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So, a pregnant woman tests 1+ pos with anti-D. Do you give her RhIg? She has many (MANY) Rh pos cells of her own, will the RhIg simply attach to those cells. What if she tests 2+? What if she previously tested 0 (prior method for us was solid phase (or tube)) and now tests 3+, do you change her type? Do you give her RhIg now because you used to call her Rh neg even though now you call her Rh Pos? What if you didn't have a prior type on her, you'd only know her as Rh pos. What do you tell the docs when you gave her RhIg at 28 weeks when she tested 1+, but now tests 3+ and you call her Rh pos and don't recomend RhIg? We are having more and more trouble, no idea why this seems "new" to us. We currently have a pregnant woman who tested 4+ with anti-D in gel and has a history (at another facility) and anti-D and anti-E. The more we talk about this the more confused we (I) get.

It was a bit of a troll question. It seemed to me that if we can't trust the reactions we get in gel then what's the point of using it. As far as I can tell regarding the IFU's Dansket is right. I realize the importance of precision and care being taken in the blood bank, but I think a lot of times we fall victim to an overabundance of undue caution.

The easy answer on a practical note is as long as the Emergency Release order has been signed by the physician who placed the order all is well in the BB. My understanding, from when I worked at a level I trauma center, is that once the patient is in the OR; the anesthesiologist is in charge and is not required to finish the transfusion orders of the ER physician. If the anesthesiologist wants to transfuse the remaining uncrossmatched unit they cancel the ER order (if electronic) and place their own when things calm down. This has to do with billing, transfusion criteria and removes ambiguity. As long as your policy ensures that any physician ordering/transfusing Emergency Release products is documented in case they need to justify their decision.

The provider who requests the Emergency release of the 2 units is who is asked to sign/take responsibility for the uncrossmatched blood, not the provider (usually surgeon or anesthesia) who gives the Transfuse order. However, we would make sure that the surgeon (or anesthesia) was aware that the unit being transfused was uncrossmatched - he/she could then determine whether or not they wanted to continue with the transfusion or wait for the crossmatch to be completed. We are a level III trauma center and this has not been an issue with TJC, CAP or the trauma surveyors from the state up to this point. You should probably check for regulations in your state, as a start.

It's all electronic orders here, so the ER physician would be initially responsible; but the OR surgeon or anesthesiologist are responsible for any transfusions there, including uncrossmatched units. Scott