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Showing content with the highest reputation on 10/15/2018 in all areas

  1. I would have got her RHD gene sequenced earlier in her pregnancy, so that I would have a better idea as to whether she required anti-D immunoglobulin. If she turned out to be (potentially) a Partial D, or a Weak D other than Types 1, 2 or 3, I would give a double dose of the normal dose of anti-D. Anti-D immunoglobulin is still derived from humans, which means it is a "soup" of different anti-D specificities against the 36 odd epitopes, some of which would be expressed on the lady's red cells, and some of which would not. Therefore, some of the anti-D specificities would be adsorbed onto the lady's own red cells, but others would remain in her plasma, and would be "available" to react with the red cells of her foetus's red cells, and so would give her some protection against producing her own immune anti-D.
    4 points
  2. Cliff

    Rh Pos or Rh Neg?

    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.
    2 points
  3. 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.
    1 point
  4. NO! I am a professional blood group sereologist!
    1 point
  5. bldbnkr

    Dispensing RHIG

    Now this question has been revised by CAP: TRM.40780 "There is a written procedure to identify all potential candidates for Rh Immune Globulin". I don't have much problem with the Postpartum ones - I have a good Cord Blood procedure and process in place to make sure that the Rh Neg moms of Rh Pos babies receive their doses. The place where it might slip through is the ED/OR if a miscarriage or ectopic came through and Blood Bank was not aware that it was a pregnancy. In the explanation it says "....the institution must ensure that all Rh-negative women receive the maximum protection against Rh immunization..." So it appears that this piece should fall on the providers - to determine Rh type when a patient comes in with a miscarriage or ectopic or other fetal bleed situation. I can't find any such policy in the hospital SOP's but perhaps I am not digging deep enough.
    1 point
  6. Auntie-D

    Dispensing RHIG

    It does drive me insane that we are expected to wipe their backsides for them... I mean, it is their responsibility to request blood products - we don't say 'oh the Hb is 45, let's issue a few units', so why are we expected to tell them to give Anti-D?
    1 point
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