Brenda K Hutson

You are correct, it is a high throughput machine. We are also a small hospital (about 180 beds). We use automation for the simple reason that we utilize mostly Generalists....so I just feel more comfortable with it. We previously used ProVue's (had 2) and there was never any question that we would stay with GEL....I love it! We did go look at both the Vision and the Erytra. We found the Vision to be very noisy. In addition, we had not been satisfied with the response by Ortho to our continuous complaints regarding one of the engineers they sent to us. So our issues with Ortho also played into our decision to go with Grifols. We did not have to modify our Lab (moved into new Hospital a few years ago and the Transfusion Service and wall space was actually quite large). We had 1 of our ProVues on a bench against the wall, so just moved that out and put the Erytra there instead. We also purchased 2 manual workstations and the DG Reader for manual reading (previously performed manual reading just visually, but I like this feature). Obviously it is more than what we need for our workload (can accommodate 96 specimens; 400 cards; 4 reagent racks; 2 probes for simultaneous aspiration of 2 samples at a time; can hold 16L each of solutions A and B if you have an external drain; 8 each if you do not). But I liked the keyboard and all of the information it allows you to access regarding anything/ everything going on. Just think it has a lot of great features so looking forward to getting the training completed and moving on with it. Since we are still in process of performing correlation testing (we did complete validation), I cannot yet comment much on reactions; difficulty of reading wells; sensitivity; etc. Will let you know more as we go along. Brenda

There are many card options available so you can select the combination that works for your processes (so you do not have to purchase cards for which you do not perform the testing). The machine will effectively utilize the cards to utilize all of the wells. Brenda Hutson, MT(ASCP)SBB

With ProVue's phasing out, there are likely some of you out there assessing what to get for replacement (Vision; switch to Immucor Solid Phase.....or, Grifols Erytra). We just purchased (and are now validating) the Erytra and I really like it (and NO, I promise I do not work for them and have no vested interest here). If anyone would like to know of our experience thus far, would be happy to share. NOTE: We previously used ProVue's (and I have used Solid Phase elsewhere). Thanks Brenda Hutson, MT(ASCP)SBB

Ok, I will answer my own Post (should have looked in Technical Manual in the 1st place). I think my predecessor just misinterpreted (or got the wording mixed up) what it said in the Technical Manual. Says 1C usually acceptable, but if >1C, have 3 options......return to distributer, have a correction factor, or discard. Ok, mystery solved.....Ugh.... Brenda

Well, that is "according to our SOP" also (apparently, for quite a few years now); but the author (my predecessor) as well as the 2 Leads that have been here even longer, had never noticed that statement at the bottom of the page (so obviously, were also not following it). So we will now have a LOT of explaining to do!! I still am not sure which direction I will go.....I have been doing this for 34 years now and in multiple Institutions and do not recall ever having a correction factor. Oh...... What to do....what to do? Brenda Hutson, MT(ASCP)SBB

Just takes time and practice (really) for staff to learn to use Safe-T-Vue correctly; but eventually they get it. I did make my staff practice when we first started using them.....and part of my annual Direct Observation on Emergent and Massive Protocol is that they have to successfully place a Safe-T-Vue 6 monitor on a unit. Brenda Hutson

While that is a true statement, I think you will find very few places that are quite that extreme.....mostly because I am thinking that probably 99% of the units we send to a Nursing Unit, are never returned (so that would be a lot of wasted, expensive temperature monitors). Plus you need to give them a little bit of the benefit of the doubt (i.e. that they would not place a unit of blood on a radiator....or some other such thing). I could be wrong, but have just never heard of places using temp. monitors on all RBCs going to a Nursing Unit. And even though we are taking the temp. of units coming back, we probably still all say they have to be back in <30 minutes such that hopefully, any extreme situation (like sitting on a radiator) would be evident upon return in such a short period of time?? I am thinking...... Now coolers are another thing......especially in emergency situations. We KNOW they take units out (because having the cooler sitting right beside the bed is not close enough....they want that unit sitting right by the person's head.....ha ha); then they return the unit to the cooler. And when it comes back with an unacceptable monitor, they swear they did not remove it from the cooler. At one place I worked that sent coolers to OR, my predecessor would accept the unit back as long as it was "cool" upon return. Um Hmm....... Just my thoughts.... Brenda Hutson

Our computer has a set place to just say Acceptable or Not Acceptable....but then there is a place to free-text the actual temperature. Brenda Hutson

But how do you REALLY feel Malcolm?! LOL......just giving you a hard time. Brenda Hutson

We use Safe-T-Vue 6 for ER, OR and L&D coolers (no one else can have coolers in-house). We send units in coolers to our Cancer Center (building is very close to us) and we validate those annually using Safe-T-Vue 10 monitors. We do not use monitors for anything else (other than annual validation of in-house coolers). I have used others in the past but prefer these. Actually, what I liked best were the ones that were made of glass and had a gel and charcoal pellets.....but I am "assuming" those were discontinued because glass and a blood bag don't mix well?? And I agree, the 30 minute rule is out. You need to actually take the temperature when unit is returned. Brenda Hutson

So I think I recall something about "not posting a question on >1 site," but I think this Forum is followed much more often than QC, so sorry if I am going against the rules..... So in reviewing some new thermometer calibration records, I just noticed a paragraph at the bottom that my predecessor had written about acceptable results. Problem is, neither my Leads or my Predecessor remember anything about it.....nor have we been following it. But then I am not convinced it is an accurate statement but wanted to throw it out there before changing it. So we calibrate the new thermometer (or existing ones if it is for annual calibration) against a certified thermometer. So what the paragraph states for acceptability is: If there is a difference of + 1C, this is acceptable, but a correction is required. Affix a label to the thermometer indicating the correction factor. So the way I would interpret that (and as I said, the ones who have been here for many years longer than I cannot explain it) would be that if for example the new thermometer is 0.5C higher than the certified thermometer, a label must be affixed to the thermometer that lists the variation (i.e. +5C) and that everyday then when you take the temperature of that thermometer, you have to add 0.5C to whatever it is reading. I have never heard of that. My inclination is to say that if the thermometer being calibrated is < 1C of the certified thermometer, it is within an acceptable range....period. But if the above statement is correct (or a variation thereof), PLEASE let me know. Thanks so much, Brenda Hutson, MT(ASCP)SBB

So in reviewing some new thermometer calibration records, I just noticed a paragraph at the bottom that my predecessor had written about acceptable results. Problem is, neither my Leads or my Predecessor remember anything about it.....nor have we been following it. But then I am not convinced it is an accurate statement but wanted to throw it out there before changing it. So we calibrate the new thermometer (or existing ones if it is for annual calibration) against a certified thermometer. So what the paragraph states for acceptability is: If there is a difference of + 1C, this is acceptable, but a correction is required. Affix a label to the thermometer indicating the correction factor. So the way I would interpret that (and as I said, the ones who have been here for many years longer than I cannot explain it) would be that if for example the new thermometer is 0.5C higher than the certified thermometer, a label must be affixed to the thermometer that lists the variation (i.e. +5C) and that everyday then when you take the temperature of that thermometer, you have to add 0.5C to whatever it is reading. I have never heard of that. My inclination is to say that if the thermometer being calibrated is < 1C of the certified thermometer, it is within an acceptable range....period. But if the above statement is correct (or a variation thereof), PLEASE let me know. Thanks so much, Brenda Hutson, MT(ASCP)SBB

Never noticed that before! Thanks. Boy, so glad I posted this....learned all kinds of things! Brenda

Regardless of where you keep them, it would still be "helpful" for them to somehow designate (as apparently Immucor does), what the changes are that they made (which apparently they did because there is a new Version Number/ Revision Date). Thanks Brenda

Yes, just responding to other Posts people had written. I did see it and appreciate it. Would like to see something then from other Manufacturer's as well. Thanks Brenda

Right you are...thanks for the clarification. I just want the Manufacturer to "give us a clue" so we don't waste so much time. Thanks Brenda

So I guess I am not so much talking about them making changes but the Inserts don't reflect it. (because they are still sending out old inserts until they use them up....though that is not good either)....I am talking about Inserts that have a different Version Number/ Date so you know there are changes in there.....somewhere.....but you can spend a lot of time looking for a one word, insignificant change. As long as they are changing the Insert and sending out those new Inserts, it would be "so" helpful if they would (like Immucor) just indicate in "some way," what changes they made (i.e. underline it; highlight in gray; etc. etc.; don't really care what they do as long as they do something). That is good customer service! Thanks Brenda Hutson

Not saying (or meaning) Immune System doesn't work (just that it is weakened in this patient population), but rather that blood not in patient long enough for patient's immune system to detect the incompatibility of say, Rh POS cells being given to an Rh NEG patient (so I am more referencing a patient making new antibodies than discussing pre-existing antibodies). And I get your comment about the dilutional effect of pre-existing antibodies (though wow, kind of surprised they got away with all of that for even 16 hours!!). However, that patient population (the ones that require Irradiated products) does have a weakened immune system which is less likely to be able to protect them from Graft-vs-Host Disease (and the reason they receive Irradiated products). That is why I was still thinking they could be at risk if not receiving Irradiated Products (same "reason" they need Irradiated Products in first place), unless somehow the massive bleeding is also keeping the transfused cells from mounting a response against patient (and that is the part I am trying to learn about). Does dilutional affect keep transfused white cells from being present "in numbers" enough to mount an immune response against patient? I am thinking maybe not because a lot of places do "try" to give Irradiated even to massively bleeding patient, but at some point, if you have to choose between patient bleeding to death and taking the time to Irradiate, you would choose to give non-Irradiated. But just wondering David, am I missing something you are saying (or seeing in my response)? I think I am getting more confused.... Thanks Brenda Hutson

Good point....and that is what I was looking for....an explanation as to why you don't have to worry "as much" about Irradiation in a massively bleeding patient. Thanks Brenda

pbaker, do you happen to know which company sells the sterilized Red and EDTA combo? Thanks Brenda

Thank you Malcolm; that does help. So it brings up that gray area I am struggling with.....in an emergency. It is true that Massive Protocol is always an emergent situation, but my struggle has to do with the fact that if you have the time to switch from uncrossmatched to crossmatched (still Massive Protocol), is the assumption then that you also have time to meet special requirements (we do not use electronic crossmatch yet....so there is a little time involved)? I am leaning towards writing in my SOP that "if time allows," we will Irradiate units for patients on crossmatched MTP who require Irradiated; but that if time does not allow, to obtain a variance from the Medical Director. I will run that by the Head of Oncology and Trauma Docs to make sure they are ok with that. My concern here (and it may just be a lack of understanding on my part) is that while I understand the theory behind the decreased risk of antibody formation say in giving Rh POS to Rh NEG (etc.), I am thinking that the issue with Irradiation is the opposite....that the reason we give Irradiated is because the patient already has a weakened Immune System and yet Irradiated products are still required to prevent the risk of GVHD. So in my mind, I would think this would put them at a greater risk of GVHD (giving non-Irradiated to a patient massively bleeding) if we are only considering the Immune System status of the patient (i.e. since the problem in GVHD is the cells you are transfusing attacking the patient.....which I am sure you know), but perhaps the excessive bleeding, also does not give the transfused cells a chance to mount an immune response against the patient?? That is the part I have never really thought about. In getting feedback from some other Hospitals, there are some that do state that once they are on crossmatched massive protocol, they give Irradiated Products (if required) and only get a variance if they cannot keep up with the need. Obviously, if the choice comes down to a patient bleeding to death vs. giving Irradiated products, we would opt to give non-Irradiated products (at least I have that part clear in my head ). Thanks again........ Brenda Hutson

I brought this up many years ago to one of the Reagent Manufacturing Companies (cannot recall now which one it was....Immucor, Gamma or Ortho....or maybe one of the ones that is no longer around). When changes are made to Manufacturer's Inserts (and they can be as minor as a change in 1 word, which we can spend a long time searching for), it would be really nice if the Manufacturer would indicate the changes on the inserts (i.e. maybe italicize what is changed; or underline it; or highlight it......just give us a clue)! We want to catch the significant changes, but not spend an hour reading and re-reading the insert to find the ever-so-subtle and non-significant changes. Thanks for listening, Brenda Hutson, MT(ASCP)SBB

I know the Immune System protection works where antibodies are concerned during massive transfusion.....just not sure when it comes to Graft vs. Host Disease? I will have to try and read up on that. Thanks Brenda

So there is such a thing as a sterilized EDTA? Interesting....but I agree, why pay for that extra tube; not worth it. But I doubt that is what all of the Hospitals are doing who have "found a way" to use EDTA tubes for cord specimens....so would love to know what "their" process is. Thanks Brenda

Would you be able to find out: 1. Are the tubes you are getting sterilized (I am pretty sure not....don't think they could be)? 2. What is their process for putting the cord blood in this "non-sterile" tube (i.e. are they changing gloves; wearing same gloves; just don't see it as an issue to use same gloves; or what?). Obviously a lot of us would like to know how your Hospital (and many others) can do what ours are refusing to do.... Brenda