To scope or not to scope...

[hmust1]

At our facility we read our negative antibody screen and panel tubes microscopically after AHG, but I've also worked at a larger facility that did not read microscopically. Ortho and Immucor LISS reagents state that an optical aid "may" be used to examine negative reactions. However, in the package inserts, Ortho defines as optical aid as a "magnifiying mirror or hand lens" but warns against microscopic examination in LISS procedures. Immucor defines and optical aid as "a hand lens, a concave mirror or a microscope."

I'm trying to gauge how many facilities are still using the microscope to confirm tube antibody detection procedures?

[Ann Viernes]

We are trying to eliminate microscopic reading of results except for DAT and fetal bleed. Old habits die hard, so it is a struggle. We are keeping the optical aid, ie. the concave lighted mirror.

[RCr]

I'm really interested in the outcome of this thread. I'd like to learn more about the use of scopes and visual aids in the lab. Is an agglutination viewer a piece of equipment that "every" lab has, or are a significant number of people using microscopes?

[LAS]

We still scope all of our AHG phase tubes.

[Sara B]

I've worked at a large 450 bed medical center and CAH (25 bed hospital). We only scoped DATs and tubes that were questionable when shaking out. We used the concave lighted mirror for everything else.

[RCr]

Is there anyone who doesn't have a concave lighted mirror?

[kate murphy]

We use agglutination viewers (concave lighted mirror) and only scope DAT, FMH screens, sometimes transfusion reaction results. Like Anne, we are discouraging routine use of microscope. Many reagents state to be read macro only.

[Mabel Adams]

We used to shake our tubes off by holding them up to the overhead light, then scope everything--agglutination viewer optional. Probably 15-20 years ago, we started requiring use of the agglutination viewer and strongly discouraging routine use of the scope. I had found that I could see titers shake off "rough" on a tube with a higher dilution than I could see microscopically, yet I found lots of what turned out to be junk by reading everything microscopically. So we made the change in hopes of finding real antibodies and avoiding junk. Obviously, this requires good shaking technique. That worked very well. Now, automation will be changing things again.

[Eagle Eye]

Is there anyone who doesn't have a concave lighted mirror?

We do not have one. We are a level I trauma center with >600 bed, transfuse ~25,000 units every year. It's been atleast 8 years we have been working without mirror!!!

[csjuarez]

We have agglutination viewer and use it for all routine tube testing (most of our testing is in gel now). We use microscope only for Fetal bleed testing, DAT, and questionable readings. I see the agglutination viewer as an essential piece of equipment for tube testing -- it's much harder to accurately read the tubes without it.

[RCr]

Wow, thanks aakupaku. That's very interesting to me. Do you use a microscope instead, or are you 100% visual? And if you're 100% visual, is it a conscious decision to not use the agglutination viewer, or is it just that you don't have a need for one?

Edited September 26, 2008 by RCr

[Likewine99]

We are a 400 bed, Level II trauma center and do not scope tube ab procedures. If we do a tube ab scren or panel we use LISS.

[Eagle Eye]

Wow, thanks aakupaku. That's very interesting to me. Do you use a microscope instead, or are you 100% visual? And if you're 100% visual, is it a conscious decision to not use the agglutination viewer, or is it just that you don't have a need for one?

We use microscope for all our DAT's(to check mixfield reaction), Fetal screen, and questionable ressults. Our test of record is Gel. Personally I do not like agglutination viewer/mirror.

[donellda]

We only use the scope for fetal screens.

[Packer Banker]

We use the mirror/viewer to read everything. Scoping is different for the different generations in our lab. Some prefer to scope everything, PEG screen/XMs included. Others prefer to use it only when looking for a positive in IDing an antibody (in a result that was neg, but expecting to be positive). We do routinely scope for DAT, fetal screen and when needed in a saline or prewarm screen/XM. If you ask me, you're just looking for trouble scoping with PEG!!

[PaulSunV]

We have agglutination viewers and use them for all routine tube testing (we are also doing most of our testing in gel). We use microscope only for Fetal bleed testing, DAT, and questionable readings.

[Melanie]

We only use the scope for DAT's and any questionable reactions in tube otherwise just a lighted concave magnifying mirror.

[AMcCord]

I ask for the scope here. I have too many rotators who don't work many hours in the Blood Bank. They were missing some clinically significant antibodies by shaking too hard and/or not looking closely enough with the mirror.

Gel is our primary method, however. (Switching to automation soon !) We use tube only for those antibodies/problems that are too puny for gel to give nice reactions or for special methods. That means we know we may be looking for weak reactions going into the tube test. So, we aren't using the scope a lot.

[Cathy]

Still using the scope.

[sgtdmski]

I am a traveller. I have worked in several different facilities all using the tube method. The policies vary according to each facility. I have worked in facilities that do not require microscopic examination of AHG phase except for fetal blood screens. Others have required microscopic exam of DATs, and currently I am working at a facility that requires microscopic exam of all AHG phase testing.

dmk