Immucor User Group Meeting Ft. Lauderdale, Florida May 12, 2016 Mary Sue Angiulli IRL/St. Lucie Medical Center Laboratory Supervisor
• Explain how an integrated hospital system utilizes automation and solid phase technology by the means of the Immucor Echo Immunohematology analyzer in their Blood Banks • Discuss troubleshooting of NTD, indeterminate and “?” Reactions
Comprised of 13 Hospitals 3955 Beds ◦ Aventura Hospital & Medical Center 407 ◦ Kendall Regional Medical Center 417 ◦ JFK Medical Center 472 ◦ JFK Medical Center – North Campus 245 ◦ Lawnwood Regional Medical Center 365 ◦ Mercy Hospital 488 ◦ Northwest Medical Center 223 ◦ Palms West Hospital 204 ◦ Plantation General Hospital 264 ◦ Raulerson Hospital 100 ◦ St. Lucie Medical Center 229 ◦ University Hospital and Medical Center 317 ◦ Westside Regional Hospital 224
13 Hospitals with More than 58,000 Transfusions Annually ◦ Aventura Hospital & Medical Center 7273 ◦ Kendall Regional Medical Center 8093 ◦ JFK Medical Center 8750 ◦ JFK Medical Center – North Campus 1042 ◦ Lawnwood Regional Medical Center 6000 ◦ Mercy Hospital 6500 ◦ Northwest Medical Center 3755 ◦ Palms West Hospital 2831 ◦ Plantation General Hospital 1700 ◦ Raulerson Hospital 1550 ◦ St. Lucie Medical Center 2978 ◦ University Hospital and Medical Center 3500 ◦ Westside Regional Hospital 4646
• With greater volumes to manage with fewer specialized Blood Bank technologists, we were looking to improve workflow efficiency • Implemented to bring automation to our Blood Banks • Automated solid phase methodology offers quality test results in a timely fashion • Broad menu • STAT priority capability • Small footprint for space restrictions
• ABO/Rh • Antibody Screen • Antibody Identification • Crossmatch on specimens with positive antibody screen
• Some sites utilize Ready ID Extend I and II in addition to the Ready ID • Some sites utilize Panocell 20 liquid panel in addition to the Ready ID panel • Some sites using Echo for Cord Blood workups, including DAT, unit retypes, dependent on workflow and staffing
• Echo – ABO/Rh, Antibody Screen • Negative Antibody Screen • Tube – Immediate Spin Crossmatch • Positive Antibody Screen • Echo – Ready ID Panel • Tube – Select Cells from Panocell 20 to Rule Out • Tube – Antigen Type Units and Patient • Echo – Crossmatch • NTD/Indeterminate • Tube Antibody Screen, Panocell 20 with PeG and/or LISS
Capture ID Backup tube medium AHG crossmatch Any other special methods Additional Echo Positive Run Capture No Cells Ab Screen Ready ID required? Report Ab ID, Ag Yes type Patient, Ag type Units, Full XM on Echo Run additional Antibody cells in ID’d PeG Tube
ABO/Rh • Check reagents • appearance, stir ball, bubbles, RT • Check specimen • centrifuged appropriately, RT • Review reaction image • Depending on analyzer access, the ? can be changed if it appears that an artifact or minute cellular aggregate is interfering • Repeat using hemagglutination tube method • Recollect specimen • Refer to reference laboratory
Antib ibody dy Sc Screen • Check reagents • appearance, stir ball, bubbles, RT • Check specimen • centrifuged appropriately, RT • Review reaction image, compare image to the assay cut-off table, access permitting - modify reaction if indicated • Repeat on Echo • Repeat using hemagglutination tube method • Perform antibody ID on Echo using Ready ID panel
Antib ibody dy Ident ntific ificati ation on • Check reagents – appearance, stir ball, bubbles • Check specimen – centrifuged appropriately • Review reaction image, compare image to the assay cut-off table, access permitting - modify reaction if indicated • Perform Ready ID Extend I and II • Repeat using hemagglutination tube method with PeG • Repeat using hemagglutination tube method with LISS • Refer to reference laboratory
Troubleshooting the Solid Phase Dependent (SPD) Antibody Run Capture Specific Echo Positive Ready ID and Yes Antibody? Ab Screen any required additional cells No Report Ab ID, Ag type Patient, Ag type Units, Full PeG Neg Pos XM on Echo Screen PeG Panel “SPD” Neg Screen with PeG Full XM Specific No Yes Antibody? Further Investigation
• Workflow more efficient • Reactions standardized, not subjective as they are using tube method • Interfacing reactions reduced opportunity for clerical errors • Automated procedure reduces risks of inadvertently not performing procedure appropriately • Bench technologists have more time to devote to other tasks
• Method to electronically document QC review in the Echo • DAT that includes Complement • Additional FDA approved Antigen Typing • Remote viewing across markets/sites • Ability to perform one antibody screen without wasting the remainder of the Capture R Ready Screen 3 strip wells
• Two vampires walked into a bar and called for the bartender. "I'll have a glass of blood," said one. "I'll have a glass of plasma," said the other. "Okay," replied the bartender, "That'll be one blood and one blood light.”
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