Expired Panels

[Blupo]

We save expired panels for select cell testing. Any suggestions on how to QC these reagent red cells when used? The AABB says each laboratory should establish their own SOP.

[Malcolm Needs ☆]

I would use genuine weak antibodies (not strong antibodies that have been diluted) and test against those antigens that are known to become labile (or, at least, are known to weaken) during storage.

These would include, at least, the Lewis and Duffy antigens, but if you are using the cells to exclude or include certain specific antibodies (for instance, if you want to exclude or include the presence of an anti-S) then I would have thought that you would have to ensure that those particular antigens (S and s) are still active. If genuine weak antibodies against the antigen are not available, then you will have no alternative than to use diluted strong antibodies; needs must as the devil drives.

Edited July 21, 2009 by Malcolm Needs
The first draft of the post was unmitigated rubbish!

[webersl]

needs must as the devil drives.

What does that MEAN? Is that some kind of English proverb?

On expired panels we QC the specific cell for the specific antigen we will be eliminating based on a negatvie reaction with that cell. (So if we are using cell # 4 to rule out anti-S, we check for S antigen on cell #4.) Unfortunately, we do not have access to truely weak antibodies and use commercial antisera - you're going to die - undiluted. There is a rumor that a study was done regarding the need (or not) for QCing expired panels and it was published in Transfusion a few years back, but I haven't found it. If anyone knows of it, please do tell.

Edited July 23, 2009 by webersl
typo

[Malcolm Needs ☆]

Hi webersl,

It means "Necessity compels".

It comes from,

"He must needs go that the Devil drives.", a quote from Shakespeare's "All's Well that Ends Well", I, iii.

The French say,

"Il faut marcher quand le diable est aux trousses."

The Italians say,

"Bisogna andare, quando il diavolo e nella coda."

Just in case anyone thinks that this poster sounds intelligent, everything underneath the sentence, "it means "Necessity compels" comes from "Brewer's Dictionary of Phrase and Fable".

I have enough trouble speaking (and most certainly spelling) my native English, let alone French or Italian!!!!!!!!!!!!!!!!!!

:redface:

[OPUS104]

I always enjoy your posts for both content and entertainment Malcolm! As a side question to this thread...... how old of a panel does everyone NORMALLY use?

[CandyCapMT]

I am a new Blood Bank Supervisor and I have a couple of questions about panels. Can someone tell me where to find the regulation that says it is okay to use expired panels for select cell testing. I can't find this regulation anywhere and my director isn't comfortable using expired reagents. Also, does anyone know of a regulation that says it is okay to not QC Panel B. We only QC Panel A before we put it into use. Thanks in advance for any help.

[Likewine99]

We don't QC panels at all. We are not an AABB accredited BB but there is a CAP std that says "are reagents used for antibody screening" QC'd each day of use, which we do.

We don't consider a panel an antibody "screen" it is confirmatory testing to f/u on a positive screen. If you refer to the current edition of the Tech Manual, 16th edition, on p. 469 it outlines Ab ID panels and talks about using expired cells to exclude or confirm antibody specificities.

It does say though that each lab must establish a policy re: using expired cells. I've 'always done it this way' for over 30 years but in the selected cell world you are ruling in or out an antibody and the next level for pt safety is the complete AHG crossmatch with antigen neg units.

Hope this helps.

[DAWNA1983]

CAP does require panels to be QC'd. Selected expired cells are qc'd again if we have to use them. If anyone would like CAP's response to my email about QC on panels I can send them a copy.

Dawn

[Brenda K Hutson]

Hmmm....I have never heard of a regulation to QC Panels (and I have been a Reference Lab Supervisor)... If there is in fact one, perhaps everyone on this site would like to know the specifics??

As far as usinig expired panels, I have heard of 2 methods (though 1 of them was dismissed in a very curt way by a well known Blood Banker on the AABB sigs website).

There is Malcom's way which is to type antigens on the panel, and then the idea of running a "control" cell on the expired panel which is positive for 1 of the antibodies you know you have; this cell should then be the same strength as on the indated panel (in that the assumption is if you are reverting to an expired panel, it is probably because you need more rule-out cells but have an idea of what you "do" have).

We store Ortho A, Ortho B and Immucor 16 and we keep the last 2 expired panels of each of those listed.

Brenda

[CandyCapMT]

I would really appreciate that information from CAP Dawn. We are CAP accredited and not AABB so it would help me a lot. Thanks.

[Malcolm Needs ☆]

There is Malcolm's way which is to type antigens on the panel.

Brenda

I should, perhaps, point out that this is by no means a perfect method, but purely indicative.

Testing for the Duffy antigens, for example, that are polypeptides, does not guarantee that such antigens as ABO, which are, essentially, carbohydrates, will survive on the red cells to the same extent, and testing the Duffy antigens does not guarantee that other polypeptide antigens, such as Rh, will survive on the red cells to the same extent.

That having been said, it may be better than nothing.

:):)

[Mary**]

I like your answer. We do it the same way.

[jcdayaz]

Hmm. I have never worked anywhere, including a reference lab, where we QC'd our panels. Obviously, screening cells are QC'd every day...panels never. We recently had our CAP and AABB inspections. We had NO issues in either inspection.

We keep our expired panels for @ 6 months. We use Ortho panel A, B and C. We will use an expired panel cell until it appears hemolyzed.

[Malcolm Needs ☆]

Hmm. I have never worked anywhere, including a reference lab, where we QC'd our panels. Obviously, screening cells are QC'd every day...panels never. We recently had our CAP and AABB inspections. We had NO issues in either inspection.

We keep our expired panels for @ 6 months. We use Ortho panel A, B and C. We will use an expired panel cell until it appears hemolyzed.

I do it simply because the national SOP tells me I have to do it.

Make what you like of that comment!!!!!!!!!!!!!!!!!

:D:D:D:D

[jcdayaz]

We don't QC panels at all. We are not an AABB accredited BB but there is a CAP std that says "are reagents used for antibody screening" QC'd each day of use, which we do.

We don't consider a panel an antibody "screen" it is confirmatory testing to f/u on a positive screen. If you refer to the current edition of the Tech Manual, 16th edition, on p. 469 it outlines Ab ID panels and talks about using expired cells to exclude or confirm antibody specificities.

It does say though that each lab must establish a policy re: using expired cells. I've 'always done it this way' for over 30 years but in the selected cell world you are ruling in or out an antibody and the next level for pt safety is the complete AHG crossmatch with antigen neg units.

Hope this helps.

Your post is what I have always done/thought in my 17 years of Blood Banking. Look at Malcolm's response to my previous post about there being a "National SOP" that requires it. Now I'm a bit nervous until I am able to gather more information.

Surely if I had been doing it incorrectly all of these years we would have been caught on at least one of our inspections?! But still, further investigation seems prudent. I will let you know if I come up with anything.

[DAWNA1983]

I would really appreciate that information from CAP Dawn. We are CAP accredited and not AABB so it would help me a lot. Thanks.

Candy, This is the quote I got from CAP. If you want a copy of the email I received from CAP, send me you fax number.

"Item TRM.31241 requires that all new lots of reagents and critical materials be inspected and tested, as applicable. This item would apply to antibody panels. The laboratory must have a process for evaluating the new reagent panel lots before they are put into use for patient testing. The process used is left up to the discretion of the transfusion medical director, but at minimum, must follow the manufacturers instructions."

Dawn

[Brenda K Hutson]

Your post is what I have always done/thought in my 17 years of Blood Banking. Look at Malcolm's response to my previous post about there being a "National SOP" that requires it. Now I'm a bit nervous until I am able to gather more information.

Surely if I had been doing it incorrectly all of these years we would have been caught on at least one of our inspections?! But still, further investigation seems prudent. I will let you know if I come up with anything.

I agree with your comment. I have been a Blood Banker for 27 years, with this being my 6th Insitution (this includes being a Reference Lab Supervisor and working in places that were both AABB Accredited and FDA Registered). I have never been cited (and for that matter, the question has never come up in any Inspection). That is why I would be very interested in seeing the reference regarding this.

Thanks

Brenda Hutson, CLS(ASCP)SBB

[clmergen]

If you read the standard, it says "as applicable". So we inspect panels but do not QC them. As long as they pass visual inspection they are good to go. And that is defined in our policy which is signed by our Medical Director.

Edited March 12, 2010 by clmergen
Typo

[heathervaught]

Look at Malcolm's response to my previous post about there being a "National SOP" that requires it. .

Remember that Malcom's "National" = UK.

Edited March 13, 2010 by heathervaught
fat fingers

[Malcolm Needs ☆]

Remember that Malcom's "National" = UK.

Very true Heather, but in this case I am being even more parochial, in that it is National, as in England, rather than the UK, and National, as in the NHSBT, rather than for the Hospitals!!!!!!!

:):)

[heathervaught]

Thank you for clarifying Malcom. I just wanted to make sure that someone wasn't going to have a breakdown because there was an SOP out there that he was not following...when the SOP to which you referred did not necessarily apply to their facility.

[adiescast]

We test the expired cell for the specific antigen we are looking for whenever possible (i.e. if we have the antisera).

[tcoyle]

CAP does require panels to be QC'd. Selected expired cells are qc'd again if we have to use them. If anyone would like CAP's response to my email about QC on panels I can send them a copy.

Dawn

Hello,

I would like to see that email too. thanks. coyle.terri@mayo.edu

[DMR]

For those of you who are performing QC on panel cells, how often are you performing QC on panel cells, expired? or indate lots? Upon Receipt, daily, day of use?

Thank you in advance for your response,

DMR

[Malcolm Needs ☆]

For those of you who are performing QC on panel cells, how often are you performing QC on panel cells, expired? or indate lots? Upon Receipt, daily, day of use?

Thank you in advance for your response,

DMR

Twice daily for our standard in date panel.

ad hoc, when we use them, for expired panels.

:(:(