Cliff

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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.

Excellent, and thank you. Very helpful. Here was my takeaway: Therefore, we recommend that samples yielding an IS tube test cutoff score of not more than 5 (i.e., ≤1+ hemagglutination) or a score of not more than 8 (i.e.≤2+ hemagglutination) by gel technology, be considered D– for the purpose of transfusion and Rh immune globulin prophylaxis.

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The site was giving @Malcolm Needs a spot of bother, so I have taken the liberty of uploading some spectacular images for him.

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Allergic Reaction This question was submitted by forum member, Malcolm Needs. Any errors are those of the site admin, not Malcolm. Allergic Reactions.pptx Submitter Cliff Category BloodBankTalk Submitted 10/05/2018  

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OK, not Rh, but D. We were using solid phase technology and recently switched to gel (IH-1000). We've had a policy for many years, if you test less than 2+, we call you Rh Neg. Now with gel, people who were 1+ are testing 2 or 3+. This is concerning for OB patients. Do we give Rh immune globulin or not? We've sent a few of these out for genetic testing to determine if they are capable of forming an anti-D, but if they've just delivered an Rh pos baby, and we don't get the results back for weeks, it's too late. We are a big organization and have a very active labor unit. We used to do about 10 thousand babies a year, but lost a big contract and now do less than 8, so there are significant financial impacts to our decisions, and since our volume is so high, we also risk finding that patient that tests as 3+, but can make an anti-D. What are you doing?