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Echo Problem


L106

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We are seeing a lot of unexplained reactions on the Echo since we started using the Echo Antibody Screening Strips Lot # 535 and the Ready ID Panel Lot # ID239 the last couple days.

 

The Echo Antibody Screens are Positive, many cells of the Ready ID Panels are Positive, but "Extend" panels on the Echo are Negative.  (The Antibody Screenings by manual tube testing with PeG are all Negative.)

 

Anyone else having a problem lately?

 

 

Donna

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On Friday Immucor Service suggested that I clean the washer manifold and try a different lot # of indicator cells (which we had just received, fortunately.)  I did those two things and the Echo behaved nicely over the weekend.  (So far, so good.)

 

(Still, it's strange that the Ready-ID panels were always trashy or up to 3+ positive, but the Extend panels were just fine.)

 

Donna

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We had been seeing this problem for several months, different lots and having to use our backup gel method and report those results.  The last lots of screening cells we didn't call as we switching to the Provue.

 

Same here.  This has been an ongoing problem since the summer.  At the end of the lot, every antibody screen had ?'s.  Very irritating.  I clean the washer manifold every week and decontaminate twice/month.  Still have this problem.

Edited by jayinsat
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The same happened to us over last weekend. Techs having tons of problem with false positive results on RS lot 547. They sent service out and replaced a couple parts but the problem continued. They had sent one box of another lot (553) which seemed fine, so we called and had them replace our entire batch with that lot.

 

Our Ready ID lot right now (ID241) is completely worthless, a couple of techs are calling the random ?, 1+ and 2+ results 'warm autos' and sending to reference lab. Think we need some re-training! We try to go straight to Extend I or II depending on the situation and have no issues.

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We have had these problems intermittently with the ECHO.  This will be our third winter to have it and these non-specific reactions seem to increase in numbers around the middle of February.  I live in Texas and have wondered if the weather or humidity at that time of the year affects the testing.  So far, we are not having more than the usual number of non-specifics.  Disinfecting and cleaning the manifold may help for a day or two, but the non-specifics soon start again.  We have a workflow for these problems.  We usually perform a gel screen while we are doing the panel on the ECHO.   Usually, the ECHO is non-specific and gel is negative.  These patients routinely have negative DATs and compatible crossmatches on the ECHO, which seems to demonstrate the problem is caused by the screening and id strips.  Very frustrating!!

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did anyone get a reply from service.  We too are seeing the same.

 

also, does anyone have a form they use to document service or error calls and follow-up.  We just went live in November and realized it would be good to have a running log for this.

 

any help will be appreciated.

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did anyone get a reply from service.  We too are seeing the same.

 

also, does anyone have a form they use to document service or error calls and follow-up.  We just went live in November and realized it would be good to have a running log for this.

 

any help will be appreciated.

 

Service suggested I clean the washer manifold and use a different lot # of Indicator Cells.  That seemed to help (at least, for a while.)

 

Yes, a Service Log Sheet is very helpful.  Ours just has our facility's name and location as a header on the top of the form, then the rest of the page is just a lined sheet.  I document the date and handwrite what the problem was, the Service Case Number, and what we or the company did to fix the problem, etc.

 

Or, you could keep a service log in your computer (ie: a Word document.)  Just make sure your staff can access it so they can record problems and look up previous problems and solutions.

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We had Ready ID Lot 239 and kept getting positve reactions in cell#4 when not expected, I called service and they sent a new LOT# and it is working better so far....... No explanation for problem was given except it may be a donor related issue.

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This week we are having a drastic recurrance of our problem of Positive Screens (lot # 535) on the Echo.  Panels are all Negative (except as RW00D27 mentioned above; every patient we test with the Ready ID Lot 239 Cell #4 gives a Positive reaction.)  For example, 5 our of 7 patients tested gave 3+ reactions on all 3 Screening Cells.

 

I called Immucor and they sent me a new lot # of Screens (lot # 557).  Retested 4 of our problem pts with the new lot # and they all worked perfectly with the new lot #.

 

(Immucor has not offered me any explanation for the problem, which makes me very concerned.)

 

Donna

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This thread is concerning me greatly.  We have been seriously considering switching from manual gel to the Echo, but if this is a recurring problem, I don't know that I want to do that.  I understand that no method is perfect, but the fact that there seems to be no explanation from Immucor is very disconcerting.  I am especially curious about those folks who are switching from the Echo to the Provue.  Why did you make that decision?  Also, the Ortho rep was here yesterday and says that their long awaited updated analyzer will be released shortly in the US.  Anyone in Europe already using it?  How different can it be?  Thanks for your input.

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What drove our decision was that we were a long time manual gel user before our administration made the decision to go to the Echo.  We were seeing all of the problems described in this post and were using the manual gel as a backup.  When our contract was up, we went to the Provue.  You can contact me off line if you like.

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I don't know if this will help any of you with these reactions or not.....

 

We have 2 Echos and recently saw an increase in non-sensical reactions on one of the Echos. I did all of the things you normally think of as in cleaning the wash manifold etc but then I checked one other thing. The probe rinse tower.

 

Move the probe off to the right so it is out of the way. Remove the cover from the top of the rinse tower. It's held on by one screw in the back left corner. This is a captured screw so no need to worry about dropping or losing it. When I did this I discovered that there was all manner of "gunk" in the overflow area around the white shallow rinse cup. Enough that it was managing to intermittently get back into the white cup and, I'm assuming, contaminating the probe.

 

After I thoroughly cleaned the tower with RelyOn I did probe rinse and then ran known true positive and true negative specimens and got the expected results. Repeated a couple of the specimens that had problems and they were negative. We have not had a problem with non-specific reactions on this instrument since (it has been about a week).

 

This instrument had just undergone monthly PM less than 48 hours before I checked the probe rinse tower. Obviously the monthly PM does not seem to address this problem in the rinse tower. We are now adding this cleaning of the rinse tower to our monthly PM.

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I am just discovering this thread now and am so glad that I'm not alone. Yesterday, Immucor told me that my currently funky screening and panel results on a specific patient were due to the patient, not the instrument or reagents and I told them that their answer was unacceptable and that I knew other people were reporting similar problems. I just heard a long quiet pause after that.

We were doing very well with the Echo, started using it full time in October then suddenly about 2-ish weeks ago, we are seeing a huge uptick in what I have to now think are false positives. Our only back-up is the tube and I hate thinking that I have to tell the techs that they must use that when we have problems on the Echo (at least sometimes). I am actively working on a workflow/troubleshooting thing for the techs and am anticipating a lot of flack from the older techs who have been waiting for the instrument to "fail" since they don't like change. I can deal with that OK but I sure wish that Immucor would at least admit they have a problem they are dealing with, offer to send new lots, something. Today I plan to call them and ask for replacement screening strips and ABID strips. The controls may look lovely but more and more results are not.

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I am just discovering this thread now and am so glad that I'm not alone. Yesterday, Immucor told me that my currently funky screening and panel results on a specific patient were due to the patient, not the instrument or reagents and I told them that their answer was unacceptable and that I knew other people were reporting similar problems. I just heard a long quiet pause after that.

 

 

Good for you, Carrie!!

 

Our staff loved our Echo for the first several years, and no one was a bigger cheerleader for the Echo than me.  But there have been a lot of problems lately, and I am disappointed at Immucor's lack of response and failure to resolve the problems.

Edited by L106
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recently seen missed anti-jka on a patient who had a history before.

Echo gave negative screen but tech ran ID and only 1 cell weak postive on ECHO.

Tube with PEG gave clean anti-jka (1+ to 2+).

 

Now, this type of problem I have not heard of lately.

 

Donna

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recently seen missed anti-jka on a patient who had a history before.

Echo gave negative screen but tech ran ID and only 1 cell weak postive on ECHO.

Tube with PEG gave clean anti-jka (1+ to 2+).

But remember when you compare two totally different methods you are going to have discrepancies (Not all methods will detect all antibodies all of the time). While we would like to have 100% correlation, that's not going to happen. Would you be equally concerned if Echo detected the Jka  but PeG "missed" it?

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Thanks L106. I used to be a vendor for a medical device company and I learned a lot about how vendors are trained to respond to customers. So I have at least a little bit of a sixth sense when they give me answers that don't make sense. I know that when they receive enough consistent complaints, they have hardware and software groups that are supposed to investigate the problems in detail and consider changes to the SW or HW. So its very important that we all stay on top of problems we see and report them!!

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We have been having the same exact issues with Pos reactions almost all the way down with

Ready ID lot 237 and if we run either Extend panels they are totally negative. My techs are doing extra work...Immucor said yesterday as is the standard answer to change the indicator cells and service on line said she did a quick query and didn't see too much of this problem. Really. I have had issues this time of year also in years past with screening cells but not the Ready ID. it is very frustrating.

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