LCoronado

We are a small facility which uses manual gel technology. We rarely see titers ordered.  However, when reporting an antibody on a pregnant patient (detected and identified in gel) we faced this dilemma: the antibody was so weak it was not detectable in tube. We then started using gel for titers with the understanding that it is the change in titer over time that is significant.  For proficiency, we use the split sample method every 6 months.  CAP and State (NJ)  inspectors have been OK with this.

For years we have been using our QC antisera and rotating one cell from the panel each day and testing it with our routine daily tube QC.  It was not so overly burdensome( one additional cell)  and even though we are testing only one cell each day we make it through the entire panel at least once during the month.  This way we are testing the "panel" if not every cell each day of use and  we have some quality control.  Everyone is correct there is no way to check every antigen so we felt this was a good compromise.

Nope, never did any QC on panels.  Could not see the sense in it.  How could you possibly test for all the antigens!!  As Malcolm says above, "You have to stop somewhere!"  I chose not to start. 

We are a small facility which uses manual gel technology. We rarely see titers ordered.  However, when reporting an antibody on a pregnant patient (detected and identified in gel) we faced this dilemma: the antibody was so weak it was not detectable in tube. We then started using gel for titers with the understanding that it is the change in titer over time that is significant.  For proficiency, we use the split sample method every 6 months.  CAP and State (NJ)  inspectors have been OK with this.

We are a small facility which uses manual gel technology. We rarely see titers ordered.  However, when reporting an antibody on a pregnant patient (detected and identified in gel) we faced this dilemma: the antibody was so weak it was not detectable in tube. We then started using gel for titers with the understanding that it is the change in titer over time that is significant.  For proficiency, we use the split sample method every 6 months.  CAP and State (NJ)  inspectors have been OK with this.

On p. 563 of AABB Tech Manual 18th edition, it only mentions that titer methods other than "saline AHG 60 minute incubation" in tube may result in higher titers and "should be validated with clinical findings" (see Malcolm's post, above).  So it does not seem to say one cannot use gel or other methods, just that you need to document validation.
I have always been a bit uncomfortable with identifying an antibody with gel (for a prenatal), then doing the titers in tube.  But then again, I guess it is the comparison of the series of tube titers that they are looking at.
Scott

Just wanted to comment that starting 6/27/2016 I will become the interim Blood Bank Manager for the Cottage Hospital system in Santa Barbara, California.  Looking forward to the challenges and opportunities this will bring my way.

Greetings, I'm back in the fold again after several years away.  Had to get back in the fray once again as being semi-retired now, I found I still need the stimulation of the verbal joust with my peers! 

We were doing some validation recently and found that a B patient (with a weaker than average reverse type) crossmatched to 3 A units in the MTS IgG card failed to detect incompatibility in one of the 3 units.  Of course, tube testing and Grifols gel also failed to detect this incompatibility.  Turns out that the unit was an A2.  As I recall, the various immediate spin methods also were negative with this unit (MTS buffered gel, Grifols neutral gel and tube IS).  This is why computer algorithms are better at picking up ABO incompatibilities than any serological testing.  The computer can't have either false positive or false negatives (as long as we get the types right).

We do the same as above for scenarios A & B, but for C we treat them like A.  We don't make them register everytime, but if it is within the 3 days, they must keep their armband on.

We have our freezer ranges set to +/- 5 degrees. We've had it that way for so long, I don't remember where I got the idea, but at our last CAP inspection it was challenged. However, while I couldn't find any references for the 5 degree range at the time, the inspector couldn't find any references or regs that stated it had to be 2, or that 5 was not acceptable. We did not get cited and we kept the +/- 5 range.

Have worked with Korchek - they do a good job. I have also heard good things about S&P.

In the olden days (when I was young) we did retest for ABO every time the tube was taken out of the refrigerator for additional crossmatching.  I think the reasons included all those mentioned above.  Now that >90% of our crossmatches are electronic, it really makes no sense.  However, for the few patients who require a serological crossmatch, the rule is still on the books.

We do not have this as a written policy,thinking it's common sense, but I guess it could be an invitation to disaster. The real question is, "How much common sense needs to be spelled out for techs who are intelligent, educated people?" The answer is, "A lot more than we sometimes realize!"

I have two technologists who went through online SBB programs.  They both passed the SBB exam on their first try. 
 
One went through UTMB.  http://shp.utmb.edu/sbb/
 
The other went through Indiana Blood Center  http://www.indianablood.org/hospital-services/education/pages/sbb.aspx

Good idea - this way, you can get your QC done weeks ahead of time! 

Yes Dr. Pepper - Have seen all that too.  Our pen was not calibrated properly on the refrigerator temperature module and it was adjusted several times but poorly.  I found a week where it was reading 7C, but the techs kept reading it as 3-4.  Another week and it was recording a temperature of 0.  The techs that week recorded it as - you guessed it - 3-4!

Well, at least theoretically, ignorance can be corrected by education (if you have time for it!).  But --
 
"Against stupidity, the very gods themselves contend in vain"

Don't even get me started!     The things i've had to deal with over the last 5 years have left me wondering how have we remained acredited.  I have had to learn how to apply the serenity prayer on a daily basis.  It's especially unnerving when the incompetence comes from the department manager.   To have to daily correct your managers errors and oversights, while not appearing to challenge their authority is quite an interesting environment.
 

I didnt start work that long ago and jobs were just done. Benches cleaned daily, centrifuges weekly, weekly and monthly maintenance done on set days - now we have logs as people just don't bother and still they don't get done! Where have the standards gone? Why do people just not care any more?

I hear your frustrations Aunti-D. Unfortunately it is all to common. All we do is put notes everywhere and have forms and more forms for things that are no brainer job tasks.

Yes Dr. Pepper - Have seen all that too.  Our pen was not calibrated properly on the refrigerator temperature module and it was adjusted several times but poorly.  I found a week where it was reading 7C, but the techs kept reading it as 3-4.  Another week and it was recording a temperature of 0.  The techs that week recorded it as - you guessed it - 3-4!

I agree Eagle Eye.
And a Biomedical Scientist/Technician, or anyone else come to that, who says that they have never made a mistake, is a major accident waiting to happen.

Auntie and others, we share your pain. If I may add to the list of pet peeves:
 
1. Starting weekly temperature discs on fridge/freezers on the wrong day and/or time. Then 5 days in a row 5 different techs document that the scribe is OK.
 
2. Not recording medical record numbers and dates on panel scoresheets. Record keeping in general.
 
3. Not printing copies of panel scoresheets on both sides so you get the extended antigen typings on the the back. Not changing the scoresheets when you open a new panel lot.
 
4. Filing QC records etc. with bloodstains (hopefully reagent but you never know) all over them.
 
5. First cousin to the above: finding blood all over the counter, centrifuges, agglutination viewer, outside of the biohazard bin, drawers or cabinets, making you wonder if a worker had been shot or merely had sneezed violently during a torrential nosebleed.
 
6. Discarding packing lists from the blood center so I have to get copies to check the bimonthly bill. Happens pretty much each cycle.
 
7. Finding obviously broken thermometers, pipettors etc. in place. Whoever broke them knew they had done so but decided to keep it secret..
 
8. Not telling you when the last kit, vial, package, bulb or box was opened so you might have a ghost of a chance to order more before you run out.
 
9. I put out a half dozen pens and markers a week. Where do they go? Even if we supply the whole lab we should have reached the saturation point decades ago.
 
10. A tech asked me if it was OK in a pinch to just use one drop of plasma/serum per tube for an antibody screen; another tech had told him that was fine if you didn't have much sample. This was right before last year's competency eval, so I included that as a question. 5 people said it was OK. So we had a little inservice on the value of following the manufacturer's directions, our own P&P, and the need to validate any variations in protocols etc before you do so. I heard a great line a few years ago that went something like "Ignorance ain't what you don't know; it's knowing too many things that ain't so!"
 
Thank you, I feel better.

We record our antigen typing results on paper and put only the interps into Cerner.  However, most of our test results are recorded directly into the computer system.  At one time we were cited by the State for too much double documententation (we were still on paper at the time, using history cards and a log book) because this was percieved as an increased risk for transcription errors.