Laurie Underwood Posted November 25, 2015 Share Posted November 25, 2015 Trying to find out what others do in the area of Rh typing for Emergency department patients. Currently it is our E.D. protocol to have an Rh ordered on all female patients suspected of being pregnant with abdominal pain or pregnant with bleeding. Do you perform an Rh on all of these type patients or, if the patient has a type on record, go by their history? Link to comment Share on other sites More sharing options...
Auntie-D Posted November 25, 2015 Share Posted November 25, 2015 Type them - we have had patients giving their friend's names to cover up the fact they are pregnant. I have known this happen 4 times in my 14 year career so far and they haven't all been young girls either... Malcolm Needs, amym1586 and Dr. Pepper 3 Link to comment Share on other sites More sharing options...
Dansket Posted November 25, 2015 Share Posted November 25, 2015 Would you issue Type-Specific blood to a patient based solely on patient history without any testing on a current blood sample? We require an Rh type done on a current blood sample prior to issue of Rh Immune Globulin. Malcolm Needs, John C. Staley and amym1586 3 Link to comment Share on other sites More sharing options...
AMcCord Posted November 26, 2015 Share Posted November 26, 2015 We require a current type prior to issuing RhoGAM. When I get a query for a blood type on record from the ER, I point out to them the possibility of an error in type due to patient ID issues. That thought has generally not occurred to them. Link to comment Share on other sites More sharing options...
tbostock Posted November 26, 2015 Share Posted November 26, 2015 We do a Type and Screen on these patients; we also want to see if they already have an Anti-D so we also need the antibody screen. The ED gives us a hard time though and says...we ONLY need the Rh. amym1586 1 Link to comment Share on other sites More sharing options...
goodchild Posted November 27, 2015 Share Posted November 27, 2015 We have it configured where they order a Type and if the Rh is negative it reflexes into a Type and Screen. We also do the testing every time - not relying on history. Link to comment Share on other sites More sharing options...
BankerGirl Posted November 28, 2015 Share Posted November 28, 2015 We always do the type. If it's negative we expect a full type and screen but it doesn't always come because the ED doc will sometimes consult the OB doc and find out that the patient just had RhIG in the office. Or, in the case of an alarming number of recent patients (2 ) they already have immune anti-D. Link to comment Share on other sites More sharing options...
goodchild Posted November 28, 2015 Share Posted November 28, 2015 We always do the type. If it's negative we expect a full type and screen but it doesn't always come because the ED doc will sometimes consult the OB doc and find out that the patient just had RhIG in the office. Or, in the case of an alarming number of recent patients (2 ) they already have immune anti-D. We've seen a recent trend with immune anti-Ds as well. I blame the anti-vaccine trend and the distrust in medical professionals. Link to comment Share on other sites More sharing options...
galvania Posted November 30, 2015 Share Posted November 30, 2015 Or maybe they can't afford it? Link to comment Share on other sites More sharing options...
Dr. Pepper Posted November 30, 2015 Share Posted November 30, 2015 Type and screen on current admission for all the above reasons. Link to comment Share on other sites More sharing options...
David Saikin Posted November 30, 2015 Share Posted November 30, 2015 We would just do a type. For years one of my OB guys would always order a TS when he wanted RhIg. My comment was that it won't hurt them to get it if they are sensitized already and especially now with the sensitivity of gel and solid phase, almost all Rh Neg pregnancies have a detectable anti-D on admission so we have crossed that bridge effectively. I guess it would depend on how many true sensitizations to the D ag I found, but they are few and far between these days (not like the 1970's - for those of you who can remember that far back). Also, if you get a pos absc on an ED order for an Rh type - you must do an id . . . if it's not anti-D, well, it's nice that you detected a sensitization but one not clinically significant for the MDs order . . . Too many variables for my taste. Give 'em the RhIg if they're Rh Negative. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 30, 2015 Share Posted November 30, 2015 I must admit that I used to think the same way David (and did until very recently), but you have to remember that anti-D immunoglobulin is made from human source material, and there is always the chance that this will carry a virus that we do not know about. As I say, I am now much more worried because I am just reading Chapter 19 (Plasma fractionation and fractionation products) of Klein HG, Anstee DJ. Mollison's Blood Transfusion in Clinical Medicine. 12th edition, 2014, Wiley Blackwell, in which two references are cited (both of which I had totally missed before) that are as follows: Meisel H, Reip A, Faltus B. Transmission of hepatitis C virus to children and husbands by women infected with contaminated anti-D immunoglobulin. Lancet 1995; 345: 1209-1211. Power JP, Lawlor E, Davidson F. Molecular epidemiology of an outbreak of infection with hepatitis C virus in recipients of anti-D immunoglobulin. Lancet 1995; 345: 1211-1213. Now, it may be countered that we can detect hepatitis C infection much better in 2015 than we could in 1995, and that we now have better ways of inactivating viruses, but, I repeat, it may be a virus of which we are yet unaware - or worse, a prion. This made me think! My comment was that it won't hurt them to get it if they are sensitized already.... Link to comment Share on other sites More sharing options...
David Saikin Posted November 30, 2015 Share Posted November 30, 2015 (edited) Malcolm I'll have to look at those articles. I know the FDA made the fractionaters change their methodology a few years back due to HepC transmission. Apparently this occurred to such an extent that the Feds took notice and initiated the change. I see the articles you quote are 20 yrs old. I'm certain manufacturing of derivatives has changed to alleviate the HepC contamination (I also want to say that albumin and some other globulins were also implicated). Dave Edited November 30, 2015 by David Saikin Malcolm Needs 1 Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted November 30, 2015 Share Posted November 30, 2015 Yes, I appreciate that David, and I do see from where you are coming, but it is NOT the known viruses about which I wrote - it is the yet to be described viruses that may be present. After all, it wasn't that long ago that WNV was described. Link to comment Share on other sites More sharing options...
David Saikin Posted December 1, 2015 Share Posted December 1, 2015 Don't lose any sleep over them . . . the time for that is when they get discovered (I think) pstruik and Malcolm Needs 2 Link to comment Share on other sites More sharing options...
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