?Bad lot of Ortho Gel Cards ???

[roberman]

Has anyone had problems with Anti-IgG gel cards lot # 121409001-31 exp 27OCT10?

We had a problem a few lots ago and Ortho replaced our cards and the new lot was fine. Now we are having problems again with junky specks in both patients and QC. The cell button ins't disturbed, nor is it going up the side.

Thanks.

[Kwenz]

We have had problems with random lots of the Ortho 0.8% screening cells for a long time. Hazy, junky reactions that are negative in tubes with PeG. Have you recently changed cell lots?

[roberman]

Nope, the screening cells hadn't changed. I opened a new set of bottles, also...just in case. Thanks for the suggestion.

[C Lumbert]

Has anyone had problems with Anti-IgG gel cards lot # 121409001-31 exp 27OCT10?

We had a problem a few lots ago and Ortho replaced our cards and the new lot was fine. Now we are having problems again with junky specks in both patients and QC. The cell button ins't disturbed, nor is it going up the side.

Thanks.

We use Ortho Gel cards on the ProVue instrument and were getting repeated volume errors. On examining the cards, I observed what I thought might be sephadex gel in the well above the gel and liquid. The field engineer said that this will not spin down, so I called Ortho and they sent replacements.

The replacements still seem to have droplets of gel on the sides of the wells above the liquid and we are still getting volume errors.

If anyone else has observed this, I would appreciate learning what Ortho's response was.

Chuck

[SveiksRita]

We have had many problems with Ortho, but I don't know if it's with the gel cards or the 0.8% selectogens. We are not automated, by the way. We have been having hazy, junky reactions for our screens of and on for well over a year now, we do the panel and it is negative. It has gotten so bad that a couple of times, the techs would call it "junk" when there was a real antibody there. The most recent problem was bizarre. We would finish a screen, obviously negative, result it, then go to use the rest of the wells on the gel card an hour or two later and the screen you had just resulted as negative was now a 2+,but it looked hemolyzed. It nearly gave a couple of techs a heart attack. It kept happening for several days, then just as mysteriuosly stopped. I called Ortho and they said it was static electricity and we should put a wet paper towel on our work station to prevent this. No conditions had changed in the lab so we didn't do this and the problem went away on it's own. I do not have the lot # of the gel cards because I am writing this at home. I honestly cannot wait until Ortho looses it's patent on the Gell cards in 2011 so we can buy them from other vendors. They don't seem to admit their problems.

[tbostock]

Static electricity, huh? That's a new excuse. So now we have to use the cells in the cold, in the dark, and now on wet paper towels. Oh for the love...

[Churchi]

You can't re-result a well that has already been used......our rule is once it's used, it's invisible. A second incubation and/or centrifugation for the same well does not yield a vallid result.

[SveiksRita]

You can't re-result a well that has already been used......our rule is once it's used, it's invisible. A second incubation and/or centrifugation for the same well does not yield a vallid result.

We do not re-result, re-incubate or re-centrifuge the same well. When we pick up the card to use the wells that have not yet been used, we would see a 2+ reaction in a well that we had just resulted as negative:eek:. Of course we are not going to result that now as positive, but it does make your heart stop because you just resulted the screen as negative and you think that you missed something.

[janet]

We've been having the same ?junky? looking results, negative panels and often will try the 3% screen made up in the MTS dilutent to 0.8% (often negative but occasionally still positive - we call the negs NO ANTIBODIES and the positives UNIDENTIFIED). Another thread discusses this problem (sorry don't know what it was called)!

As far as volume problems go - is the volume problem at the end of the run?? We have ALWAYS had volume errors, usually we'll see bubbles at the top of the plasma well and we were told that those bubbles prevent the analyzer from reading the miniscus therefore it cannot read the volume = error. We don't repeat these (if the volume looks okay) - we trust our manual pipetting with a visual check!!

We also get some cards with 'sephadex' (fill residue??) ... since the Provue rejects these before starting a run we use them manually. There were a couple occasions when we've had ALOT of cards rejected by the Provue from a certain lot # - Ortho replaced them for us :0)

[Churchi]

I see! Sorry, I misunderstood what you were saying. Of course that would give any tech reason to pause!!

[rravkin@aol.com]

We do not re-result, re-incubate or re-centrifuge the same well. When we pick up the card to use the wells that have not yet been used, we would see a 2+ reaction in a well that we had just resulted as negative:eek:. Of course we are not going to result that now as positive, but it does make your heart stop because you just resulted the screen as negative and you think that you missed something.

SveiksRita,

I am having trouble visuallizing a gel card well being resulted as negative and then upon use of another well in the same card the previously resulted negative now being 2+ positive. The cells at the bottom of the well (Negative result) would have had to migrated back up into the gel and agglutinate (2+ Positve result). This seems impossible. Is it possible that a layer of cells was present at the top of the gel in the well when it was resulted as negative that perhaps was not noticed. I have seen this happen but I've not seen this layer migrate down into the gel upon standing at RT and then incubated at 37C and spun when another well was being used.

[dcubed]

Negative result to a 2+ positive....hmmm. How do you explain the red cells traveling back towards the top of the well. That sounds like a pretty unlikely thing to happen.

[tupton]

Wow, problems from Ortho!!! Imagine that!

[LisaM]

I think the Gel cards are pretty good for ABO typing, but for antibody screens, if I had my choice, I'd use strictly tube method. We use a mix of both methods where I work, but I'd prefer to always see what happens to the patient specimen, at all phases in tube. We even have a procedure for Gel crossmatches, but I will never do that--Immediate spin in tube, or full-phase in tube if the patient has antibodies/issues.

[LaraT23]

It sounds as if the better question might be who hasn't had problems with the gel? Lately I get what I call a "blob" of red cells, just one blob just above the cell button with an other wise totally clear well. I changed to some new screen cells that had not been opened and it has seemed to clear up.

And yes, we cut out the bottom of a box and keep it over the screen cell bottles when they are not used, so that they are in the dark. We also keep them in the fridge when not constantly in use. Next we will be able to use then only on a full moon in a climate controlled static free clean room! GEEZ:cool:

[tgarrison]

I don't know what lot number it was, but we had a lot of gel cards that well #6 didn't look like it had all the gel, liquid in it. We had some screens that came up positive in well #6 (guess no one looked at the card before use), but when repeated it was negative. We had this happen several times before one of our techs pointed out the problem. During this time we had a proficiency test that was missed. Tech noted on paperwork that even though ABO, and Antigen negative, crossmatch was positive (however did not repeat). When reviewing the xerox copy of her card, it was noticed that the volume level and gel did not look like the other wells.

[Steven Jeff]

I think the Gel cards are pretty good for ABO typing, but for antibody screens, if I had my choice, I'd use strictly tube method. We use a mix of both methods where I work, but I'd prefer to always see what happens to the patient specimen, at all phases in tube. We even have a procedure for Gel crossmatches, but I will never do that--Immediate spin in tube, or full-phase in tube if the patient has antibodies/issues.

I have been reading this thread with a somewhat distant interest. We use Ortho BioVue cards for blood transfusion using manual procedures and do not appear to experience the same difficulties that you have across the Atlantic. The columns we use are fundamentally different in that they contain beads and not gel, but the same principles should apply.

In my experience a lot is dependent on how well the samples have been collected and then processed prior to reaching the test bench. Poor collection into EDTA anticoagulant can lead to fibrin clumps as a result of partial clotting. Centrifugation of samples at high speed packs cells too hard and can cause false positives (see pack inserts).

A recent example was a difficult to bleed short sample (into EDTA) received at the grouping bench, which produced positive Ab. Screen results and reactions with the A,B and O cells in the reverse group. Yes there could be a legitimate serology reason for that result. However, the EDTA sample collected for the FBC on the same patient at the same time was cleaner in appearance and produced a negative Ab. screen and did not react with the O cells and produced the expected reverse group for the forward group. As always we are very dependent on the quality of samples received to test.

For me Lisa I would not return to tubes for antibody screening, and am more than happy to cross-match in the BioVue Cassettes.

Steve

:)

[LisaM]

^^Thanks Steven! I think because I'm a fairly recent re-trainee in Blood Bank after not having worked in that department for close to 20 years, I'm more comfortable sticking with the old school ,tried and true methods--especially where we seem to go through periods where there's a rash of issues with gel. Just last week, I did 6 antibody screens together in a run, in gel, and 3 out of the 6 came up positive. Upon further workup (in tube!) only one was for real and the other two were false positives. The reactions in gel didn't even "look right"--they appeared to have a haze of hemolysis and the patient samples were free, clear and looked fine. Probably as I work in that department more, I'll get to a better comfort zone.

[Steven Jeff]

Hi Lisa

I fully understand your response, however from your photograph you must only just have left school when you last worked in blood transfusion:flirty:I can certainly recall moving from the tip and roll technique on a light box (does anybody still do that) to the BioVue cassette back in 1996 and retraining myself to trust what I was reading. I will also say there is a difference to reading those reactions in gel against the reactions in beads which take some getting used to.

The comment still remains, poor samples can make reactions more difficult to read in columns than in tubes. Over the years experience does help you build confidence in the technology you are using, but we still ask for a second opinion in the lab with each other when we are uncertain.

Regards

Steve

:)

[tbostock]

^^Thanks Steven! I think because I'm a fairly recent re-trainee in Blood Bank after not having worked in that department for close to 20 years, I'm more comfortable sticking with the old school ,tried and true methods--especially where we seem to go through periods where there's a rash of issues with gel. Just last week, I did 6 antibody screens together in a run, in gel, and 3 out of the 6 came up positive. Upon further workup (in tube!) only one was for real and the other two were false positives. The reactions in gel didn't even "look right"--they appeared to have a haze of hemolysis and the patient samples were free, clear and looked fine. Probably as I work in that department more, I'll get to a better comfort zone.

Hi Lisa. Be a little cautious when going to tube testing after the gel screen is positive. In my years of working with gel, we have picked up quite a few (Fya, Jka, K and E) that were negative with tube testing. Although there is no perfect method for antibody detection, gel and solid phase are considered more sensitive.

Sounds like rouleaux from the description of the hazy appearance though; this is a problem in gel testing...once we prove that there is no specificity in gel, we go to tube testing in this case.

[Malcolm Needs ☆]

Hi Lisa

I fully understand your response, however from your photograph you must only just have left school when you last worked in blood transfusion:flirty:I can certainly recall moving from the tip and roll technique on a light box (does anybody still do that) to the BioVue cassette back in 1996 and retraining myself to trust what I was reading. I will also say there is a difference to reading those reactions in gel against the reactions in beads which take some getting used to.

The comment still remains, poor samples can make reactions more difficult to read in columns than in tubes. Over the years experience does help you build confidence in the technology you are using, but we still ask for a second opinion in the lab with each other when we are uncertain.

Regards

Steve

:)

You old rogue Steve; I'll tell your wife!!!!!! Mind you, I didn't like to say anything, but you do have an extremely good point.

In answer to the serological side of your post, yes, we certainly do still use the "tip and roll" technique on a light box - and almost daily at that. Some of the column agglutination and solid-phase technologies are so sensitive (particularly where auto-antibodies and "cold" antibodies - even with a true specificity, such as anti-M, are concerned) that we will very often resort to this technique, despite what John Judd (for whom I have a great deal of respect) says about "warming away" potentially clinically significant antibodies.

I have a healthy respect for the word "potentially" in this phrase, as we have never yet caused a transfusion reaction using the technique.

:D:D:D:D

[Steven Jeff]

Oh come on Malcolm be fair you can’t have all the fun, you just received an invite to work with the ladies in question!!!!!

On a serious note though I do fully appreciate the need to revert to tube techniques when necessary. However, my first line of testing is always the Ortho BioVue cassette and the second line as you know is your reference laboratory. I only wish I still had my light box and tube reagents but then I run into the problems of keeping multidisciplined staff trained in all technologies and satisfying CPA etc. All my staff are only really experienced in using column technology.

From my own experience (discussed in an earlier thread) I cannot confirm whether an anti-M is just reactive at 37°C or not. I have had one of each so far this year.

Steve

:)

[Malcolm Needs ☆]

Oh come on Malcolm be fair you can’t have all the fun, you just received an invite to work with the ladies in question!!!!!

On a serious note though I do fully appreciate the need to revert to tube techniques when necessary. However, my first line of testing is always the Ortho BioVue cassette and the second line as you know is your reference laboratory. I only wish I still had my light box and tube reagents but then I run into the problems of keeping multidisciplined staff trained in all technologies and satisfying CPA etc. All my staff are only really experienced in using column technology.

From my own experience (discussed in an earlier thread) I cannot confirm whether an anti-M is just reactive at 37°C or not. I have had one of each so far this year.

Steve

:)

I was hoping only I had noticed the invite!!!!!!!!!!!!!! Ah well.

Also on a serious note, I would be the first to agree that most, if not all, Hospital Blood Transfusion Departments (even the really big ones) could only ever hope to retain competence in one technology. The only reason that we can maintain competence in more than one technique is that we are using more than one technology on a daily basis. That having been said, we use the DiaMed gel technology as our "first line of attack", and for most of our cases, it is an excellent technology.

All that having been said, I suppose that being able to perform technologies not necessarily readily available to Hospital Blood Transfusion Laboratories is, in part at least, the raison d'etre of the Reference Laboratories (that, and making my life one long bout of enjoyment looking at the stuff we get sent - speaking as a pure blood group serologist, rather than a pure blood transfusionist).

:D:D:D:D

[LisaM]

Terri--Thanks! Two of the patients in question were routine prenatal screens, and the other was an oncology--he was the for-real positive. I'm sure as I continue to re-acquaint myself in the bloody-bank, I'll learn all the little tricks to make my day more pleasant in there! LOL

Steve and Malcolm--On the serious note, if it had been only one patient in the batch that came up positve but looked questionable, I would probably have just repeated the testing in gel to see if it would duplicate. Where I had 3--I questioned the integrity of the gel cards, so I felt it was best to try tube at that point.

On the not-serious side: Yes, I did work blood bank right out of college and I'm 43 now. And no fighting, now, boys, or I'll pull off that wig I'm wearing in my avatar and whomp you both with it--lol lol! (I'm working on growing my hair back after chemo. . . .)

[Malcolm Needs ☆]

On the not-serious side: Yes, I did work blood bank right out of college and I'm 43 now. And no fighting, now, boys, or I'll pull off that wig I'm wearing in my avatar and whomp you both with it--lol lol! (I'm working on growing my hair back after chemo. . . .)

Wow Lisa, I'm sorry to hear that, but it is great that you are obviously feeling better.

I will say a couple of things though. From your avatar, I would never have guessed that you are anything like 43 yet, and I would never have guessed that you are wearing a wig.

Good on you!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D:D