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Found 1 result

  1. I realize the topic of Rh-discrepancies has been oft-discussed on these forums but I wanted to get an idea of what kinds of different policies are out there. A recent incident has brought this issue to a higher level of attention and we are looking at revising our current policy but before we do so, we'd like to find out how many other institutions have adopted something similar so we could feel comfortable that we'd fall under the umbrella of 'Generally Accepted Practice Standard.' A prenatal patient was typed at an outside facility on a Galileo and found to be Rh-negative. When the patient came in to deliver they were considered Rh-positive on the Ortho ProVue (2+ reaction). We had no previous history on the patient so a second specimen was drawn and was also Rh-positive on the Ortho ProVue. (2+ reaction). Our current policy says for women of childbearing age perform tube testing when anti-D is 1+ on ProVue. If tube testing is negative report Rh negative and if any degree positive report Rh positive with a comment that RhIg is at physician's discretion. I don't think this is sufficient; I think we should look at 2+ gel reactions. I'm also concerned with the report of Rh-positive and a comment about RhIg administration. From a physician perspective, how do we know they are even seeing this comment to make the decision to administer RhIg? (the comments issue has been a long topic of debate through all sections of the laboratory, certain lab results show up in the EMR as SEE COMMENT specifically because of this) Partly based on recommendations from http://www.ncbi.nlm.nih.gov/pubmed/18067505. There are definitely problems associated with changing the policy; how do we handle patients who we have previously typed as Rh-positive, change their blood type? Is it inappropriate to get positive anti-D results but report Rh-negative, will the techs or physicians be confused? Are we wasting our time/energy on something that isn't really worth it? We're very curious to see how other institutions have handled this with the new anti-D reagents and testing platforms that are out there today.
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