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
• ther 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

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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)

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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

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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

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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 6th baby – B negative – Antibody Screen positive – Rhogam administered 3/30/15

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Case Study #1

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D C c E e V Cw K k K p

a

Kp

b

J s

a

J s

b

F y

a

F y

b

J k

a

J k

b

L e

a

L e

b

P 1 M N S s L u

a

L u

b

X g

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 + +

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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

27

D C c E e V Cw K k K p

a

K p

b

J s

a

J s

b

F y

a

F y

b

J k

a

J k

b

L e

a

L e

b

P1 M N S s L u

a

L u

b

X g

a

I + + 0 0 + 0 0 + + 0 + 0 + 0 + + 0 0 + + + + + + 0 + 0 II + 0 + + 0 0 0 0 + 0 + 0 + + + + + + 0 + + 0 0 + 0 + + 4+ III 0 0 + 0 + 0 0 0 + 0 + 0 + + 0 0 + 0 0 + 0 + + 0 0 + 0 4+

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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

31

D C c E e V Cw K k K p

a

K p

b

J s

a

J s

b

F y

a

F y

b

J k

a

J k

b

L e

a

L e

b

P1 M N S s L u

a

L u

b

X g

a

I + + 0 0 + 0 0 + + 0 + 0 + 0 + + 0 0 + + + + + + 0 + 0 3+ 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

32

33

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

36

D C c E e V Cw K k K p

a

Kp

b

J s

a

J s

b

F y

a

F y

b

J k

a

J k

b

L e

a

L e

b

P 1 M N S s L u

a

L u

b

X g

a

I + + 0 0 + 0 0 0 + 0 + 0 + 0 + + 0 + 0 0 0 + 0 + 0 + 0 0 II + 0 + + 0 0 0 + + 0 + 0 + + + + + 0 + + + 0 + 0 0 + + 4+ III 0 0 + 0 + 0 0 0 + 0 + 0 + + 0 0 + + 0 0 + 0 0 + 0 + 0 0

37

Case Study #4

• This case illustrates how multiple antibodies

can be quickly identified with just one panel

• Anti E and Anti K
• Patient antigen typed E negative and K

negative

• Antibody Screen interpreted as positive
• Transfuse antigen negative units
• Full crossmatch

38

Case Study #5

• History

– 92 year old female – Seen in the emergency department for acute abdominal pain – Surgery for Exploratory Laparotomy small bowel resection – repair of perforated bowel – B positive – Antibody Screen positive

39

Case Study # 5

40

D C c E e V Cw K k K p

a

Kp

b

J s

a

J s

b

F y

a

F y

b

J k

a

J k

b

L e

a

L e

b

P 1 M N S s L u

a

L u

b

X g

a

I + + 0 0 + 0 0 + + 0 + 0 + + + + 0 + 0 + + 0 + 0 0 + + 4+ II + 0 + + 0 0 0 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 4+

41

42

Case Study #5

• This case shows our initial panel with only 1 cell for

rule outs but by running the Extend I we were able to identify the antibody

• Anti e
• Antibodies identified at another hospital Anti e & Anti C
• We honor previously identified antibodies
• Antibody Screen interpreted as positive
• Transfuse antigen negative units
• Full crossmatch
• Units ordered and shipped from HFH

43

Case Study #6

• History

– 71 year old female – In Preop for replacement of her deep brain stimulation battery – Unspecified anemia – No history in our blood bank – O negative – Antibody Screen positive

44

Case Study # 6

45

D C c E e V Cw K k K p

a

Kp

b

J s

a

J s

b

F y

a

F y

b

J k

a

J k

b

L e

a

L e

b

P 1 M N S s L u

a

L u

b

X g

a

I + + 0 0 + 0 0 0 + 0 + 0 + + 0 0 + 0 + + + 0 + 0 0 + + 4+ II + 0 + + 0 0 0 0 + 0 + 0 + 0 + + 0 0 + + + 0 + 0 0 + 0 4+ III 0 0 + 0 + 0 0 + + 0 + 0 + + + + 0 + 0 0 0 + 0 + 0 + + 0

46

47

Case Study #6

• This case illustrates again that with additional

panels you can identify multiple clinically significant antibodies

• Anti D, Anti C and Anti E
• Patient typed C negative and E negative
• Antibody Screen interpreted as positive
• Transfuse Rh negative, antigen negative units
• Full crossmatch

48

HF West Bloomfield Blood Bank

• For a community hospital we get some very

interesting and at times challenging antibody patients

• Our echos have allowed the Generalist

technologists to become very proficient in solving positive antibody screens

• We are able to provide compatible products in a

timely manner

• We are able to provide outstanding service to the

community we serve

49

Thank You

50