Bit the bullet and put the IS crossmatch back into place with the IgG gel crossmatch. Pathologist was fine with the idea since the electronic crossmatch is not an option for us and likely will not be for some time yet. Feel like I am going backwards with this addition to the testing.

Just received a FYI from Ortho regarding the AHG IgG MTS cards and the requirement for determining ABO compatibility. Ortho's stance is the same at this point as the CLIA interpretation; the AHG IgG cards can be used for AHG crossmatches to detect antibodies of the IgG class. They do indicate that they are aware of their "customer's desire to use the AHG IgG cards to satisfy the requirements for the detection of ABO incompatibility concurrent to the detection of clinically significant antibodies". Also says they, Ortho, are "looking at several options involving the detection of ABO incompatibility in gel". Anxious to see how quickly Ortho comes up with something that will satisfy the requirements by using the AHG IgG card. We are settling in with the IS tube crossmatch for now.

Does your prewarmed xm detect abo incompatibility?

I would do a prewarmed XM for a cold or clin insign cold.....

I got the same notice and we are also starting the IS crossmatch.

We put the IS cross match into place at the first of this year. About 2 weeks later we had a lab inspection by HFAP. The inspectors were not aware of the background with this situation, but were certainly looking into it by the time our inspection was over. We were not cited for the lack of IS cross match, but I feel we are ready for the next inspector in this arena.

The recently updated product information from OCD indicates that "since the MTS anti-IgG gel card does not contain FDA approved labeling for the detection of IgM antibodies, it is not adequate to demonstrate ABO incompatibility." Somehow the buffered gel card, which contains nothing but buffer, is adequate for the detection of ABO incompatibility. The IgM antibodies in both systems come from patient plasma. I guess the anti-IgG in the anti-IgG card can neutralize or inhibit the IgM antibodies in patient plasma ? OCD reccomends use of their buffered gel card. I'm a bit cinfused.

That is in addition to Gel crossmatch using IgG gel card we need to also do IS crossmatch using buffered gel card or bu tube method or by computer crossmatch.

I beleive that performing the IS XM or electronic crossmatch will satisfy CMS. It is only the IgG gel crossmatches that also require an IS XM crossmatch.

We will be setting up electronic crossmatch within the year. I thought that to qualify for electronic crossmatch that the patient cannot have antibodies. So how can we use it to confirm ABO when using a gel IgG crossmatch?

This issue has been debated here for several months, and the answer is that IgG Gel cards are not labeled by the manufacturer for the purpose of detecting ABO incompatiblity. Period. You cant in-house validate them for this puspose either, and be in compliance with CMS, FDA, or AABB. I attach an article from the AABB assessor newsletter which explains it nicely, I think. Also, the vendor for our IgG gel cards recently sent out a memo to this effect as well, so there should be no more confusion about the why and the wherefores on this subject!

To Gel Crossmatch or Not To Gel Crossmatch.doc

That part I get, in fact I started this discussion about a month ago. We are just starting the IS crossmatch along with our Gel. The part I don't understand is how to use electronic crossmatch instead of the IS when the patient has an antibody and does not qualify for electronic crossmatch.

Keep in mind I am obviously just in the thinking stage of electronic crossmatch.

You cant use the electronic crossmatch if the patient doesnt qualify, and for us, the only time we use the gel xm is when the patient doesnt qualify for an IS or electronic. The easiest way to incorporate this into your computer is to rebuild your gel xm to include an IS phase along with the AHG results. It wasnt that difficult for us to do

Thanks that is just what I wanted to hear and we have built a test in Soft Bank to include both phases.

I don't understand what all of the talk is about using electronic crossmatch for ABO confirmation when using Gel but I am confident we are both on the right track (even if we don't agree with the principle).

What is this "electronic cross-match" everyone is talking about?

"Electronic issue" I fully understand, but where is the cross-match involved electronically???????????

Sorry, I'm being pedantic again!!!!!!!!!!!!!!!!!!!!!!!

And you are very good at it! The term comes from the idea that the unit and the patient are matched by the computer and determined to be "compatible" blood types. Wherever did we come up with the term "crossmatch" to begin with?

It originated from when the patient's serum (as it always was in those days) was tested against the donor's red cells, and the donor's plasma was tested against the recipient's serum; neither of which happens with the electronic issue!!!!!!!!!!!

Ah, so the "cross" came from doing both major and minor? Just wondered...

"Match" is still appropriate to what the computer does before you issue the unit. "Issue" does not refer to matching the types and determining if the unit is acceptable for transfusion. How's that for pedantic?

Ah, so the "cross" came from doing both major and minor? Just wondered...

"Match" is still appropriate to what the computer does before you issue the unit. "Issue" does not refer to matching the types and determining if the unit is acceptable for transfusion. How's that for pedantic?

Admirable!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

You been taking lessons from me????????????????????/

:haha::haha:

Learned from the master!

OK, you two!!..........Let's call it a draw!!

OK, you two!!..........Let's call it a draw!!

Yes Miss.

:handshake:handshake:handshake:handshake:handshake

We are also changing our policy to include an immediate spin crossmatch tube method and will follow with the crossmatch by IgG card. We have also purchased the buffer card for immediate spin crossmatches but we have not started using yet.

I have been reading this thread with some interest and have now decided to tell you my current practice. For the last 16 years we have used Ortho BioVue technology which has a bead type support rather than gel, which I understand is not available in the USA. However, the principles are the same. We have an Ortho manual for this technology in which it clearly describes the cross-match technique using either IgG or polyspecific cassettes. I have not validated the technology to determine whether it will detect ABO incompatibilities other than from those samples provided by the National External Quality Assessment Scheme to test our competence. Like most of you if I tried to provide ABO compatible blood the computer system alert and prevent this action.

In summary, I have never used IS for cross-matching, even before the cassettes it was an IAT cross-match in a tube. Finally, I suspect that most hospitals in the UK perform IAT cross-matches if computer issue is not available. I do not know how many do IS cross-matches in the UK.

Regards

Steve

:)

That part I get, in fact I started this discussion about a month ago. We are just starting the IS crossmatch along with our Gel. The part I don't understand is how to use electronic crossmatch instead of the IS when the patient has an antibody and does not qualify for electronic crossmatch.

Keep in mind I am obviously just in the thinking stage of electronic crossmatch.

We perform Elecronic/Computer crossmatches.

We perform Gel Crossmatch and do not perform Immediate Spin (IS) crossmatches, when the patients have antibodies (Historical or current).

Our computer system logic will alert the user to discrepancies between the donor ABO/Rh and that of recipient ABO/Rh. Blood group confirmatory test is done on patients with a second sample (if the patient has no history of blood type in our computer system) and retype the donor units. If blood is needed urgently before second sample ABORh confirmation, we can only issue Group 'O' red cells.

At our last join CAP/AABB inspection the issue of IS crossmatch was raised by the inspector (CLIA reference) , but we were not cited because of electronic/computer crossmatches.

Brenda,

you need to visit this site more often!!!!!!

There a whole article from AABB accessor in AABB news....

I was thinking to add IS as one of the detail under my gel crossmatch...as doing IS separatly there are so many problem...

1) If we order IS on same unit..unit will be in crossmatch ...can we bill the patient again..No.

2) Peinting a TAG ...so many problem..I do not think i will order IS again in computer instead will find a way to change the way gel crossmatch is set up in computer...which will solve all other problem.