Chapter 10 Automation for Transfusion Science

Question 1

What are the benefits of automation (how many can you name) in the transfusion lab?

Answer 1

1. Reduction in operating costs.
2. Re-design of work processes and support systems.
3. Increased productivity.
4. Enhanced total quality.
5. Less human error (e.g. drop size, grading subjectivity).

Question 2

What are challenges of automation in the transfusion lab?

Answer 2

1. Concerns among staff re job replacement, involvement in decision making process.
2. Cost justification issues (capital investment plan should be developed).
3. Automation implementation issues (time investment, training and validation may require extra staff).

Question 3

What are important requirements for testing in TS automation?

Answer 3

1. Random access mode.
2. Simultaneous multiple analyses.
3. Extensive test menu.
4. Automated reader.
5. Precise pipetting.

Question 4

What are important requirements for sample processing in TS automation?

Answer 4

1. Clot detection.
2. Liquid detection.
3. Bar code reader
4. Closed tube sampling.
5. Precise sampling.
6. Accepts multiple samples.

Question 5

What are important requirements for data handling in TS automation?

Answer 5

1. Flexible software.
2. Flags discrepancies.
3. Laboratory information system interface.
4. Automatic patient updates to LIS.

Question 6

What are the assessments performed in the selection of automation in the TS lab?

Answer 6

1. Vendor assessment: Determine vendor’s experience with customer support, training, and service.
2. Base technology assessment: Investigate the reliability and accuracy of technology.
3. Instrument assessment: Consider the adaptability, availability, and cost-effectiveness of the automation to assess the instrument’s performance.

Question 7

What technologies have automated systems been developed for so far?

Answer 7

1. Microtiter plates.
2. Solid Phase Red Cell Adherence (SPRCA) assays (aka Capture technology.
3. Gel technology.

Question 8

What testing can be automated by developed technologies?

Answer 8

1. ABO and Rh testing
2. Direct Antiglobulin Test
3. Antibody Detection and Identification
4. Crossmatching.

Question 9

What are automated hemagglutination assays?

Answer 9

1. Assays are performed on microplates using the same principles as in tube agglutination.
2. Barcoded samples and reagents are used.
3. Plates are automatically read using a camera reader.

Question 10

Describe some of the capabilities of the Solid Phase Red Cell Adherence Assay automated machines?

Answer 10

1. Fully walk away analyzers.
2. Continuously loaded and unloaded.
3. ECHO holds 20 samples, NEO holds 224.
4. Runs ABO/Rh typing, Donor confirmation ABO re-type, Weak D, RBC phenotype, Ab screens, Ab ID, DAT and crossmatch.

Question 11

How does Solid Phase Red Cell Adherence Assays (aka Capture Technology) work?

Answer 11

1. Microtiter wells have RBC bound to the surface (screening cells or panel cells).
2. Patients antibodies (if present) will attach to the corresponding antigen covering the well.
3. Negative results form a button at the bottom of the well.

Question 12

What does Capture-R Select assay system perform?

Answer 12

Immobilizes RBCs other than screen or panel cells.

Question 13

What are the advantages of Solid Phase Red Cell Adherence Assays (Capture Technology)?

Answer 13

1. Standardization of agglutination grading.
2. Can use hemolyzed, lipemic or icteric samples.
3. Enhanced sensitivity detects weak allo-antibodies.
4. LISS reagent turns colour when plasma added.

Question 14

What are the dis-advantages of Solid Phase Red Cell Adherence Assays (Capture Technology)?

Answer 14

1. Requires special equipment.
2. Increased sensitivity may detect weak autoantibodies.
3. May miss clinically significant IgM antibodies (forming during a primary response).

Question 15

What is solidscreen II?

Answer 15

Solid phase assay that detects RBC antibodies in serum or plasma.

Question 16

How does solidscreen II work?

Answer 16

Wells are pre-coated with protein A, which has a high affinity for the Fc portion of immunoglobulins.

Positive Test: RBCs and antibody to immunoglobulin G (anti-IgG antibody) bind with protein A, forming a smooth monolayer.

Negative Test: RBCs form a button at the bottom of the well.

Question 17

What is gel technology and how does it work?

Answer 17

1. Developed in 1980s to 1990s.
2. Uses gel particles (dextran-acrylamide gel) in a specially designed microtube, with pre-dispensed reagents
3. Agglutinates get trapped in the gel. The larger the agglutinate the less distance it can travel.

Question 18

What can gel technology be used for in the TS lab?

Answer 18

ABO/Rh typing
Ab screen & ID
DAT
Rh phenotyping cards
Compatibility testing.
Titration/eluates.

Question 19

What are the advantages of gel technology?

Answer 19

1. Reduced sample volume (25 uL of plasma and 50 uL of RBCs).
2. Standardization of agglutination grading.
3. No need for washing in IAT procedure.
4. No check cells required.
5. Enhanced sensitivity and specificity.

Question 20

What are the disadvantages of gel technology?

Answer 20

1. Requires special equipment.
2. False positive mixed-field reactions with fibrin strands.
3. Cannot use hemolyzed or grossly icteric blood samples.
4. Grossly lipemic samples will clog the gel.
5. Rouleaux causes hazy results.

Question 21

Name an example of a fully automated gel system machine given in our notes and its features?

Answer 21

ID-MTS Gel Test (Ortho Clincial Diagnostics).
- Automated instrument is ORTHO ProVue
- Microprocessor controlled unit
- Stand-alone or interfaced unit
- Uses gel cards and digital image processing.

Question 21

Name an example of a fully automated gel system machine given in our notes and its features?

Answer 21

ID-MTS Gel Test (Ortho Clincial Diagnostics).
- Automated instrument is ORTHO ProVue
- Microprocessor controlled unit
- Stand-alone or interfaced unit
- Uses gel cards adn digital image prcoessing.