Do you have policy in place to cover "deviation" from O negative to O positive males and females outside of childbearing age?  Do you notify attending physician?

9 minutes ago, Kim D said:

Do you have policy in place to cover "deviation" from O negative to O positive males and females outside of childbearing age?  Do you notify attending physician?

Below is our policy for switching Rh negative patients to Rh positive red cells for non-emergent cases. We would document that decision and any pathologist instructions in the patient's profile. 

For emergency release/MTP we follow policy and do not notify the provider unless it is a patient under 19 years or a female of child bearing potential. 

1 hour ago, Kim D said:

Do you have policy in place to cover "deviation" from O negative to O positive males and females outside of childbearing age?  Do you notify attending physician?

Yes, nationally in the UK, via BSH Guidelines.

We have had a physician who would not approve O positive so I guess my question should be can our medical director make decision without consent of attending.

Of course, if our SOP is written to state that is our policy.

1 hour ago, Kim D said:

We have had a physician who would not approve O positive so I guess my question should be can our medical director make decision without consent of attending.

Was the physician happy for his/her patient to expire if there was literally no group O, D Negative blood available, or, indeed, to condemn some other patient to death if, for example, they were exsanguinating and also had an anti-D???????

RIDICULOUS!!!!!!!  NOT you, the physician.

We have it written in our policies.....based on what our Medical Director wants.  He'd much rather transfuse Rhpos and the patient live than NOT transfuse and have them die.

His philosophy is that we can deal with the anti-D later - (IF it develops - which it often does NOT).  There's nothing you can do with a dead patient.

We transfuse OPos LTWB to ALL our adult (or >50kg) MTP trauma patients.  If an Rh neg patient is bleeding - but not MTP, our policies allow us to switch to Rh pos after a designated # of Rh neg units have been transfused to conserve Rh neg inventory.

This is why all transfusion services need experienced/trained physicians.   It's a clinical decision weighing the risks of not transfusing urgently vs. the risks of alloimmunization.  And the risks of not having Rh negative red cells for patients where such products provide important safety (girls and women <40-50; patients with anti-D). 

Obviously the issues in alloimmunizing a male patient, particularly an older patient, are very different from a woman or girl with the potential for future pregnancy.  If not terrifically urgent, requires a discussion between the practitioner responsible for the patient and the transfusion service physician. I've certainly made decisions independently and only informed the patient's physician after the fact, when the maintenance of Rh negative red cell supply has been a priority.  Hard to write a procedure that covers all possibilities, so one would have to be broadly written, and probably kept it short on details, since these are so variable.