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RhIg after giving 12 Rh pos units is futile. The patient will either make anti-D or not, too late to prevent at this point without exchange transfusion, which seems like overkill. We always say the female of childbearing age has to live in order to worry about anti-D in a future pregnancy, so we worry about that first. Our policy is to revert to the patient's actual type after a massive situation. We would give A neg. Now, if the patient starts massively bleeding again, we would revert to A pos. Until the patient makes that anti-D of course. Even though you've already given Rh pos to this patient, you did it during a mass transfusion, which is physiologically different than tranfusing an Rh pos unit low and slow.

I agree entirely, EXCEPT, we should think of females of child bearing POTENTIAL, rather than child bearing AGE. Think, for a moment, of a female who is group A, D Negative, who is, for example, 11 years old. Sorry to be picky, but, so often, these female children do not get the anti-D immunoglobulin they should be given.

For us it would depend upon the patient's age and child-bearing potential. If that is unknown or unclear, routine transfusion after MTP would be A NEG. Additional massive bleeding A POS.

Following - I am so glad you asked this question as I have asked the same thing to both Ortho and AABB with no direct response. My question was, is there a requirement for an incubator and centrifuge to be an FDA cleared medical device? We use them throughout the lab and blood bank for specimen centrifugation and for serologic tube testing, and those are not FDA cleared devices. As long as your equipment is maintained and is meeting the requirements of the circular/instructions for use, aren't you compliant?

First question, is the patient actively bleeding? If not and they just want to "top them off" then A neg is the choice. If they are and your A negs are very limited then stay with the A pos blood. As far as RhIG goes, as mentioned above, forget about it. All it will do at this point is cause more problems. That's what I would do.

If you are accredited by AABB, you need a policy. 5.19.6 Massive Transfusion The BB/TS shall have a policy regarding compatibility testing when, within 24 hours, a patient has received an amount of blood approximating or greater than the total blood volume. I'm sure The Joint Commission has something too.

Sounds to me like you should only be concerned with the fact that you might be needing 2 exchange transfusions and a bleeding mom to occur at the same time. Busy, but not unmanageable. Maybe make sure you have blood and plasma per your SOP for the exchange in house, and plenty of A pos for mom. Good luck!