CMCDCHI

I just run the old controls with the new lot kit.  Never had a problem with inspections.  My anticipated results are positive with the old and new pos cts and negative with the old and new neg cts.

Ask your blood supplier if they can give you a list of their charges with CPT codes attached. If there is a CPT code, you can charge for it. If there isn't, you eat it. The STAT, call in, import fees, etc. are the ones with no CPT codes. I bill much like Teristella. If I do it, I bill for it. If reference does it, I only bill for it if it doesn't duplicate my charge. Exceptions might be antibody screen and antibody ID - those can be billed separately for each method used. My panels and screens are usually done with solid phase. Reference uses tube, sometimes gel. Those additional screens and panels can then be charged as different media. For ID panels, you can charge for each panel AND media.

One thing that I have not understood throughout this thread is, in the case of antibodies/antigens that show dosage, and I know that the number of antigens for a particular specificity varies with the human source of the red cells, if the antibody/antigen reaction is showing dosage, surely it doesn't matter how many examples of red cells expressing "heterozygosity" are used, they are still going to have negative reactions.
Surely, cells expressing "homozygosity" is the way to go, if they are available?
:confused:

I was a key operator at my last job for the erytra. Fantastic instrument! It is incredibly quick, easy to understand, and I had very few errors with it's use. Also, TRUE stat function! We did have a problem with HLA antigens in our screen cells, that lead to a lot of unnecessary panels being run. After contacting Grifols, they quickly adjusted their donor screening process and the subsequent lots were clean. I was very satisfied with their customer service, and willingness to modify their products and software for their clients.

We went live on our Erytra over a year ago. We're very happy with the analyzer and I love working with grifols.

Went live with our Erytra in February (used to have a ProVue).  The staff has been extremely happy with the switch...especially our 2nd and 3rd shifters who are covering more than one department.  True random access, great traceability, & responsive company who are already implementing our suggestions.  

It's definitely possible.  Many our patients are running a fever for one reason or another.  It's up to the physician to transfuse, as it is for any other patient, acutely ill or not.
Scott

We transfuse febrile patients regularly. The nurses look for an elevation in temperature (1.5 C) above the starting temp to call a febrile reaction. I don't feel that we are doing a large number of workups simply because the patient transfusion started with an elevated temp.

Perhaps it is not a false positive KB but rather a "false negative" flow?  One of the reasons for false negative KB is incompatibility between mom and baby.   If specimen for flow was allowed to sit for a while, could it be possible that baby cells were destroyed by mom's antibodies?  

Just curious: Other than common sense, is there a regulation that says coolers or blood boxes/transports need to be cleaned?
Obviously, if there is some overt issue, they should be cleaned, but in practical terms, the OUTSIDE of blood bags do not claim to be clean/sterile. I can't imagine that the coolers themselves are taken into "clean" areas like ORs, but if they are, that's a different story - they should be clean INSIDE and OUT. While the Blood Bank is probably cleaner than the "smoking" shack, I'm sure it's not claimed to be clean in the clinical sense.
As a parallel.....how often are blood storage refrigerators and freezers cleaned? Certainly not every time they are used.
Perhaps more focus should be on coolers returned with noticeable blood contamination: where did it come from?, was the blood inside compromised?, did a unit of blood with a hole in it get transfused? Of course, that still implies an inspection process, but doesn't necessarily mandate cleaning.
Just a few brain drippings, no soap box or intent to offend.

Yes!  The paperwork for the J survey is always a nightmare!  If I could look at one "patient" at a time, that would be great!

Yes!  The paperwork for the J survey is always a nightmare!  If I could look at one "patient" at a time, that would be great!

I could've sworn CAP said that the data entry was better this year.  It is still taking me 30 minutes to enter results for the DAT survey.  {Rant over}

Yes!  The paperwork for the J survey is always a nightmare!  If I could look at one "patient" at a time, that would be great!

Yes!  The paperwork for the J survey is always a nightmare!  If I could look at one "patient" at a time, that would be great!

Yes!  The paperwork for the J survey is always a nightmare!  If I could look at one "patient" at a time, that would be great!

Found early mornings and evenings are best.   A martini in hand doesn't hurt either.

I could've sworn CAP said that the data entry was better this year.  It is still taking me 30 minutes to enter results for the DAT survey.  {Rant over}

That makes sense, Malcolm, and I agree - but then there's that pesky IS incompatible crossmatch...
Generally speaking, my techs don't like an IS incompatibility!  So we give O.   Or B, if the patient is AB.

I had a tech tell me one time (long time ago) that he could not find K neg units. All of the units of RBCs he tested were K antigen positive. He was reading his tube typings microscopically! Probably a trace of another antibody in the antiserum (human).

Many years ago, Peter Issitt stated that microscopes should be banned from Transfusion Laboratories (I think it was in the orange edition of his book) except for such tests where cells are being counted (such as the Kleihauer).
Many years after his wise words, I still follow his advice, and have not (yet) been involved in a missed weak antibody that has caused a clinically significant haemolytic transfusion reaction (43 years in the job), and many of those tests were performed in opaque tiles and then, as we "modernised", tube techniques.

If the tube testing showed 2+ or less reactivity with anti-D reagents (same as used on Echo) I would suspect that the reason for the negative results on the Echo is that the reaction was shaken away during the resuspension step of the testing.
Remember that Echo has an algorithm that it follows for resuspension. Shake so many times, swirl so many times etc. This can cause weak reactions (their limitations and warnings state 1+ or less) to be interpreted as negative by the instrument.
Techs who are resuspending a button in a tube are visually looking for an end point and immediately stop shaking the tube when the cell button is resuspended whether that takes 5 shakes/swirls or 15 shakes/swirls......Echo can't read for an endpoint in that same way, it must follow it's algorithm. Additionally techs consciously or unconsciously will adjust the intensity of their shaking in response to what they are visualizing. A good way to demonstrate this is to take that same specimen and have a tech who doesn't know what the reactions have been resuspend it with their eyes closed. Tell them to shake it for say 15 seconds and then see what the reaction looks like. It's a fun experiment.
Having said all of that.....if you see this often you can always have your FSE come in and adjust the resuspension step.

I'm none too sure that I would count LISS as an enhancement medium, but I would definitely count PEG, albumin and enzymes as enhancement media.
We use pre-warmed LISS IAT almost every day in the Reference Laboratory, although we use column agglutination technology as the first "line of attack".
When I started training at the Blood Group Reference Laboratory in circa 1973, pre-warmed saline IAT (with an hour and a half incubation) was the norm. The 90 minutes incubation was largely because that was how long Rob Race and Ruth Sanger took for lunch in the MRC Blood Group Unit, and the BGRL adopted this technique!!!!!!!!!!!!!

We've been running on our Erytra for a while. I really like it, but I'm not thrilled with the range of their reagents. Only one panel has been limiting for us. We found it easier to continue purchasing our ortho panel A and IgG cards. I'm also not thrilled with their service department, but I'm hopeful it will improve.

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