Rh pos to Rh neg patients

[BBsue]

Hello, I am looking for a procedure that  discusses giving Rh positive red cells to Rh negative patients when there  are critical shortages. CAP TRM 40710

any help would be greatly appreciated. thanks, 

[David Saikin]

My Medical Director still has to approve this switch.

[LIMPER55]

Basic guideline from our trauma center--

O Pos to all males and females over 50

Critical shortage--use O Pos.

The Medical Director can sign after the emergent event

[Ensis01]

My Medical director wanted/authorized Rh pos to all during massive transfusion protocols. That made a huge difference in conserving Rh neg and especially Oneg. 

[MAGNUM]

We give Rh positive to  males and females >45 for traumas and MTP's. The medical director still wants to be made aware of the switches though.

[applejw]

Our pathologists have authorized O POS for adult males and females 56 or older without requiring permission - we have this written into our MTP and Emergency Release policies.  Younger females or pediatric patients would require a phone call.  Since we average 25 MTP monthly, this is a tremendous help in conserving O NEG.

[David Saikin]

We have the same for MTP and Emergent Release (we use 50 as the cutoff age).  For routine transfusions we still require Path approval.

[jshepherd]

We are similar to others, male traumas and women over 50 get O pos immediately, children and women under 50 get O neg until we have a type, but still no more than 10 units of O neg if they are on MTP. A critical shortage could be handled the same way. Place a limit on how many O neg units each patient should get, based on your available inventory, and write this in to your policies, both internal BB and the hospital versions. 

[Ensis01]

We rarely had 10 O beg in inventory

[Bet'naSBB]

This is a line straight out of our MTP / Emergency Release protocols......."Rh-negative adult males or females may be switched to Rh positive after six (6) Rh negative packed cells have been Issued.  The Medical Director should be notified if the patient has anti-D and/or is a female of child- bearing age (females < 51 yrs old)"

[Malcolm Needs ☆]

1 hour ago, Bet&#x27;naSBB said:

This is a line straight out of our MTP / Emergency Release protocols......."Rh-negative adult males or females may be switched to Rh positive after six (6) Rh negative packed cells have been Issued.  The Medical Director should be notified if the patient has anti-D and/or is a female of child- bearing age (females < 51 yrs old)"

I am uncomfortable with the use of the term "child-bearing age" because, if the bit in the brackets isn't properly interpreted, a four-year-old D Negative female (for example) might be given D Positive blood because she is NOT of child-bearing age, but is, of course, of child-bearing potential.

[Bet'naSBB]

@Malcolm Needsas stated in my original comment............ that's just one statement from a very lengthy, detailed protocol which clearly delineates the differences......especially since we are a level 1 adult / pediatric trauma center.  If we HAD TO we probably would give Rh pos to anyone......they have to live first.  We can deal with the anti-D later if we have to.  

See attached article below  - sent to our BB mgmt staff by our Medical Director.  His favorite line in the whole article is,  “After all, a woman cannot have a pregnancy affected by HDFN tomorrow if she dies from bleeding today”.  He is currently in discussions with the "powers that be" to make a decision regarding females of childbearing potential receiving Rh positive blood in trauma....

 

Risk of Rh pos RBC to female of childbearing potential.pdf

[Malcolm Needs ☆]

1 hour ago, Bet&#x27;naSBB said:

See attached article below  - sent to our BB mgmt staff by our Medical Director.  His favorite line in the whole article is,  “After all, a woman cannot have a pregnancy affected by HDFN tomorrow if she dies from bleeding today”.  He is currently in discussions with the "powers that be" to make a decision regarding females of childbearing potential receiving Rh positive blood in trauma....

 

Risk of Rh pos RBC to female of childbearing potential.pdf 190.48 kB · 1 download

Thanks for that.  I was actually aware of this paper (I have know one of the authors, Heidi Doughty for many years - and she has my greatest respect), but you will also note that the title rather makes my point.

[Clarest]

On 7/19/2022 at 9:07 AM, Malcolm Needs said:

I am uncomfortable with the use of the term "child-bearing age" because, if the bit in the brackets isn't properly interpreted, a four-year-old D Negative female (for example) might be given D Positive blood because she is NOT of child-bearing age, but is, of course, of child-bearing potential.

Yes, I agree with you Malcolm. We use child-bearing potential in our policy.