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After a lot of reading and deliberation, here is what we ended with. Testing of Male Patients and Female Patients ≥ 56 Interpret according to Rh Tube Test SOP. Follow discrepancies as outlined for women below, except for sending for molecular testing. Testing of Female Patients < 56 For newly tested women less than 56, if result is 0, testing is complete. If > 0 but < 2+, interpret as Rh neg and perform Rh molecular testing. Notify a supervisor to have molecular testing performed. If ≥ 2+, interpret as Rh pos. This is for all women less than 56, not just OB patients. Discrepancy Resolution What is a discrepancy? Let’s keep it simple. Regardless of what methodology was used for their previous type, if it was interpreted differently than the SOP says to interpret it now, it’s discrepant. If we get conflicting info from an outside facility, or the patient themselves, it’s discrepant. Discrepant is defined as: Rh pos when previously resulted as Rh neg, or Rh neg when previously resulted as Rh pos (at BWH, at any other institution, or per patient history.). For Male Patients and Female Patients ≥ 56, follow the Rh Discrepancies chart in Rh Tube Test SOP. For women < 56 with a discrepant result, interpret as Rh Neg. Notify a supervisor to have molecular testing performed.

Has anyone heard of the Blood Bank supervisor being required to be proficient in another department?

You may be interested in "Strategies to identify candidates for D variant genotyping" by Luo, Keller, et. al. (Blood Transfus 2018; 16: 293-301). Our facility currently uses BioRad Anti-D via tube testing. If an OB patient reacts 1+ or less at immediate spin we send the patient out for Weak D molecular testing. We just got an Ortho Vision, so I am looking at implementing the strategies outlined in the paper to help identify those Weak or Partial D patients.