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Galileo issues


redwiner

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I just had a patient with 2+ reaction on an antibody screen on the Gallieo.

The panel had all negative reactions, except for one ? reaction. When I looked at the wells visually 2 of them looked as positive as the one the Galileo interpreted as "?" All of these cells as well as the 2+ cell on the screen were Kell postive (all of these cells were heterozygous).

Repeated testing in Gel. It was a perfect Kell reacting 2+ with both hetereozygous cells.

Has anyone else had these type of problems with the Galileo? We have had quite a few and no explanation from the company.

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We occasionially have issues with our Galileo. Mostly in OB patients, very low level or ? reacations that do not reproduce. Low titers of antibodies or new antibodies will give low reactions in any method. I would suspect that there was some IgM component to your antibody.

We view it the same way as we would in traditional tube testing - a weak reaction you would try to enhance: PEG, dry drop, etc. It seems that now that we're on an instrument, we're expecting perfection right from the get go. Not so, even with an instrument, you sometimes have to back it up with another method.

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  • 1 month later...
  • 4 months later...

I would be really interested to hear from anybody about missed antibodies using Capture-R, especially if your previous testing was by Gel technique. My lab acquired this automation In Jan 2008, and are due to re-validate the system- due to on-going concerns.

If anyone has a validation protocol as well- that would be really appreciated.

Please feel free to contact me via this site or by email :

rashmirook@hotmail.com.

Many thanks!

Rashmi

:)

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  • 7 months later...

Yes, we have had issues with missing Kell antibodies using Capture-R and when done by the MTS Gel Method, no problem. Today we had a positive antibody screen with Capture-R and when we ran the ID panel, the tech could not figure it out. I thought perhaps it was a anti-Jka but it missed 2 homozygous Jka cells on the panel. We then ran the screen and antibody ID using the MTS Gel Method. No problem. Reacted with all the homozygous and heterozygous cells. I repeated the few cells missed on Capture-R and they repeated negative. I am not sure what is going on. When I did my validation when we first got Capture-R it was definitely more sensitive than the MTS. But now it seems...????questionable. We use the 3-5% Ortho Screening Cells, which doesn't have the enhancement media that the Panel A 0.8% does. My techs are losing faith.

I am currently doing a whole new validation. Not happy at all.

Heather

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Hi Heather,

Does your current software allow patient plasma to be aspirated prior to the wash cycle ( I can't remember software version for this)?- if not, it would be a good starting point to have this installed and validated.

Regarding the solid phase panels, they are difficult to interpret, and seem to show correlation with an 'enzyme-IAT' technique. I like the ease of use, but not the fact that it is difficult to see clear dosage reactions. The company say that using the 'extended panels' could help with this aspect.

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Hi Heather,

Does your current software allow patient plasma to be aspirated prior to the wash cycle ( I can't remember software version for this)?- if not, it would be a good starting point to have this installed and validated.

Regarding the solid phase panels, they are difficult to interpret, and seem to show correlation with an 'enzyme-IAT' technique. I like the ease of use, but not the fact that it is difficult to see clear dosage reactions. The company say that using the 'extended panels' could help with this aspect.

Are these "extended panels" extra, or more expensive than the "normal panels"? If so, and excuse my cynicism, I bet they say these could help!

:rolleyes::rolleyes:

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We've been live with the Galileo for almost 3 years and have seen several instances of antibodies that are excluded homozygously in solid phase but clearly demonstrating in gel, mostly with Anti-K, Anti-Fya and Anti-Jka. We've had to become accustomed to going to gel when the solid phase panel doesn't make sense. The 'extended panels' aren't any better, just different donors (D-positive and D-negative panels). They suffer the same issues.

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Are these "extended panels" extra, or more expensive than the "normal panels"? If so, and excuse my cynicism, I bet they say these could help!

:rolleyes::rolleyes:

The extend panels are just different sets of donors. They have an Rh positive and an Rh negative set. I think the price is the same as for a regular panel, but of course you are buying them in addition to the regular panel. We use them and they can be quite helpful. It sounds like the issue in this post may be more technique dependent, however, so I don't know that running more solid phase would necessarily help. We use solid phase and tube, occasionally PEG; we do not have gel, so we usually report out an indeterminant if we can't get a clear pattern or we will give antigen negative based on suspicion. As we used to say in the old days, if it isn't clear this time, transfuse them and it will pop up. That sounds so blase', but most of the time it works without obvious adverse consequences to the patient.

:eek:

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I just don't like having to go to Gel. Do you think there is a problem with the processing of the panels? I often wonder that. I really don't think it is technique based, especially when I repeat the test and it comes out the same. I have been using the manual Capture for 6 years, and Galileo for 5 years, but lately it seems that we have seen more of this.

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I just don't like having to go to Gel. Do you think there is a problem with the processing of the panels? I often wonder that. I really don't think it is technique based, especially when I repeat the test and it comes out the same. I have been using the manual Capture for 6 years, and Galileo for 5 years, but lately it seems that we have seen more of this.

Quite a few of us are having problems with the panels. We currently perform Id mainly in Gels due to difficulties in interpreting the capture panels at least 20% of the time. We would like to do all panels by capture- but as we had to keep reflex testing into gel, was more time consuming and expensive. Our lab will be performing a full evaluation of these panels against gel IAT and Enzyme-IAT technique next year.

You could try freezing some of your plasma and running the capture panels against different batches over the next few months, to see if there is a difference or improved clarity.

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I just don't like having to go to Gel. Do you think there is a problem with the processing of the panels? I often wonder that. I really don't think it is technique based, especially when I repeat the test and it comes out the same. I have been using the manual Capture for 6 years, and Galileo for 5 years, but lately it seems that we have seen more of this.

Sorry, I didn't mean the user's technique. I should have said method dependent.

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All,

We have been using the Galileo (we have two) for over two years. We have seen many times where it calls screens negative, when visually they appear slightly positive when viewed on an Immucor Light Box. There is an abstract that I submitted to AABB last year that reviews our findings. We continue to collect this data today. One of the main players is anti-E as well as anti-K.

If anyone would like more information, please let me know. Terri

AABB abst from site.doc

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We also do a visual review on all of our screens and panels on the Echo. We sometimes see things that are positive (weakly, usually heterozygous cells) on visual inspection of the image but the analyzer called negative.

While this is not ideal, we like the analyzer very well otherwised.

When the techs were originally trained on the Echo, they felt that this was no big deal, since they had been using manual methods and grading everything by hand.

Linda Frederick

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All,

We have been using the Galileo (we have two) for over two years. We have seen many times where it calls screens negative, when visually they appear slightly positive when viewed on an Immucor Light Box. There is an abstract that I submitted to AABB last year that reviews our findings. We continue to collect this data today. One of the main players is anti-E as well as anti-K.

If anyone would like more information, please let me know. Terri

Thanks Terri, your article is very interesting. Do you have information on the number of antibodies that you detect visually from the plates ( that the instrument calls screen negative) but are easily detectable by gel?

I also seem to recall that the instrument manual says that there can be problems interpreting reactions < 1+ in strength.

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We do not perform our confirmation testing in Gel, but in the tube with PEG. When we brought the Galileo’s in, we were performing our antibody screens with Gel, and antibody ID with PEG. All data is associated with antibody ID being performed in PEG. Terri

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My intent is to get rid of the Gel and move to the tube with PEG. I haven't really started the validation, but I hear pros and cons to the method. Any input into the method would be greatly appreciated.

We have done validations in the past and I actually think PeG is the better method. However, we switched to Gel because we couldn't really afford to keep doing PeG. Both Ortho and Immucor/Gamma had raised the prices so much on reagents for it that it was costing us approximately 40% more on reagent cost to do tube testing than to do Gel. I would never have believed it but the double and triple digit increases had that effect.

That being said, I think Gel actually is better for some Rh antibodies and occasionally Kell. However, PeG is generally better for Kidd antibodies. But there are certainly no absolutes for a given antibody.

Good Luck - but make sure that you also look at your costs.

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Yes! Just yesterday I had a completed gel panel come to reference lab with only one single dose cell not reacting in a prefect 2+ Jka pattern. I wanted to throw it on the Galileo for rule outs. The panel came back TOTALLY negative! What is up???:eek:

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Just today we had our first case (that we know of) where we got a negative screen and negative panel on the Echo, a negative screen in the tubes using LISS/PolyAHG, but the patient's Anti-Kell showed up a perfect 2+ positive pattern with Gel. Not sure what to think about that! The Capture and tube methods both missed this Kell. :(

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The "extend panels" are just more panel cells. Same as using more panel cells in any other method. In our experience, solid phase is more sensitive than gel or tubes - but sensitivity and specificity are 2 separate things. I don't think there has been enough experience with solid phase to show that what we thought of as "dosage" in traditional methods will still exhibit "dosage" in solid phase. At least not alot of publications.

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