN

[rebel1]

Immucor pretty much gives you a validation plan for the instrument. Takes about a day to complete. We were previously testing on Immucor's ABS2000 so we did not need to repeat validation of the method. We performed parrallel testing between ABS and Echo for 3-4 weeks.

[mlee]

Has anyone interfaced the ECHO to a DI Instrument Manager?

[jcoburn]

Immucor's validation plan is very complete as it comes from the manufacturer. You may have to tweak it a little depending on your circumstance. (We are very simple, primarily obstetric patients so we didn't have to add anything, just delete the many options that we are not using).

Good luck!

[sgoertzen]

Hi jcoburn!

When do you get a copy of this validation plan from Immucor? We are only a couple weeks out from getting our Echo delivered and installed, and I have a paper copy of the "Preparing for Better Blood Banking", and the CD of Recommended SOPs and Validation Guide. Is the validation plan you mention in your 3-19-09 note the validation guide on the CD?

Thanks!

[L106]

Hi sgoertzen.

We installed our Echo in August 2007. I think the "Validation Plan" jcoburn is talking about is really Immucor's "Validation Guide". It has "scripts" that tell you what you need to do to validate all the various functions. I also thought the Validation Guide was very helpful, and as jcoburn mentioned, you can omit some functions you don't use in your department, etc.

I interpreted the "Validation Plan" to be something that the user facility writes up. It doesn't have to be elaborate, but it should include documentation of the instrument serial numbers and software versions, spell out who is going to do what testing and how much testing/checking you plan to do, state criteria of how you are going to determine if the testing results are "acceptable" or not, state who responsible for making the final decision & "signing off" on whether the instrument's performance is acceptable for your use, etc.

Your Immucor Rep should be able to give you some examples of "Validation Plans" that some other Echo users have written. (Good Luck!)

[jcoburn]

Sorry, I guess I misled you. L106 is correct, Immucor supplies a very well thought out validation guide. This makes it extremly easy to write your plan: basically the plan is to follow the guide for each function that the facility utilizes. If the performance is as expected, that function is validated. L106's response is correct, our rep was very helpful in getting us examples to model our "plan" after. It ended up being just a couple of pages. Hope that your rep is helpful, too.