Rh positive blood to Rh negative patients when it's NOT an emergency

[Mabel Adams]

I hope someone can share their policies or criteria for switching O negative patients to getting O positive RBCs due to a blood shortage but NOT when it is uncrossmatched or massive transfusion etc.  The usual scenario is that we are on allocation for O neg red cells and have a GI bleed who is usually a male over 50 who needs 1-3 O neg units per day over several days.  We don't have other hospitals that we can borrow blood from and we are several hours from our supplier (if they would even release any O neg units beyond our allocation).  Have you established a minimum of O neg units that you must maintain for surge capacity if someone with childbearing potential should need several units of O neg? Do you limit how many units of O neg such a patient can take before switching them?  Do you try to switch them early if you are going to rather than give them 6 O negs and then have to give them 2 O pos and then they stop bleeding. If you start giving them O pos, when do you switch back to O negs?  Yes, we can ask our pathologists but it is they who are asking for some idea of what other places do.

[David Saikin]

When my supplier has a dearth of O Negs, if I get an O Neg patient who looks like they may be a big user, I contact the Medical Director.  I also talk w the provider.  Depending on my inventory I may ask to immediately switch to Rh+ units.  We only stock 6u (overstock hosp); we have to have 2 for females of child bearing potential.  A big user can totally deplete all my O's.

 

[Neil Blumberg]

This is a clinical call that we make between the senior medical technical staff present and the attending physician.  We routinely switch male patients, and older females who are Rh negative to Rh positive red cells when transfusion rate is significant and supply constrained. No policy.  Just a clinical decision, which we communicate to the treating team.  Typically a liver transplant that has gone badly, an exsanguinating trauma patient and similar situations.

[jojo808]

I wouldn't think you need to create a new policy, you should already have a policy regarding situations requiring path approval or regarding a deviation from your SOP. Agree with what was mentioned previously in that a conversation must happen with your medical director and ordering MD. The blood shortage is worldwide with the donor pool going up and down so this shouldn't come as a surprise to the MD.  We also switch male patients (not that often) but the MD's understand the situation. We note it in the patient files the date and how many Rh pos units were transfused just for tracking and in case an anti-D is made. 

[Auntie-D]

The first question before switching should always be 'can the patient tolerate a low hb until D Neg become available?'. If the patient is in bed and asymptomatic having their hb a bit low for a while is probably the easier option. Give them iron and epo and let them make their own

[AuntiS]

We are similar to those above - if a male or female over the age of 45 is using up all the Rh Neg stock we can switch them to Rh Pos.  Earlier is better if they are a big bleed.  We only require to alert the MRP it is happening.  We also have no additional requirements/policies for switching back to Rh Neg once the bleeding has stopped.

[Auntie-D]

18 hours ago, AuntiS said:

female over the age of 45 

That's a low cutoff (speaking as someone who is 45 and trying to conceive). Do you include the risk to future pregnancies in your consent? We only recently moved from 60+ to 50+ - having it at 45 may affect women who are late starting a family or starting a second family.

[MAGNUM]

Our cap is 45 also. Has everything to do with the population at hand.

[Auntie-D]

36 minutes ago, MAGNUM said:

Our cap is 45 also. Has everything to do with the population at hand.

Sad that you have written me off :'(

[TreeMoss]

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

[Malcolm Needs ★]

24 minutes ago, TreeMoss said:

A lecturer I listened to discussed MTP and stated that using Rh positive packed cells keeps the patient alive.  He said that if anti-D is built, it can be dealt with when the woman gets pregnant.  If she dies because she didn't get transfused with Rh positive packed cells, she certainly won't even have the opportunity to become pregnant.  So, there's that.

QUITE!

[AuntiS]

On 12/2/2022 at 4:28 AM, Auntie-D said:

That's a low cutoff (speaking as someone who is 45 and trying to conceive). Do you include the risk to future pregnancies in your consent? We only recently moved from 60+ to 50+ - having it at 45 may affect women who are late starting a family or starting a second family.

There was a study done here by ORBCoN in Ontario, Canada.  It showed that most (I think it was 99%) babies were delivered from people under the age of 46.  So yes, not all.  But most.

Best of luck on your journey to conceive.  I had mine at 40.  So I'm always tired, but love her to bits.