ProVue: Ortho Reverse Typing Cells

[Brenda K Hutson]

We have been having problems for a couple of weeks now with our Revers A1 cells on the ProVue. We are getting a lot of NRD results. When we look at the cards, we do not see any problem with the A1 cell well (and these are on patients who should be NEG with A1 cells). We have:

1. Had both machines serviced since then (we have 2 Hospitals); though it would not make sense to me that both machines would suddenly have the same problem (and we are seeing this at both locations)

2. Received a new Lot# of Reverse Typing Cells (still have the problem)

3. Tried a new Lot# of Cards (still have the problem)

4. It is an intermittent problem; not with every patient who should be NEG

It is getting to be very frustrating! I have had the Techs. repeat them manually (in tube) to see if we could "see" anything in the tube; nothing...

1. Any others having this problem recently?

2. Any thoughts/suggestions/recommendations?

I am not new to GEL, but I am new to the ProVue. But as a Blood Banker, I am used to looking for "patterns" and for things to "make sense;" and I can't find the sense in this.

Thanks,

Brenda Hutson, MT(ASCP)SBB

[JOANBALONE]

We also have been having problems on and off and have done what you have done. We do not repeat in tube though. If we review the card and see no reaction we will modify ProVue results before we interface. Let me know if you find out what is causing this problem.

JB

[CM2]

If it was just one site I would say doublecheck your centrifuge settings/speed and the storage conditions of cards. We had boxes stored sideways once so the gel was all slanty that ended up having to be tossed. Youd think they would have spun out flat but no. That camera can be pretty sensitive and I think it sees little cardboard particles on the outside of the well too. Curious what you find!

Oh Provue, You so crazy!

[dcubed]

Brenda, we also have seen quite a few "?" on the A1 well. It is getting to be a real pain to have to look at all of these. Also, I am afraid that techs will get complacent and will assume that "it's just the A1 cell acting up again" and not really take a good look at the well. Just a PM done a couple of weeks ago....may be related???? Anyway I will be calling service today. Brenda, have you seen more "?" on the B cell when the patient is type B?

[Brenda K Hutson]

I asked my Techs. today about patients who are group B or AB (though obviously, that would represent a much smaller population). They have not noticed these reactions with B Cells. My predecessor is out-of-state at the moment but happened to call a little while ago. She said they had this happen before and that it had to do with changes in the computer program. She said the Service Rep. came out and adjusted the camera (as another responder mentioned) which seemed to help (though that was just 1 of our Hospitals; would not seem to me to be a camera issue at both locations, at the same time).

Not having a good understanding of how the ProVue works (yet; but I will; I always want to know the "why" of things), I am at a loss at this point. I have run out of "patterns" I know to look for.

Thank you all for your replies.

Brenda

Brenda, we also have seen quite a few "?" on the A1 well. It is getting to be a real pain to have to look at all of these. Also, I am afraid that techs will get complacent and will assume that "it's just the A1 cell acting up again" and not really take a good look at the well. Just a PM done a couple of weeks ago....may be related???? Anyway I will be calling service today. Brenda, have you seen more "?" on the B cell when the patient is type B?

[Eagle Eye]

I asked my Techs. today about patients who are group B or AB (though obviously, that would represent a much smaller population). They have not noticed these reactions with B Cells. My predecessor is out-of-state at the moment but happened to call a little while ago. She said they had this happen before and that it had to do with changes in the computer program. She said the Service Rep. came out and adjusted the camera (as another responder mentioned) which seemed to help (though that was just 1 of our Hospitals; would not seem to me to be a camera issue at both locations, at the same time).

Not having a good understanding of how the ProVue works (yet; but I will; I always want to know the "why" of things), I am at a loss at this point. I have run out of "patterns" I know to look for.

Thank you all for your replies.

Brenda

During your PM if camera adjustment was off then you would see this and yes # of B & AB patient are less, you would not notice it. We have seen this on more than one occassion. The rep. came back and adjusted camera...and it was fine.

[blarney]

Brenda,

We also see this problem sporadically, and we check the following things: make sure there are no plasma splashes on the white diffuser plate, dust particles on the outside of the card, any hazy looking areas in gel which could be rouleaux. Also, one of the latest mods that has been added to the Provue is enhanced reading of the ABD/Rev cards to pick up any possible subgroups or reverse discrepancies. The techs just review the card manually and approve. If anything looks suspicious, we just repeat in tube. Sometimes it is a matter of asking for a camera ajustment - ask your FSE to show you how to check in the software in the image files if the cards are being read at an angle.

[DANDERS]

I'm having the same issue. I too assumed it was the camera. It's been adjusted and a new one ordered. I thought it was just me. Good to know.

[cthherbal ☆]

We have been noticing it sporadically as well. All have repeated normal in tube. I better keep a closer eye on it.

[galvania]

I have never worked with the Provue /Provue cells but would i be correct in thinking that the A1 cells are always pipetted in the same position in the card? What you could try - ONLY for the purposes of testing out the problem - is to print out the barcodes of the A1 and B cells and then switch them - so A barcode goes on B cells and B barcode goes on A cells. then run a batch. the machine will then pipette the A cells in the B position and viceversa. Obviously you will have discrepant results unless you can work just with plasma samples, in which case, a run of AB plasmas would be ideal! If you get problems with the B cell (which in reality is the a cell), then you know the problem is related to the cell itself. If, on the other hand, you get problems with the A cell (which is in reality the B cell) then the problem has nothing to do with the cell but with the position and you should look to see if there is a problem at that position in the cassettes. hope that makes sense

Anna

[sblanchard]

We have had the same problem for the last 3 months. It seems to start about 2 weeks after we receive the new lot. Our storage practice has not changed. We have had the Provue serviced and the cameras have be adjusted multiple times to no avail. Ortho hotline acts as if this is not occurring all over the country. I think this is a reagent issue for Ortho to resolve. I don't believe all these instruments have suddenly changed. We review the card and move on but I too worry about techs getting complacent about the "?".

[vam3401]

We have seen the same thing on both of our ProVues. It's very frustrating. We have tried all the same troubleshooting ideas that you have. Ortho is telling us "others" are seeing the same issue. We have had our ProVues for almost four years and are just now having this issue. It has to be something in the A1 cells or perhaps the software. We are not repeating testing at the bench, but are just reviewing the card from the ProVue. There doesn't appear to be anything wrong with the reaction! I hope Ortho figures this out soon.

[dcubed]

Field engineer was here last week. Adjusted camera and rebuilt the gripper. Problem solved.

[Brenda K Hutson]

I hear what you are saying. You missed your calling; you should be an investigator!

Thanks,

Brenda

I have never worked with the Provue /Provue cells but would i be correct in thinking that the A1 cells are always pipetted in the same position in the card? What you could try - ONLY for the purposes of testing out the problem - is to print out the barcodes of the A1 and B cells and then switch them - so A barcode goes on B cells and B barcode goes on A cells. then run a batch. the machine will then pipette the A cells in the B position and viceversa. Obviously you will have discrepant results unless you can work just with plasma samples, in which case, a run of AB plasmas would be ideal! If you get problems with the B cell (which in reality is the a cell), then you know the problem is related to the cell itself. If, on the other hand, you get problems with the A cell (which is in reality the B cell) then the problem has nothing to do with the cell but with the position and you should look to see if there is a problem at that position in the cassettes. hope that makes sense

Anna

[sdweaver29]

I am glad to hear that others are seen the same problem I have been fighting for quite sometime. As a matter of fact the whole thing got to be too much that I loss confidence on the instrumen. Which is soon to be replaced, mostly because Ortho forgot what matter most- THE CUSTOMER.