Greetings from Alaska,

Sheila submitted a question about limits of Rh negative blood going to one patient.

My question is from the supplier side - are Blood Banks limiting/monitoring the number of Rh negative units a hospital may order at one time? And if so what criteria is being used, who is directing/implementing the management, and what is the feedback from the hospitals on this matter?

We are frequently asked about units of Rh negative blood that we are ordering from ARC. Sometimes they only ask if the blood is for a specific patient or for "stock." Other times the questions are more pointed such as- what is wrong with the patient, what is their Hgb, is the patient male or female, and the age of the patient. The responses then go before their medical director who decides when there is a severe shortage.

I think one has to look at the services offered in their institution to decide what patient population and procedure risks are present. If you have an Emergency Dept. or Obstetrics, you need to have enough Rh negative blood to service child bearing age females and newborns. Our blood center monitors the amount of O Neg donor blood that we use. They use 6% as the community number of O Negs. We have a 580 bed hospital with a large cardiovascular program, large orthopaedic center, a cancer center and moderately large OB service and finally a 40 bed Emergency Dept. We keep a minimum of 6 O Negs and try for a dozen as routine stock. We keep 12 to 15 units of A Neg RBCs in stock at all times. Our total daily inventory is approx. 150 units of RBCs. There is abuse of O Neg RBCs in our area because some of the smaller hospital blood banks use O Neg on everyone after hours so there are no "accidents". This is the reason our blood center monitors usage of O Negs. We've had occasional shortages of O Neg and we have converted elderly patients to Rh Pos blood in emergent situations such as prolonged usage for GI bleed or a difficult surgical case. Some hospitals routinely give O Rh Pos units to O Neg patients if the patient is over a certain age. I've seen too many of these cases live long enough to come back and haunt us multiple times with Anti-D. All the experts say it is a rare phenomena, but we have at least 4 cases a year that fit this category. We encourage patients to know their blood type so they can get directed units from friends or relatives for elective surgery if they are Rh Negative. We have local health fairs for the public a few times each year; the blood type booth is a favorite. We give out wallet cards with the type and tell them what their % is. An educated Rh Neg patient can do alot to make sure they get the proper donors lined up for surgery.

Thank you Jane and bbkDiane for your responses. As I am a "non-tech", I am hoping to gather information that will be of assistance when dealing with situations that threaten to wipe out the entire inventory (20 ONEG to an 84 yr old female scenario comes to mind). So any information I can gather on other regions standards of practices in managing Rh Neg units would be appreciated.