Pre-delivery Type and Screen

[Karen Olsen]

We perform a T&S on all Moms prior to delivery. We have a lot of patients with very little to no prenatal care and very incomplete prenatal records. We have had several instances of incorrect blood types in the patient history. We also have the policy in place of setting up two units on Surgical or OB patient's with antibodies- this can be a real pain but often the Mom has already delivered by the time we identify the antibody and the Physician will say all is well and they do not need the 2 units set up-YES!! Another problem we have is women using each others identification - so a current blood type and screen is always helpful at the time of delivery to determine necessity of RhIG and DAT requirements for baby.

As for the passive anti-D issue-we report them out as an anti-D possibly due to RhIG.

[Malcolm Needs ☆]

Whilst I hate to admit this, particularly on a worldwide site, I have to agree with you about the knowledge of an antibody screen prior to prophylaxis.

This is why, unless we have been told by a hospital that prophylaxis has been given, and we detect an anti-D with a level of 0.5 IU/mL or below, we state that an unspecified anti-D is present. If, however, the level is above 0.5 IU/mL, we are confident that it is an immune anti-D, as extensive tests have shown that, even with a prophylaxis dose of 1, 500 IU (and a BSW {British Standard Woman!]) the level never exceeds 0.5 IU/mL.

Of course, if the lady is very petite, or they give the world's supply of anti-D immunoglobulin to a single lady (or, a married lady, come to that, ha!, ha!), then we may be caught out by stating the anti-D to be immune, but then, if we are not told of these circumstances by the hospital, what can we do?

We had a lady in today with an anti-D level of 829 IU/mL.

We assume this one to be immune, rather than prophylactic!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[RR1]

Whilst I hate to admit this, particularly on a worldwide site, I have to agree with you about the knowledge of an antibody screen prior to prophylaxis.

What worries me is when I read of labs performing titres on all pregnant woman during routine antenatel screening to ascertain if the antibody is immune or not. The reasoning being based on a 'missed immune anti-D' that staff thought was prophylaxis but turned out to cause severe fetal anaemia.

It would be far easier to ensure the midwives sent a blood sample for group and screen prior to administering prophylaxis, and senior transfusion staff checked patient history before assuming antibody origins. Establishing good communication with antenatel clinics is much more important than performing these titres.

p.s Keep taking those tablets!!!:tongue:

[bbbirder]

At our hospital, we get a "BBSpecimen to hold" (we use typenex system) on all OB patients. We inspect them upon receipt for acceptability, and immediately reject if not acceptable. We see some OB docs ordering T&S on some of these patients. After a couple of serious maternal hemorrhages, the OB nurses have a 'protocol' for calling for a massive transfusion protocol from us. We thaw FFP, Cryo and prep a cooler. We have wasted some FFP and Cryo this way, but we'd rather have a little waste than a death.

I can see where having the T&S completed would be nice, but not absolutely necessary. We are automated (Galileo Echo), so it wouldn't be a burden for our staff.