I would be interested to hear how many Blood Banks refer their KB Stains to another lab, or do flow cytometry instead. We have periodic problems with getting unacceptable answers on the CAP Surveys for KB and nothing seems to be causing this, except that I feel it is a marginal test at best. Only a few techs are "good" at counting these and they get tired of doing them.

Opinions are welcome.

We have problems occasionally also. We keep the techs "fresh" by giving everyone at least one KB stain a quarter. Everyone gets a shot at the CAP survey after it has been sent off and we receive the results. We wait until we have the results in order to ensure we have enough left to repeat the test if we don't do well on the survey.

BC

We dumped them a year ago. I was the only one who could ace the surveys and I got tired of doing them all. Another, larger factor was that we were doing more survey samples than patient samples. Doesn't seem like a good way to do business. We send ours out and get results in less than 24 hours - even on New Year's Day. Works for me!

We send ours to the system core hematology lab.

We send to our core hematology lab.

We still do K-Bs for trauma and such to determine if baby is bleeding into mom. No counts, just are there fetal cells or not.

We don't do them to determine RhIG dosage. For that we send positive screens to the local reference lab for flow.

Where do you send them?

How are flos reported and how do you calculate doses of Rhogam from the results?

Thanks.

We do fetal cell screen and if positive send to our Hematology lab for KB. Use use the results for dosing RhIG. All Rh neg Mom's with Rh positive babies get one dose post partum, the question would be for >30 ml bleed as I understand the process.

We send the sample to ARUP in Salt Lake City, UT. It's just 40 miles down the road from us. They report it as a percentage just like the calculations for KB only more accurate, at least that's the story. We then calculate the rhIG dosage just like we did when we were doing K-Bs.

We still do KB's. (I'd love to send them out, but turn-around-time is an issue.)

We require a 2nd tech to review all of them. While doing a quick review they are to estimate the count, if they disaggree with the originally reported count, they will do a 2nd count. Because of staffing issues, the first tech's results are reported out before the review some of the time.

Since 90+% of the patients are negative, this is usually a very fast review.

We implemented this after we missed a CAP survey and have not had any problems with CAP since.

Linda Frederick

Linda, we have a second tech review all stains also, and this has really helped. We also use a Miller optic field to help count. I have used this quite successfully to estimate fetal cell counts.

BC

Hi from Canberra Australia - it is comforting to know that you guys face the same dilemma in the US with the KB tests as us here in OZ - everyone hates counting them - and on most surveys I end up sending in my result as most people over estimate & even though we have a flowcytomer here in the lab - we perform 8 survey quantitations a year but probably only need to quantitate 2 or 3 patients a year so it would be is very costly to just move it over to flow - even just to score better on our surveys!

We started sending ours out to our ref lab a few years ago (Quest, now Labcorp) because we had so few and were also doing more surveys than patients. If we have a positive screen, we call the OB doc and suggest they give the patient an extra shot of Rhogam until we get the results back. We have only had one patient that needed more Rhogam and in that case, the office called the patient back in and gave her the other 2 shots.

I guess I should have mentioned. We always issue the initial RhIG and not wait for the results of the flow from the reference lab. About one per year we have to get a second dose to the patient.

We send the sample to ARUP in Salt Lake City, UT. It's just 40 miles down the road from us. They report it as a percentage just like the calculations for KB only more accurate, at least that's the story. We then calculate the rhIG dosage just like we did when we were doing K-Bs.

We do the same, ARUP in SLC. If you don't do these on a regular basis it's impossible to get anyone to be proficient with the test. I was approached about doing these in-house several years ago but it would have involved less than 10 a year.

I need your help. Does anyone have a nice picture of a print-out from a flow cytometry showing the presence of fetal cells that I could use in powerpoint. I've spent hours looking for one on the net with no success and I don't have access to a flow cytometer myself. If anyone has something they could scan, please send it to me at a.galvani@freesurf.ch. I would be very grateful. Thankyou

This link may be helpful.

http://bloodjournal.hematologylibrary.org/cgi/content/full/96/10/3610/F4

BC

Thanks.

So how do you deal with sending out fetal cell quantitation for deliveries on weekends? Can you send specimens out on weekends? A Friday evening delivery that needed a second dose would be beyond the 3 day limit by the time the results came back the next Tuesday.

Mabel,

ARUP does the testing 7 days/week. I guess the issue would be getting the sample to them in a timely manner on a week end. Not sure how you could work that one out. Maybe UPS or FedEx overnight or something like that.

We are looking for a different method to quantitate fetal hemaglobin. Our obstetric department orders KB stains STAT to determine if a Mom has a fetal bleed during pregnancy. Based on our KB results additional procedures may be done on the Mom. The test is very inacurate, time consuming, and difficult for some techs to read. Does anyone know of an instrument that has Fetal Hgb testing available? Please send manufacturer or contact information, thank you so much.

at UMCB we perform KB stains in Hemo. i don't know why.

Question though, we are trying something new here. Is it okay to freeze the control slides without fixing it first? I know a bit dumb question.

Check the manufacturer's instructions. If not mentioned, try calling them. If they don't support it you will have to validate yourself that it doesn't change the results. Why do you want to. I think you can fix them and save them for quite a long time, although it may depend on the kit you use.

On 6/21/2007 at 5:57 AM, John C. Staley said:

We still do K-Bs for trauma and such to determine if baby is bleeding into mom. No counts, just are there fetal cells or not.

We don't do them to determine RhIG dosage. For that we send positive screens to the local reference lab for flow.

Hi! We are planning to do KB testing for traumas as well. Do you report it as fetal cells positive or negative?