Emergency Release Question

[ATWALKER74]

I am at a new facility where the current emergency release policy states to

give O= units to any pre-menopausal female until the ABO/Rh has been determined.

I was quite surpprised by this statement and wish to clarify what is meant by premenopausal.

The Technical Manual use the term "femeles of child-bearing potential".

I would prefer to use an age of 50 or below, but wish to hear what others think.

Thanks

[Malcolm Needs ☆]

I assume you mean group O, RhD-, rather than O=?

Our Guidelines in the UK state females under 60 should be given group O, RhD-, K-, But males can be given group O, RhD+, K+.

The reason for this is that women these days can get artificial insemination and ovum donation, so we have to be careful not to immunize.

Men (like me) don't matter!!!!!!!!!!!!!!!!!!

[ATWALKER74]

Sixty is a bit old, but I will keep this in mind. Thanks for your input.

[ldlashley]

I would rather be referred to as a "woman of non child bearing potential" than a post menopausal woman. We use the > 50 marker as our "women of non child bearing age". In USA, Florida. In our tri county area we give OP to men when in a trauma situation and low on ON.

[JOANBALONE]

Hi

I just read that a 66 year old British woman gave birth. We have no policy in writing stating an age in which we would give RhD+ red cells. We handle situations on a case by case basis. We also get the medical director involved.

[Malcolm Needs ☆]

Hi JOANBALONE,

Yes you are quite correct, but I am not allowed to make judgemental comments! It is not politically correct.

I also agree with you, ATWALKER74, 60 is a bit old, but that is what the Guidelines dictate.

[ATWALKER74]

I agree with you Idlashley, and will stick with the term "female of child-bearing potential" in clarifying the policy.

The American College of Gynecologists' definition, like several others, has a relatively broad range to define menopause. They use 51 as the average with a usual range of 45-55. There will always be exceptions.

The technologist need a clear decision point and the medical director and I will provide this soon. All input from

others with more experience than I is very much welcome. AT

[John C. Staley]

I assume you mean group O, RhD-, rather than O=?

Our Guidelines in the UK state females under 60 should be given group O, RhD-, K-, But males can be given group O, RhD+, K+.

The reason for this is that women these days can get artificial insemination and ovum donation, so we have to be careful not to immunize.

Men (like me) don't matter!!!!!!!!!!!!!!!!!!

Malcolm, in the US, as a general rule O= is shorthand for O, RhD-.

At my previous facility 50 was considered the cut off for child bearing years.

[clmergen]

We changed ours to 65 as a cut off. We had to have a clear guideline and at the time of the change a 56 yr old woman had just had a baby.

[Malcolm Needs ☆]

Thanks John C Staley.

That great big puddle between England and the USA certainly does cause problems with us understanding each other on occasions.

I apologize if I caused you any offence ATWALKER74. There was certainly none meant.

[RR1]

Anyway.......the latest news is a 72yr old giving birth. I dread the day when the first male achieves this!

Wouldn't it be nice if the UK guidelines were a bit more sensible and kept the 50yrs old (female for now!) age limit ? It's an emergency release policy we are discussing- in which case we would try to give the best possible Rh D type- depending on our stock availability at the time.

Edited June 1, 2009 by RR1

[Eagle Eye]

our cut off for child bearing age is <50. we give O Positive to males.

[tmccann]

Hello

We give O neg blood for emergency release to every patient unless we are short in O neg blood. We will let pathologist know if we are short in O neg RBC.

Tina

[Eagle Eye]

Wow O neg to every patient...We are a trauma center and we can not give O neg to everyone.

[bbbirder]

I think you need to determine what is best for your setting.

Here, if we have an isolated case that we may need to convert from Rh neg to Rh pos, we consult with the pathologist as needed.

But when we have multiple 'vicitims' we have a policy that states for females less than 50 years of age use O neg (everyone else would get Opos). (Approved by Trauma Committee)

However, if the doctor declare a "Massive transfusion protocol" for a patient, we convert to Rh pos for everyone except females less than 40 years of age. If female less than 40 years of age, we'll give the first 6 Rh neg, then convert to Rh positive. This age was approved by the OB/Gyn department.

We are too far away from our blood supplier to hand out Rh negative blood when 'gobs' of blood is being used quickly on a patient with low likelihood of survival.

Linda Frederick

[Malcolm Needs ☆]

That all seems eminently sensible Linda.

One should always take into account local rules, as it were, and if you are geographically remote from your supplier, I really can't see what else you can do. That having been said, if you run out of O D Negative blood, and simply have to give O D Positive blood to a 40-year-old female (or below), would you follow it up with anti-D immunoglobulin, if the patient turned out to be D Negative (and possibly even an exchange transfusion)?

[bbbirder]

Malcolm,

No, we wouldn't do those things. Instead, as soon as the patient was stable enough to ship, we'd probably ship her to the big house down the road and let them decide.

;>)

Linda Frederick

[Malcolm Needs ☆]

Once again, that seems fair enough, although, if the "shipping-out" is longer than 72 hours, it may be worthwhile thinking in terms of the anti-D immunoglobulin, but, come to think of it, I should think, under the circumstances that would prevail, the last thing on anyone's mind would be litigation.

[RR1]

. That having been said, if you run out of O D Negative blood, and simply have to give O D Positive blood to a 40-year-old female (or below), would you follow it up with anti-D immunoglobulin, if the patient turned out to be D Negative (and possibly even an exchange transfusion)?

How much anti-D Ig would you need to give if Rh D+ blood was used ( assuming this would have been a transfusion of >3 or4 units) ?

[Malcolm Needs ☆]

How much anti-D Ig would you need to give if Rh D+ blood was used ( assuming this would have been a transfusion of >3 or4 units) ?

Well, to a certain extent, it depends whether you are talking about 3 or 4 units, because there would be quite a difference. It would actually also depend upon the haematocrit of the units given.

In round terms, and I mean round terms, you would normally give 500IU per 4mL, but, in such a case, you would have to give the anti-D immunoglobulin IV, rather than IM. In such cases, you more or less halve the number (250IU per 4mL). Unless your name was Count de Sade, you most certainly wouldn't give the anti-D immunoglobulin IM (I'm told it hurts like Hell, although being male, never having given birth, not sufferring from ITP and being an R1R1, I can't say I've had personal experience).

The real problem is, nobody actually really knows how the anti-D imunoglobulin works (although Belinda Kumpel has put forward an extremely convincing thesis that it is to do with the white and red pap in the spleen), so to a certain extent, nobody knows how much to give. It sort of depends on what you believe yourself (or, at least, your Pathologist!) but in round terms, it's 250IU per 4mL.

I hope al that makes sense???????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[RR1]

Thanks Malcolm-so basically...an enormous amount !

[Jaimie Nicholson]

The only time we've ever run low on O Neg blood here, was when a patient was actually O Neg. That time we had to switch to O Pos while the patient was still hosing, and switched back once they got him/her (can't remember which) under control. In all other cases, at most the first 6 units were O Neg emergency blood, because we always demand a sample, and do a rapid (tube) forward group so we can start issuing group specific blood as soon as possible.

And yeah, I don't think we have enough anti-D in stock to act as a chaser for even one unit of red cells if it's 500 IU/4 mLs...

[Malcolm Needs ☆]

No, neither would our hospitals. They get it from the Blood Centres if and when required in doses of 2, 500IU for IV use.

[Wooly Mammoth]

I'd like a little clarification from those technologists that indicate their facilities have a policy to give O+ blood to males, and de facto to females past child bearing age, in an emergent trauma and O= blood to females (of child bearing age). While I understand that when O= is not readily available it may be necessary, at times, to do this, but to basically say if you're a male of Rh negative status we will give you Rh positive blood and we guarantee to give you a circulating antibody to D antigen for all your future years and increase your medical costs for all of those future antibody IDs that technologists will have to deal with or send out for reference. If that is your 'policy' then I have a good lawyer I'd like you to talk to. Please explain.

[Malcolm Needs ☆]

I'd like a little clarification from those technologists that indicate their facilities have a policy to give O+ blood to males, and de facto to females past child bearing age, in an emergent trauma and O= blood to females (of child bearing age). While I understand that when O= is not readily available it may be necessary, at times, to do this, but to basically say if you're a male of Rh negative status we will give you Rh positive blood and we guarantee to give you a circulating antibody to D antigen for all your future years and increase your medical costs for all of those future antibody IDs that technologists will have to deal with or send out for reference. If that is your 'policy' then I have a good lawyer I'd like you to talk to. Please explain.

From the point of view of the UK, we are not encouraged to give group O D Positive blood to all males in an emergency situation, but what we are encouraged to do, by the BCSH Guidelines, is, if there are many victims of a major incident, then females of child bearing potential are given the group O D Negative blood, whilst males and females beyond child bearing potential are given the group O D Positive (perhaps I did not make that clear in my earlier posts).

Under these circumstances, of course, I would welcome a chat with your lawyer, on a winner takes all basis!

Send an ant-D to the Reference Laboratory? Blow me. They would get very short shrift from my Laboratory, if they did that on a regular basis!

The difference between the UK and the USA, however, is stark in that nobody as an individual has to pay for antibody investigations (unless, of course, they decide to go "private") but the cost of such treatment comes out of the public purse in the form of money from our taxes.

This, in my opinion, is a good way to spend taxes. Unfortunately, Governments of all all political persuasions find numerous ways to spend our taxes badly - all the time.