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
2nd 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