C3 testing on Positive DAT's

[ChrisH]

Hi everyone,

I was wondering what smaller hospitals are doing about c3 testing. We are doing only about 12 C3 tests a year, so that the Positive QC is real expsensive for us.

And if we want to send it out to our reference lab they want to do All the DAT and eluate if needed (which we may have already done).

If you are not doing the C3 are you putting a disclaimer on the report and if the doctor wants a C3 you would then send it out?

What are your inspectors saying, if anything.

Thanks

[PAWHITTECAR]

ChrisH,

We are currently "doing them" though the only ones we have done in the last 12 months were 2 on transfusion reactions. I looked into doing away with C3 totally but the CAP checklist question about testing for RBC bound complement. I did the math and would save $2700+ dollars a year if I could do away with C3 but I have not figured out how.

[David Saikin]

You might run polyahg and, if positive, anti-IgG. I don't know if you would want to assume that if the IgG was negatve you were seeing a C3+ DAT . . . I have seen the poly be weak pos and both monospecifics be negative . . . sometimes the cost of doing business seems excessive but - you could always send out all your +DATs and just run polyahg.

[PAWHITTECAR]

That is what I suggested but the "pathologist" that floats through once a week wasn't convinced.

[tbostock]

We do Poly AHG, and if positive, we run IgG. That's it. If the physician wants it, he/she orders just the complement, which is a reference lab send out for us. Unfortunately they require a different tube type, so the patient has to be redrawn. But these are ordered very rarely.

[Malcolm Needs ☆]

What tube type do they require that is different to (or should that be "from"?) your normal tube type Terri?

Edited January 11, 2013 by Malcolm Needs
Conscience-stricken about grammar!!!!!!

[DOGLOVER]

If you are a small hospital are you part of a larger sytem? We are a 4 hospital system and we run C3s for the 3 smaller facilities, if needed rather than them sending it to the reference lab. Or could one of the facilities that your "once a week" pathologist is associated with, run them for you? This is way more cost effective than reference labs. Sorry Malcolm

[PAWHITTECAR]

We unfortunately are not associated with any other hospital but we do use one of the larger hospitals nearby to do most of our "reference" work as they are much cheaper. I will run this by Dr S again and see what I get.

[Malcolm Needs ☆]

If you are a small hospital are you part of a larger sytem? We are a 4 hospital system and we run C3s for the 3 smaller facilities, if needed rather than them sending it to the reference lab. Or could one of the facilities that your "once a week" pathologist is associated with, run them for you? This is way more cost effective than reference labs. Sorry Malcolm

No problem DOGLOVER; I agree entirely with your thinking.

[tbostock]

What tube type do they require that is different to (or should that be "from"?) your normal tube type Terri?

We send to Quest Laboratories and they require a yellow top...not sure what the preservative is on that one.

[PAWHITTECAR]

ACD - perservitive in yellow top

[Malcolm Needs ☆]

Neither do I, but I can't see why they can't just use a potassium EDTA sample. I am, of course, aware that they cannot use a clotted sample, because of non-specific complement activation, but why not an EDTA sample I wonder.

[Malcolm Needs ☆]

Sorry, I think we cross-posted Trish, but I still don't understand why they want ACD, rather than EDTA samples for this.

Would you mind asking them Terri (in your own time - no hurry)?

[Eagle Eye]

It will require validation for Quest. Quest is a very big lab providing services to physician labs and hospitals worldwide. Making a change would be difficult but it would be a good idea to ask them question. If everyone using Quest would ask they might think about it.

Sorry, I think we cross-posted Trish, but I still don't understand why they want ACD, rather than EDTA samples for this.

Would you mind asking them Terri (in your own time - no hurry)?

[BUGGIE]

We are a small rural lab and for years have sent all Poly AHG Testing out to our United Blood Services reference lab for Anti C3d confirmation as we can't afford compliment coated check cells. We report the initial results and say we have sent the C3d out for confirmation, we only request the C3d and that is all that is done. For all the non-neonatal DATs we do it is much less expensive than ordering Compliment coated check cells. It has always been an EDTA sample as well.

[ChrisH]

We had an arrangement with our blood supplier to do C3 but they got bought out and no longer do just C3 they want to do the whole workup which would be duplicate. We are a stand alone hospital, but we do have a larger hospital not that far, I am going to see if they will do just C3 for us.

[mhinrichs]

I am coming in to the discussion late but could you stock the Anti-C3 but only perform QC when it is actually used?

[PAWHITTECAR]

That is what we do but the cost comes from keeping compliment control cells that are not expires. Many months I throw my $200+ bottle of compliment control cells away without ever even opening them. I just feel that it is a huge waste.

[Eagle Eye]

Yes. You are right. The complement control cells are expensive and has 4-5 weeks expiration. To make the process simple we QC everyday and that is how we are able to finish whole vial.

[PAWHITTECAR]

Still seems like a waste

[ChrisH]

i agree, very big waste/

[PAWHITTECAR]

I think I've got our pathologist convinced to just do the poly and if its positive send out the c3. Not going to change till after CAP gets here. Sometime before March 19

[AMcCord]

Have you checked pricing with Hemobioscience (I think they are the ones that have recently gotten FDA clearance for CCC cells)?

[PAWHITTECAR]

I did that yesterday and they are about $20 a bottle less but I still think that I will try to do away with this testing in house.