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Automation in Blood bank


WFMB

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Well we have a bed count of around 140 and recently bought an Immucor Galileo Echo (solid phase)  which is designed for smaller labs. What may be more important to know is what is your daily volume of types, screens, antibody Ids etc within the Blood Bank. We have no outreach so we see samples one or two at a time only on all three shifts. So the Echo works well for us but can take several samples at one time. I have heard that the Ortho Diagnostics Provue is only appropriate for very large labs and there were two of them at a lab I worked for that transfused about 3000 units per month. Personally, if you are short on staff, I would avoid the manual Ortho gel as you still need someone to sit there to do the incubation etc manually. Hope this helps.

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  • 1 year later...

I'm resurrecting this thread to pick your brains!!! - we are looking at automation as well.  We have generalists (core lab) in our hospital - transfuse about 275-300 RBC per month.  We are do manual testing currently - tube ABO/Rh and gel for screens and antibody idents.   And... we are looking at automation.

On my radar?  The Ortho Vision, Immucor Echo and the Biorad Tango (the IH hasn't yet been approved for use). 

I'm curious to hear any thoughts from you all.  What you like, didn't like, cost... How switching from gel to other methods went over...

s

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Why would you want to switch from gel?  If you go to solidphase, you don't have a mirror back-up to run on the bench. Furthermore, its quite the learning curve to move from gel to reading/reviewing solidphase, particularly with the '?' and NS the plaques solidphase (search on this site to see all the posts) Staying  with the same vendor will minimize new vendor qualitfacation, validation (on bench), etc. Gel historically has been the easiest to read, interpret and train-particularly when you have generalists as you mention that are more used to pipetting (bench method at least). Check out the MDBuyline data, it has given the VISION great reviews recently. 

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Well, I don't WANT to switch from gel.  :wacko:  But, when it comes down to it, I think the solid phase (the Neo anyways) is less expensive than the Vision.  I really like the look of the vision, and a couple of hospitals in our area have just started using them and seem very happy so far.

The reasons you state above are all the reasons I think staying with gel is the right choice for our lab.

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We switched from gel (used it for 6+ years) to the Echo and it really is not that big a deal. We LOVE automation. I'm not sure why solid phase has kept such a scary reputation. It's different, but so is gel compared to tube and many of us have managed that change. And it has evolved over the last 10 years so it's important to consider when an article was written and how long its been since someone else's experience with the method. (And there are individual lemon instruments out there - from all vendors.) As Blood Bankers we seem to be pretty reluctant to jump into the unknown to change things. Me included! But once we've made the jump we wonder why it took so long to do it.

Except for me, everyone is a generalist here and they were all up to speed with solid phase in a very short time. There are some '?' results - most of the time it doesn't mean there is a problem, just means the result is borderline and someone needs to verify the result as positive or negative. You will get perfectly fine results for the vast majority of patients. It doesn't take very long to get a feel for which way the decision needs to go and there is a nice guidance document (with photos) to help. If you have a process map for your staff, they'll know what to do those times when the '?' needs evaluated with additional work. As far as backup is concerned, there is a manual station for Immucor solid phase. It's very similar to using a manual gel station. I've never bothered to validate, though, because the Echo has been so reliable we are rarely down (and then not for long). When our 4 year contract for the Echo was up I had the option of switching to a Tango or returning to gel with automation. I decided to stick with the Echo. We are a 150 bed hospital using one Echo. We do lots of clinic work in addition to our inpatients. I know of a major university hospital that is running 2 Echos and their workload has to be MUCH MUCH larger than ours.

Look at all the instruments with an eye toward safety features and ease of use. There is often one instrument (in chemistry, hemo, any section you name) that stands out in these categories. Do site visits to see them in action.  How do they handle stats? Do you have the physical space for it? How are the reagents stored - room temp? refrigerator? - do you have the space to store them. How long will it take to get a service engineer out to you? Look at the CAP (or other) survey results - how well does the instrument/method perform on the surveys? Think about your patient population - do you see lots of antibodies? weak backtypes? warm autos? - how does the method perform with those types of patients. Check for the latest literature for antibody detection performance. Is the maintenance on the instrument going to be a burden? Cost (sadly) is a major consideration - can you work a deal with the vendor to get your preferred system at a better price? I always like to ask not what someone likes about the instrument/method, but what they don't like. That may tell you things you don't think to ask.

Bottom line - they all have FDA clearance, so they will all do the job. One may fit you better than the others, but they will all safely deliver good patient results.

 

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Wow!  Thanks for such an amazing, well thought out reply! 

I said Neo in an earlier post - I did mean Echo. 

We had a rep out here the other day who put on a presentation for the Neo/Echo.  All the staff loved it.  And we love the idea of automation.  It just seems like such a big change to go to a whole different technology.  The rep also mentioned that we would have the manual back up included.

We are definitely getting out there to check out some other lab set ups.  I have a long list of questions (as I always do!!!) for each of the other labs and I will definitely be adding a couple more points from the post above.

Fingers crossed - I think automation is so important.  So much safer and freeing up the tech to do work other than manual pipetting is so appealing!

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6 minutes ago, tricore said:

Have you looked at the Grifols WADiana?

I had not!  Honestly, I had to google it because I had never heard of it!  In our area, I know other labs have old Provues, Visions, Echo/Neo and a couple of Tangos...

Do you have experience with this analyzer??

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1 hour ago, AuntiS said:

I had not!  Honestly, I had to google it because I had never heard of it!  In our area, I know other labs have old Provues, Visions, Echo/Neo and a couple of Tangos...

Do you have experience with this analyzer??

It's essentially the ProVue.

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Our company is implementing all three Grifols analyzers - Erytra, Wadiana, and DG reader. One of our hospitals currently live on all three.

Total 9 sites. The Erytra and Wadiana are interfaced to LIS for both download and upload. The DG Readers are upload only.  As Goodchild said, the Wadiana is essentially a ProVue.

The Erytas are at our two large hospitals (have all three), one is a Level One Trauma Center. All sites will have a DG Reader. Commercial Lab, and two other hospitals will have the Wadiana.

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21 hours ago, BBKT said:

I work at two hospitals (100+ beds and 250+ beds) - one has Echo and one does gel.  Personally, I prefer gel.  There seems to be less "false positive" reactions with gel. 

Solid phase is very sensitive to warm autos, though I wouldn't call those 'false' positives - they are more a pain in the tush. Repeat the screen with PeG or LISS. If the repeat screen doesn't react, do an AHG crossmatch with that enhancement - good to go.

Solid phase on occasion will pick up a non-specific reacting antibody. Run a panel (or 2) and rule out all common clinically significant alloantibodies, do an AHG crossmatch with solid phase - good to go. There are facilities who've done retrospective studies which seem to be showing that up to 30% of these types of patients at some facilities (this would depend on the patient population) are in the process of making an antibody that will be identifiable at a future visit. We've seen a couple of patients that seem to fit in that category. Another thought for these reactions is that the patient is actually demonstrating an antibody to a crypt antigen on the screen/panel cell. The crypt antigen is exposed because of the way the antibody screen and panel cells are prepared for microwell testing.

Personally, I was vaguely dissatisfied with gel. When we were using gel, there were too many patients that we had to perform tube/PeG antibody IDs on to identify weakly reactive antibodies. We could tell there was something there in gel, but there weren't enough/strong enough reactions to ID. With solid phase, some of these same patients  were reacting 2+ or better.

I'm willing to trade a few annoying 'false' positives for the increased sensitivity of solid phase. My 'no interpertation' rate is usually under 2% of our antibody screens. We do about 400 ABS a month, so that's anywhere from 8 -12 questionable patient results on average, some months can be few more. But again, consider your patient population. I see a lot of patients with no history and frequently transfused patients, percentage wise, in our patient population. The increase in sensitivity is a good thing for us.

 

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