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