Karrieb61

OK, thanks, Our trainer said that running the DAT on the Echo with or after the panel a is what many Echo users do!

Hi all Echo users- we are now in the installation/training process with our new Echo and see that the Capture basic panel does not have an autocontrol. While technically I understand why it doesn't, what do you do for panels where you have no auto control to check against all positive cells in a panel to rule out or an a warm auto?

Yes, I've seen a few posts that bring up the one screening cell "rule out". I know I will get flack about the 3 and 3 as the techs who aren't in the BB often will say they don't have the time to do this. But that's another story....

HI all and my apologies if I've asked this before in one post or another, I just can't keep track these days. Anyway, we have a poor, unclear procedure here for ruling in and ruling out antibodies when reading antigrams. I should mention that we don't do anything beyond routine panels, no enzyme panels or other fancy stuff. We are a tube method, very small volume, lab but within a couple of weeks should be solid state (Echo) users. :D Might as well get a decent process in place now that is applicable to both technologies when cells in the panels are positive. I should mention that most of our techs are crosstrained and can go weeks before working in the Blood Bank. So they all need a decent procedure to have as a reference. Currently, we rule out antibodies based on the first negative homozygous cell we get for a specific antibody in a 10 panel screen (manual, I think the Echo has many more cells for the Echo). One negative cell that should be positive, for example, for anti-C , and out it goes! I don't think that's enough and I know at least the wonderful Malcolm has said this also. Ruling IN is another story. We don't actually tell our techs how many positive cells they need to find to rule IN an antibody that may be overlapping another one. For example, we had a clear anti- Fya the other day where the same cells were positive for anti-C. The tech found one Fya neg cell that was homozygously positive for anti C, got a positive result and declared that the patient had anti-C. But another tech tested a couple of other Duffy neg cells that were homozygous pos for anti C and they were negative. We need clarity! How many cells do you use to rule out an antibody and how many to rule in an antibody. This is a poll. Thanks for your help and Happy Weekend!!

We haven't ordered the automated BB survey from API but will by the end of the year for the Echo. In the meantime, I also am NOT an API fan. We got a fetal blood survey in late but they didn't extend the return time for the survey and it was a stupid hassle to get the techs to find time to fit it in under the deadline. So far, I am hearing that our Chem lab is going back to CAP, per order of our Medical Director, for troponins at least due to failures with 2 API surveys- not sure why but I do know the lab is not at fault for the failures. And the bunching up of multiple surveys at once- yikes! I also miss the follow-up feedback from CAP which we don't get from API. But money talks

Gee, I'd be happy just to have something. Other than some basically free text result entries (type/Rh and "compatible" and free text on a positive screen) in an old Star/McKesson system, we are 100% paper. Talk about waiting for the shoe to drop.

Thanks to all for your comments. I had to take a few days off unexpectantly so sorry for the delayed thanks. We did locate a couple of units through our rare donor registry at the local reference center luckily. I hear they are going to give the patient Procrit to try and reduce his transfusions.

Hi, our local Reference Lab is valiantly trying to find a Vel neg RBC unit or two for one of our patients. He has received many Vel neg units and seems to have depleted the supply, possibly nationwide. Just curious- what, if any, is a "typical" reaction to a patient with Anti Vel receiving a Vel pos unit? None to Severe won't help if I have to chat with the patient's MD about this. Thanks

As an about-to-be- new Echo user, this concerns me a bit. We tell our techs that we are converting to a "better" method (which I AM all in favor of BTW) but when we can't figure out a pattern, we switch back to tube and may or may not do a full crossmatch by solid phase? I anticipate some negative reaction by our techs (no pun intended) when the recommendation is made to switch back to tube and more or less ignore what they see on the Echo when there is no pattern to identify an antibody. Makes you wonder about the confidence level in the solid phase technology. Believe me, I am very excited about getting away from microscopic read tubes, and all the potential problems you can have with tube technology, primarily inconsistency in reading results, but how have you handled it when you've had to say "Oops, not working, lets use tube"?

HI, I just went looking for a thread like this. Yippee, here it is! We are moving to the Echo in September and aside from potential issues with API (which my hospital is required to use), two questions: 1) if we go live in September, are we required to do the next available PT which for API will be in December or can we wait till 2015? 2) Are we required to do PT on what will be our back-up tube method also once we have Echo in place or can we only order the automated PT and just continue with internal competencies for tube testing? Thanks!

OK, thanks so much everyone, I'll look at all of these!

HI, getting ready to embrace an ECHO. We don't have a scale in our lab that goes to 2 decimal places and it sounds like we don't need a big one, just a small precise one. Only quote I got so far was for one close to $900. Yikes! Any other recommendations for the strip/residual saline checks I hear we will need to do? Thanks

OK, thanks Maureen!

Just back from a short vacation and I will check my PMs. Thanks all!

HI all, I am still fairly new to the small blood bank I am supervising and am finding many SOPs where the flow of process just kind of ends with "record on worksheet" with no follow-up, next step, whatever about what to do if a result (ie a DAT) is positive. Many follow-up steps are "understood" here and I want to get them on paper. I'm thinking that a basic flowchart or algorithm type cheat sheet might be nice to use to lead the techs to the correct follow-up step and I could add that that to several procedures. We have many techs who float in and out of the Blood Bank so they don't get constant exposure to some processes and need to rely on written SOPs. If you have a flowchart or something visual for one or more procedures (AB ID, DATs, eluates, ABO discrepencies, etc) and would like to share these, please send me a PM. Thanks and Happy 4th of July to my fellow USA'ers!

Oh boy, so much left to learn, thanks again everyone and comments are still very much appreciated!

Thanks again everyone, my learning curve is helped by these thoughtful comments. ECHO should be arriving on our doorsteps in about a month, wish us luck!

I share your frustrations about RL Solutions which we use at my hospital. Useless for many things including review of corrective action measures etc. I also have a spreadsheet, I code all events by type so I can sort them as needed, I write down my CA, what kind of follow-up is needed and when, and all CBER info if needed for particular events. Works for me. And I have an event report with a number that matches the spreadsheet so I can go back to the raw data if needed. However, we have a very small institution and I can't imagine how effective this would be if you were managing multiple blood bank labs within one big system

Great read but I guarantee that Hubbie will still roll his eyes around his head. We have friends who asked if platelets meant little plates......can't win'em all

Thanks to both of you! I could make a career out of looking at processes in blood banks and setting them "right". Tons of fun!

Hi all, we have a very loosly written procedure for resolving discrepancies between forward and back types that I am detailing. There has been a common, undocumented process here where cord blood cells are used to back type a patient when the patient has a strong cold autoantibodies to eliminate the interference of an Anti-I. Cord cells of the same forward type of the patient are used with the patient's plasma to substitute for the commercial A and B cells. I can't find any specific procedures for resolving ABO discrepancies and our local Reference Lab does not do back types with cord cells. We don't do absorptions or enzyme testing or anything "fancy" here. Do you think it makes sense to continue with using cord blood cells as a back-type cell when auto Anti-I is suspected? If so, I will write a procedure but I wanted to run it by you first. My goal is to get rid of all undocumented practices and provide the staff with genuine procedures for these uncommon scenarios. Thanks!!

I am personally amazed at how many places do a second Type/Rh on the same specimen. That doesn't address the wrong patient being drawn and/or the wrong labels put on tubes. I work now in a small hospital where one set of Blood Bank tubes are drawn with two people in the room and they each initial one of the tubes. This does NOT prevent the wrong identification of a patient so I am hoping to move towards a second "event" for the retype tube. How many wrong-blood-in-tubes leading to a near miss or fatality does an institution need before they have some better system in place to TRY and ensure that the right blood is in the right tube? Bad publicity costs how many $$$$?

OMG, just checking into this thread again and having a good laugh that I needed. For what its worth, I worked in Providence for a few weeks before I realized that the accent I was hearing was not from people from New York. Grew up only 30 miles away in Mass and never knew that RI'ers had their own accent. Dollar is Dalluh, What is Wha (no T) and I'll leave it at that. Then there is the issue of crossing the border from RI to Mass which rarely is done without very good reason. LOL My son in law is from RI so I have to behave now. And my soon to be born grandson will be half-RI'er so I'll have to educate him as soon as he starts talking. LOL again

Well you won't hear any arguments from me about that Dansket. I am always surprised by both nursing and lab staff who insist that they couldn't possibly make an error identifying a patient. Currently we have two people in the room, one draw, and each of the staff in the room put their initials on one tube each. I am saying to them that this doesn't prevent the patient from being wrongly identified just because two of you are in the room. I wish I had a solid standard to back me up as I move this hospital towards 2 separate draws on new patients- oh well! Thanks again to everyone!

Good question, the date on the reference is unknown at the moment. Bottom line is that we need to improve the process here where I work and I find that being able to quote a standard makes all the difference in compliance. Just saying 'best practice" or "suggested by CAP" may not hold a lot of water. Thanks Dr Pepper for the laugh. I live in Mass. so I wasn't aware that this was a RI saying. Learn something new every day.