Rhogam

[DeniseRupert]

Interested in knowing how many require an antibody screen to be performed before issue of Rhogam. My procedure requires an ABS, but there is some discussion with the LIS department in reference to the need. Please tell me what your facilities' policies are. Thank you.:cool:

[johna]

I'm not in a hospital situation at this time but the hospital where I formerly worked had a policy that the antibody screen specimen be drawn prior to the injection but the test did not have to be completed beforehand. This seems reasonable to me from both a patient and laboratory convenience perspective. The patient doesn't have to wait around for results and the blood bank doesn't have to deal with a stat.

The chances of the patient being immunized at 34 weeks is remote and even if she was the pre-RhIg specimen would serve as a baseline for future testing. The anti-D in the injection would have a negligible effect on future titers and the only loss would be a vial of RhIg.

I realize that there's a move to eliminate these pre-RhIg antibody screens but if they are useful in identifying only one Rh-sensitized patient a year I would still support them.

[Lcsmrz]

We also issue antenatal RhIg on receipt of the specimen, but complete the testing on postpartum samples before giving it out. A few of our moms have residual RhIg (?) in their systems at delivery, and we use a 3-cell minipanel to rule out the other significant antibodies.

[John C. Staley]

Antenatal RhIG orders get an antibody screen. Post partum does not if we have a record of a negative screen at antenatal testing.

[David Saikin]

Antenatal RhIg gets an antibody screen. One doc wants it done before it is given, the other wants it released at the time of phlebotomy. Post delivery, there is no standard demanding absc, but our docs want it, so we do it before release.

[QDeb]

Our minimum testing requirement is an ABO and Rh before issuing RhIg. The Standards state that a patient shall be considered for RhIg administration if a woman is not actively immunized to the D antigen. So, unless there is evidence that the patient is actively immunized then we would administer RhIg. It is up to the physician's discretion if he/she wants to have an antibody screen at the time of or after delivery (it was thier insistance that they have this choice - they did not see the need to repeat the screen if prenatal records were available). An antibody screen is typically performed at the time of delivery if there is no prenatal record.

[rachel]

does anyone know what is actually REQUIRED?

[David Saikin]

What is required is that the mother be Rh=, the baby Rh+, and the mother is not sensitized to the D ag.

does anyone know what is actually REQUIRED?

[rcollins]

Bringing up an oldie but goodie. Our facility feels more comfortable administering RhIG to miscarriage patients even if they're very early into their pregnancy. We routinely perform antibody screens on these patients (not necessarily before issuing the RhIG). It doesn't seem like we would have to do this...but it is worth it to have a "complete" picture for the OB patient?

[PAWHITTECAR]

I have been enforcing the policy of doing an ABS before giving RhIG. The package insert states that it is for non-sensitized patients so we feel better. If there is a documented administration of RhIG we will give the RhIG proir to the antibody Id otherwise we wait for the Id.

[tbostock]

We do an antibody screen before giving RhIg.

[Deny Morlino]

For many years we have done the same (ab screen before RhIg). Recently one of our OB satellite facilities wanted to stock RhIg for issue. It would not be possible to complete the ab screen prior to administration in this scenario. We went to a policy of performing a records check in our blood bank to determine whether the patient had history from the current pregnancy of a negative antibody screen as performed in our blood bank. If so, the checks are all documented and charted in the OB office and in blood bank and the patient is drawn for testing. The patient then proceeds to have the RhIg administered by the OB office. If the patient has not had the testing performed in our blood bank, the specimen is drawn and the patient scheduled to return to the OB's office the following day to allow the blood bank time to assure a negative ab screen. This is working well for us. We may pursue changing all antenatal RhIg administration to this process to better serve our patient's needs.

[Mabel Adams]

We do an antibody screen on an antenatal RhIG candidate if the doctor orders it. They give the RhIG at the offices. We don't know how many of them give it without doing a screen. I think there is an ACOG guideline on it from a few years back. If I remember right, it said a screen was not required. Better check. This memory isn't so good anymore.

[JoyG]

What is required is that the mother be Rh=, the baby Rh+, and the mother is not sensitized to the D ag.

This is true as well as the OB docs follow ACOG which, last time I looked, was an antibody screen at initial and I think possibly a 28week follow up as needed but not in conjunction with the RHIG.

[OxyApos]

I am in an area with lots of non existent prenatal care. For liability reasons and the lack of patient history we do an antibody screen on anyone receiving RhIg. Over half of ours is given in the ER for miscarriages and "pre natal" care patients.