RhIG after Rh positive PLT

[bbbirder]

I am wondering if other hospitals pretty much follow the AABB Technical Manual recommendations to give 1 dose RhIG after 7 Rh positive PLT apheresis are given to an Rh-neg patient?

We have been using these guidelines, but now we have a patient, Rh-neg young woman who is requiring lots of (CMV neg) PLTs while she waits for a bone marrow/stem cell match. We can't always get Rh neg PLTs for her, but I am not sure giving her RhIG once a week (even if she has rec'd 7 Rh pos apheresis in one week) is necessary, but I don't have any thing to back this up.

(Fortunately, we have IV RhIG to give her.)

Thanks,

Linda Frederick

[janet]

You say you're not sure giving RhIg is neccessary.....do you think she probably won't make an Anti-D to any red cells in the platelet units?

I've seen it happen (recently 2 within a couple months). Both were oncology patients - one post autologous stem cell if I recall. We don't give RhIg to our oncology patients unless they are female and childbearing age.....neither of these patients fit that criteria, were given Rh positive random or apheresis platelets - took a few transfusions but the Anti-D showed up :0(

[bbbirder]

I do think that RhIG is necessary, I just wonder about the frequency of it. She gets at least 6 apheresis a week, sometimes more. So we could be giving her RhIG once a week... that seems like overkill, but I don't know.

Thanks,

Linda F

[jhaig]

It's probably in the patient's best interest to continue to be protected against possible Anti-D formation with the IV RhIg after every seven units of pheresis platelets. I don't think it's overkill because of the sheer volume of the infusions being given. As long as the potential for Rh-pos RBC's to be in her system exists, she should have coverage via RhIg. The patient shouldn't suffer any side effects from RhIg (that I know of) but I suppose anything can happen.

[pdavenport]

We offer RhIG but our HemOnc docs always refuse it. They're more concerned about possible complications from giving an injection to a patient with a platelet count that's near zero. So far we haven't seen any immunization.

[Mabel Adams]

Could you get a more precise count of red cells in the pheresis units from the blood center and calculate the RhIG dose more precisely? Every time the red cell dose approaches 15 ml of red cells, she would need another RhIG dose, right? The persisting RhIG from previous doses should add some "cushion" for imprecision and patient variation. You might even take the patient's size into consideration and talk to a pharmacist. Still, if you can give it IV, it won't do her any harm. Hopefully the titer of anti-D wouldn't cause significant compatibility problems if she got a BM from an Rh pos donor. I wonder how high you could get her titer to go? Also, does she get mostly Rh neg pheresis, so the 7 pos ones could be spread out over several weeks?

[GilTphoto]

We currently have an A negative patient with GI Bleeding. She is an older woman who is receiving about 2 packed cells a day, 3-4 FFP and PLT's on a daily basis for past 3 weeks. Most of the platelets she has received have been Rh positive. We have not given her RhIG and she has not developed an anti-D as of yet. Platelets have been a mix of pheresis and pooled. What ever we can get!

[AMcCord]

We've given a number of Rh neg patients Rh pos platelets over the years, though only a couple of them were women of childbearing years. Only one of our patients developed anti-D and she did it after receiving 1 single donor unit. She, of course, was one of our young women. Fortunately, pregnancy was not something we had to worry about in her case. This woman was a big responder - she developed 3 antibodies with red cell transfusions and then added the anti-D with the platelets.

Our oncologists refuse the RhoGAM - usually the comment made is about the lack of reimbursement for using the product on elderly or male patients, as in Medicare says it's not indicated for that use.