Maximizing the Echo as a Resource for Problem Solving Immucor User - PowerPoint PPT Presentation

Maximizing the Echo as a Resource for Problem Solving Immucor User Group Meeting Livonia, MI May 5, 2015 Amanda Poxon MPA, BB (ASCP) CM Laboratory Supervisor Henry Ford West Bloomfield Hospital

Objectives • Explain how a community hospital utilizes solid phase technology in their Blood bank • Show through case studies how to identify antibodies using solid phase technology 2

Henry Ford Health System • Comprised of 5 Hospitals with 4 blood banks – Henry Ford Hospital (800) – Henry Ford Macomb Hospital (400) – Henry Ford Wyandotte Hospital (350) – Henry Ford West Bloomfield Hospital (200) – Henry Ford Kingswood (100) 3

Henry Ford West Bloomfield Hospital • Opened in 2009 • Nearly 200 bed hospital • Situated on 80 acres in Northern Oakland County • Labor and Delivery, ICU and GPU beds • Emergency Room • Operating Rooms • Staffed by physicians from the Henry Ford Medical Group and the Community 4

HF West Bloomfield Blood Bank 5

HF West Bloomfield Staffing • We are a 24 hour laboratory with 3 shifts • We have laboratory assistants that staff our out- patient phlebotomy department and receive, sort, deliver and pack /track specimens • Medical Laboratory Technicians that process our send out and surgical specimens • Medical Laboratory Technologists and Senior Laboratory Technologists that are trained as Generalist and do all our testing 6

HF West Bloomfield Staffing • 1 technologist in each department – Blood Bank, Urinalysis, Hematology/Coagulation and Chemistry • Usual staffing is: – Midnight shift - 4 technologists / 1 lab assistant – Day shift - 5 technologists / 2 technicians / 2 lab assistants – Afternoon shift - 5 technologists/ 2 lab assistants 7

HF West Bloomfield Laboratory • Our laboratory is divided by a wall, with Blood Bank and Urinalysis on one side • Accessioning, Chemistry and Hematology on the other side 8

HF West Bloomfield Blood Bank • We transfuse approximately 4000 blood products each year – Leukocyte reduced red cells (irradiated and non irradiated) – Fresh frozen plasma – Pooled platelets – Pooled Cryoprecipitate • In 2014 we worked up 300 positive screens, year to date we have worked up 115 positive screens • All our blood products come from Henry Ford Hospital • Henry Ford Hospital is our reference laboratory 9

Our testing menu in Blood Bank • ABO, RH and Antibody Screens • Antibody Identification and work up • Antigen Typing • Electronic, Immediate Spin and Full Crossmatch • Direct Antiglobulin Testing • Cord Blood Evaluations • Fetal Cell Screens • Transfusion Reaction workups 10

Blood Bank Staff Responsibilities • Quality Control • ABO, RH and Antibody screens • Antibody Identification and workup • Antigen Typing • Electronic, Immediate spin and full crossmatches • Answering the blood bank phone • Allocating and issuing blood products • Thawing Plasma and Cryoprecipitate 11

Responsibilities Continued • Preparing baby syringes • Working up transfusion reactions • Unpacking blood boxes • Shipping back short dated blood products • Answering the blood bank phone • Training students and new employees • Covering the Urinalysis tech for breaks and lunches 12

And Continued….. • Answering the blood bank phone • Preparing a cooler for emergency transfusions • Proficiency testing • Competencies – 3 test systems each with 6 elements • Automated testing • Manual testing • Components 13

HF West Bloomfield Blood Bank • So……we are just like many other blood banks with a generalist staff • Asked to do more with less • Patient safety is our first priority • Maintain turn around time targets • Utilize LEAN principals to maximize through put • Continue to have an engaged staff that comes to work to do their best 14

Henry Ford Health System Technology • We are standardized across our health system utilizing solid phase technology for antibody screens and panels – Galileo Neo’s • Henry Ford Hospital – Galileo Echo’s • Henry Ford West Bloomfield Hospital • Henry Ford Macomb Hospital • Henry Ford Wyandotte Hospital • We use manual LISS and PeG for additional work up of antibodies 15

Advantages of Automation • Automation delivers: – Consistent amount of patient sample – Consistent amount of incubation time – Consistent re-suspension of cells – Consistent reading (strength of reactivity) – Increased sensitivity – No interference from “unwanted” IgM antibodies 16

Advantages Continued • Frees up staff to be able to handle other things in your blood bank • Screens and Panels completed in ~ 30 minutes • The 3 cell screen gives you a lot of information about potential antibodies before you run a panel • Allows us to workup many antibodies in a timely manner and have compatible units available for transfusion without having to send our sample to HFH 17

HF West Bloomfield Blood Bank • We have 2 Echo analyzers (affectionately known as the Prince and the Princess) 18

HF West Bloomfield Blood Bank • Midnight shift runs QC at 3am • Afternoon shift runs QC at 3pm • We have a primary analyzer on each shift, but if things get busy, lots of panels etc. the other analyzer is always ready to be utilized • All ABO, RH and Antibody Screens and initial panels are run on the echo 19

Positive Screens • Ready ID – 14 cell routine panel • Ready ID Extend I – 14 cell specialty panel – All 14 cells are from D positive donors • Ready ID Extend II – 14 cell specialty panel – 13/14 cells from D negative donors 20

When do we send samples to HFH • Patient's that have Warm Auto Antibodies requiring Eluates or Adsorptions • Strong reacting Cold Auto Antibodies that require Adsorptions • Multiple antibodies that we do not have enough rule out cells to complete the workup • Titers 21

Case Study #1 • History – 39 year old female – Admitted to our Hospital for delivery of her 6 th baby – B negative – Antibody Screen positive – Rhogam administered 3/30/15 22

Case Study #1 K J J F F J J L L L L X P Kp V C w D C c E e K k M N S s p s s y y k k e e u u g b 1 a a b a b a b a b a b a I + + 0 0 + 0 0 + + 0 + 0 + + + + 0 + 0 0 + 0 + 0 0 + + 3+ II + 0 + + 0 0 0 0 + 0 + 0 + + 0 + + 0 + + + + 0 + 0 + + 3+ III 0 0 + 0 + 0 0 0 + 0 + 0 + 0 + 0 + 0 + + 0 + 0 + 0 + + 0 23

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Case Study #1 • Ran the Extend II because we knew her Rhogam history • Anti D due to Rhogam • At our institution we interpret the antibody screen in our Lab information system (SUNQUEST) as “Positive for clinically insignificant antibodies” • Eligible for a computer crossmatch 25

Case Study #2 • History – 31 year old female – 28 week labs – 7 previous pregnancies, 3 live births, 4 spontaneous abortions – A negative – Antibody Screen positive 26

Case Study # 2 K K J J F F J J L L L L X V C w D C c E e K k P1 M N S s p p s s y y k k e e u u g a b a b a b a b a b a b a 0 I + + 0 0 + 0 0 + + 0 + 0 + 0 + + 0 0 + + + + + + 0 + 0 + 0 + + 0 0 0 0 + 0 + 0 + + + + + + 0 + + 0 0 + 0 + + 4+ II III 0 0 + 0 + 0 0 0 + 0 + 0 + + 0 0 + 0 0 + 0 + + 0 0 + 0 4+ 27

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Case Study #2 • Ran Ready ID, clearly showed our antibody • Anti FyA • Patient antigen typed FyA negative • Antibody Screen interpreted as positive • Transfuse antigen negative units • Full crossmatch • Sample sent for FyA titer 1:16 29

Case Study # 3 • History – 50 year old female – In pre-op for surgery for a total abdominal hysterectomy, appendectomy, biopsy liver lesion and lymph node dissection – Diagnosis Uterine Cancer – No history in our blood bank – A positive – Antibody Screen positive 30

Case Study # 3 K K J J F F J J L L L L X V C w D C c E e K k P1 M N S s p p s s y y k k e e u u g a b a b a b a b a b a b a + + 0 0 + 0 0 + + 0 + 0 + 0 + + 0 0 + + + + + + 0 + 0 3 + I 0 II + 0 + + 0 0 0 0 + 0 + 0 + + + + + + 0 + + 0 0 + 0 + + III 0 0 + 0 + 0 0 0 + 0 + 0 + + 0 0 + 0 0 + 0 + + 0 0 + 0 0 31

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Case Study # 3 • By running both the Ready ID and the Extend II we confirmed our suspicions • Anti JkA reacting on homozygous cells only • Patient antigen typed JkA negative • Antibody Screen interpreted as positive • Transfuse antigen negative units • Full crossmatch • 11 units screened for JkA – 2 JkA negative units crossmatched • Blood available before surgery completed 34

Case Study #4 • History – 76 year old male – Seen in the emergency department for shortness of breath – Previous diagnosis of Acute Myelogenous Leukemia – Since 2011 has received 16 PRBC’s & 11 Plts – A positive – Antibody Screen positive 35

Case Study # 4 K J J F F J J L L L L X P Kp V C w D C c E e K k M N S s p s s y y k k e e u u g b 1 a a b a b a b a b a b a 0 + 0 + + 0 + 0 0 0 + 0 + 0 + 0 0 I + + 0 0 + 0 0 0 + 0 + 0 + + + + + 0 + + + 0 + 0 0 + + 4 + II + 0 + + 0 0 0 + + 0 + III 0 0 + 0 + 0 0 0 + 0 + 0 + + 0 0 + + 0 0 + 0 0 + 0 + 0 0 36

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