We are looking to decrease cost for our systems laboratories. We had some ideas for change, We are looking to see what others are doing. We use a combination of gel

We use a combination of gel technology (not automated) and tube

1. We currently antigen test in tube. Moving to gel would cut down on the now very expensive anti-sera used. I realize validation is required. What is your lab doing for antigen testing.

2. We were cited by our state on not performing reverse typing on our same specimen ABORH rechecks. As a result, our use of affirmegen has increased significantly. I do not believe our state has mandated this nor cited others. We are looking to approach the state for a revesal. Do you perform reverse typing on same sample rechecks?

3. DAT on cord bloods, we perform on all. Do any out there perform only when moms screen is positive or the possibility of ABO discrepancy exisits? I realize a pos DAT to a low incident antibody may get missed.

Your feedback appreciated!

We antigen type in tube but do Fya in an IgG gel card. We validated 20 donor units with gel testing vs tube. We are considering moving Kell, C, E and little c to a buffered gel card, just haven't had time to do the study.

We do bld type and DAT's on all cord blood samples. We do not do eluates on cord bloods if DAT is pos.

We do not reverse type our retype specimens, I have not heard of being cited for that, we are in Missouri, I better go check my regs:eek:.

Hope this helps

Was your ABORH recheck sample a confirmation sample to justify an electronic crossmatch policy? I was considering dropping the reverse type to save $$ but I need to look into our reg's now. Thanks for the info.

Thanks! As far as the reverse on recheck, we do you it for electronic crossmatch ,and iimediate spin prior to electronic we were doing rechecks. This was our policy. I could not find any specifics in the regs for reverse typing on rechecks. The definition of ABO type was the argument. CAP refers to the definition, I believe the FDA was OK with foward, either way it was vague and my state went with a citation. However, I have found that not all in our state were cited and continue to do foward only on rechecks... If you find any literature regarding this issue and electronic XM, please let me know...Thanks

Gel cards for antigen typing sounds nice, but nothing's stopping Ortho from raising prices on those cards if they see people switching over to them. What anti-sera do you keep in-house? We eliminated keeping any anti-M or anti-S because we rarely see them in our lab. I'm not spending $1000+ for a 5-ml vial of anti-S just to watch it expire. Let the reference lab do it and charge me as needed. You could evaluate your patient population and eliminate some anti-sera, altogether ("You could evaluate your patient population and eliminate some anti-sera" - sorry, "Airplane" reference, if you've seen it, you'll get it):cool:

We only do front types on our ABO retypes and have never been cited, but I guess I should double-check our regs. as well.

We are also using tube for ABO/Rh and manual gel for Antibody screen and ABID. We just got our Echo, so are looking forward to training and validating.

1) We do Fya, Fyb, Jka, Jkb in gel. We validated all of these with 20 specimens each. Besides saving reagents, we also have an easier time keeping antigen typing on many units at one organized.

2) If you are doing electronic XM, AABB standards requires both forward and reverse for the retype (Std 5.15.2.2 says two determinations as specified in 5.13.1, and 5.13.1 describes both forward and reverse.)

3) We do DATs on cords from all group O moms and the Rh negs. I would love to get rid of this and only do if there is some clinical evidence of HDN. We don't do elutions on these, except in rare circumstances.

Linda Frederick

1. We have validated antigen testing on gel for the Rh System, Fya/b, Jka/b, S, K1.

2. We do not do reverse typing for any ABO Rechecks (donors nor patients) ... and never have! Do request a copy of the reference for this citation.

3. We perform routine ABO/Rh/DAT on Cord Blood from Rh negative mothers. Testing should only be performed if it is clinically necessary. Why consider otherwise? Do we treat ABO Incompatibility (eg. Mom O, Baby A)? No, we don't ... so why chase it down? If the child is showing adverse symptoms of red cell destruction, the MD will order appropriate testing and we will go from there. Yes, this policy saves us a lot of time and money.

Another money saver: Don't run full panels. The question in mind is 'Are there new antibodies?' First, rule out using the screening cells ... we use the homozygous cells to rule out only (nb. But Anti-K1 is ok to use heterozygous, not a dosage issue there). Then, select cells from the panel (and saved panels) to rule out the rest. It's not unusual for the techs here to run a panel of 1-2 cells to get to the answer needed. I have the screening cell sheets attached to the bottom of the panel sheet and make copies as worksheets. This way, the screening cells become part of the panel and part of the patient's file.

Another ... if a patient has a demonstrable antibody, use the patient's serum/plasma to crossmatch FIRST. Then, perform Special Antigen Testing on only the compatible units. Patient plasma is $free.

We perform our donor typing (Duffy, Kid, S, s) using IgG gel card. (Do you guys confirm antigen negative units by tube?)

For those who is using gel for C, c..RHs, did you do cost comparision Gel Vs Tube??

I know if the cost of antisera is >$100/3 mL vial ...gel is cheaper then tube.

We do only IgG DAT on all our cord.

We do reverse type for all our rechecks as we had several errors were tech was busy and entered incorrect result in the computer. (errors were detected at the time of verification of second type (second type was done in ProVue and exported to LIS).

Antigen screening- We screen units with the patient's plasma if the antibody is showing, then we antigen type using commercial antisera in the tube those that were compatible. If the antibody is not showing strong enough, you can use gel Igg cards or buffered gel and test units with the commerical antisera. Since we have not validated this in gel, we would confirm with a tube test.

2nd ABO type- I hope it is not a state requirement. We just went to electronic Xm and we do a forward type to confirm on the smae sample.

DAT on cords- We quit doing this unless the physician requests it for some reason. We had routinely been doing a DAT and ABOR on babies born to RH + moms. We were continually working up ABO incompatibilities and Rhogam.

1. We currently do all antigen typing in tube, but because of our workload, we frequently order antigen negative blood from our supplier. Our expense in this area has been outrageous. I'm thinking about setting up a protocol for using expired antisera, patient sera, etc. for preliminary screening of our donor units, & then using tube method to confirm negatives. Anyone out there doing that? We frequently have students who could perform the preliminary testing. Also considering doing cell separations inhouse to antigen type recently transfused patients but haven't researched that either.

2. We do front type only on our repeat blood types on same samples, but we are not doing electronic xm yet.

3. We don't have any OB patients at this facility. Can't comment on that.

Listen to JP Croke..........He is making sense. I support everything he says. Save $$$ everywhere you possibly can without bending the rules

SMB

Indianapolis IN

Thanks for the letter of support ... but just one correction ... I'm a girl!

As my son would say...........MY BAD !!!!!

Profound apologies for the assumption of gender,

SMB:cries:

Thankyou all for all the good info