Immucor User Group Meeting Boca Raton, Florida May 12, 2016 - PowerPoint PPT Presentation

Immucor User Group Meeting Boca Raton, Florida May 12, 2016 Patricia Houtz BS, MT (ASCP) Martin Health System Blood Bank Supervisor

Objectives  Describe Martin’s antibody resolution workflow  Illustrate workflow using case studies  Review how automated antigen typing is performed on the NEO and Echo to screen red cell units and the advantages of doing so.

Martin Health System  Three Hospitals -450 beds  One Free Standing Emergency Room  More than 12,300 Transfusions annually  9,200 are Red Blood Cells Transfusions  13,050 Type and Screens  570 Antibody Identifications  2,700 AHG Crossmatches Echo/NEO  9,500 Electronic Crossmatches

Routine Protocol for Positive Antibody Screen  New Patient with positive Antibody Screen  Capture R Ready-ID and Extend-I/Extend-II  Rh positive patient Extend-I  Rh negative patient Extend-II  Automated DAT (auto control)  Patients with History of Antibodies  Choose a panel or panels with the greatest number of negatives for the antibody the patient has.  Automated DAT (auto control)

Case Study FW  74 Year Old Male  Caucasian  History of Anti-E, Anti-K, Anti-Fya, Anti-Jka, Anti-S and Anti-Kpa  Gastric Antral Vascular Ectasia Gastric antral vascular ectasia (GAVE) syndrome, also known as watermelon stomach is a  significant cause of acute or chronic gastrointestinal blood loss in the elderly. Presenting with occult blood loss leading to transfusion-dependent chronic iron-deficiency anemia, severe acute upper gastrointestinal bleeding, and nondescript abdominal pain.  Multiple Transfusions from 2/2011 – 6/2014 ≈ 100 units of RBC’s have been given at Martin Medical Center.  Jka has not been demonstrating Since 3/2011

Antibody Screen  Type & Screen and Two Units of Red blood Cells to be transfused as an outpatient.  Antibody Screen Results from Echo:

Ready-ID ** Two cells negative for all antibodies

Extend-II ** One cell negative for all antibodies

PeG Selected Cells

Patient Results  Anti-Jsa identified and reported  Automated DAT Negative  Patient Results : Anti-E, Anti-K, Anti-Fya, Anti-Jka, Anti-S, Anti-Kpa and Anti-Jsa  Two units ordered from Oneblood crossmatched on Echo- Compatible (AHG)

Case Study PE  44 year old Female  Presented to the ER with dizziness and heavy vaginal bleeding for the past 4 days. She is hypotensive with a low grade fever.  Laboratory Results:  WBC 7.6 10*3/uL  Hgb 4.9 g/dL  Hct 16.8 %  Plt 2 10*3/uL  History of ITP and Uterine Fibroids with Menorrhagia  History of Anti-E and Anti-S  Three units of Red Blood Cells transfused 8/2015

Antibody Screen  Type & Screen and Four Units of Red Blood Cells to be transfused  Antibody Screen Results from Echo:

Ready-ID

Extend-I

Ready-ID Rule Outs

Extend-I Rule outs With the Two Panels Can not Rule out- Jkb, M, K Low-incidence antibody's that cannot be ruled out Cw, V, Jsa and Kpa

2 nd Ready-ID to Rule out M

PeG Selected Cells

PeG Selected Cells rule out K and Cw

Patients Results  Patient Antigen Typed For Jkb - Negative  Automated DAT- Negative  Anti-Jkb identified  Patients Resulted As: Anti-E, Anti-S & Anti-Jkb  Antigen Screening of Donor Units Performed on NEO and Echo  Six units Crossmatched on Echo Compatible (AHG)

Antigen Typing on Echo/NEO

QC ECHO/NEO With Approved Reagents  QC performed every 24hours  Echo QC can be performed with patient/donor samples.  NEO QC has to be performed and Qualified before patient/donor samples.  All Patient and donor results can be transmitted to the LIS for Verification.  Print and Review QC results.

Materials Needed  ECHO  Specimen diluent (small 10ml bottle)  Antisera- E, e, C, c, K  CMT strips  QC: WB corQC  C- Levels 2 & 4  c- Levels 1 & 4  E- Levels 2 & 4  e- Levels 3 & 4  K- Levels 1 & 4  Bring all reagents to Room Temperature.

Materials Needed  NEO  Specimen diluent (large 57ml bottle)  Antisera- E, e, C, c, K  CMT strips  Cor QC Extend 1,2,3, & 4  Bring all reagents to Room Temperature.

Antigen Screening On NEO Jka, Jkb, Fya, S and s Monoclonal Reagents NOT APPROVED for Test of Record  Must be Validated by facility Instrument- 50 samples  Follow the package insert for assay method (RT or AHG)  Room Temperature- 30 minutes mAgScrRT  AHG- 44 minutes pAgScrAHG  With all batches a known positive and negative donor is run.  Jka and Jkb all negatives are confirmed by tube method with positive and negative controls.

Antigen Screening on NEO  S, s and Fya we report from the NEO manual entry into the LIS  QC is performed by tube method using the weakest expression of the antigen (heterozygous).  Antisera is aliquoted into a 12x75 tube  Used Straight  Labeled with the Antigen being tested  Labeled with Lot# and expiration date

Benefits of Screening Donors on Echo/Neo  Automation saves Tech Time  Uses Smaller sample size  Less Reagent  All results can be transmitted to the LIS for Verification  Medical Center keeps inventory of antigen negative units, to distribute to the other sites and to reduce antigen screening on off shifts.  Approximately 40 to 50 O positive units Screen at a time  Approximately 5 to 10 O negative units Screen  Turn around time (reference lab 2hours away)  Cost savings