Jump to content

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


Recommended Posts

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.

Link to comment
Share on other sites


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.

 

Link to comment
Share on other sites

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.

Link to comment
Share on other sites

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. 

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
 Share

  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.