Testing Mother's Blood for RhoGam

[Kathyang]

In our hospital, blood is collected on all patient's that come into Labor and Delivery. The testing we do for Fetal Maternal bleeds is completed in hematology. Some of the techs want a new specimen after the mother delivers to complete the type and screen. Other techs want to use the specimen before they deliver. I just wanted to know what other hopitals. Is it OK the to use the pre-delivery specimen to verify the type and sreen or does it need to be recollected after delivery?

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[Malcolm Needs ☆]

It depends on how long before delivery the maternal sample was drawn. As long as it is still in date for cross-match, the pre-delivery sample is quite adequate.

From the transfusion point-of-view, even if there had been a foeto-maternal haemorrhage at partum, the mother would still not have made any new antibodies that quickly.

[David Saikin]

You can use a pre-delivery specimen for the T&S; you MUST use a post-delivery specimen for the Fetal Bleed Screen. There is no requirement for an antibody screen to administer RhIg. Most of my Rh= deliveries have anti-D due to the use of gel and antepartum RhIg.

[Malcolm Needs ☆]

You can use a pre-delivery specimen for the T&S; you MUST use a post-delivery specimen for the Fetal Bleed Screen. There is no requirement for an antibody screen to administer RhIg. Most of my Rh= deliveries have anti-D due to the use of gel and antepartum RhIg.

Totally and utterly agree.

[Kathyang]

The specimen is within the 72 hrs for a crossmatch. The specimen for a fetal bleed is collected after delivery. Most of our patients do have an Anti-D due to antepartum RhIg and using gel.

Thanks for your help

[bevdu]

we have gone to using tube on rh neg moms who are in lab/del to avoid detectin the residual D due to antepartum dose of rhig.

[Brenda K Hutson]

The issues of the Type and Screen;whether it is required, whether to do it prior to delivery, whether to do it post partum, will differ from Institution to Institution.

With regard to detecing a fetal maternal bleed, in general, it is done on a post partum specimen. I only say that because there are the situations where the patient is in L&D because perhaps they were in a car accident and they want to evaluate a fetal maternal bleed (we had that just the other night; but then you are talking KB vs. Fetal Screen; but if your Hematology dept. is doing this, perhaps you also are talking KB). But if we are talking about your average Rh Negative mother, in to deliver, the policy at our Institution is: The Fetal Screen (and KB if applicable) is done on a post partum specimen. We do require a Type and Screen on that current admission. If they order it prior to delivery, that is fine (and they may want to do that, "just in case" there is a problem; or perhaps they have a patient with no prenatal care), or they can order it post partum, along with the Fetal Screen. I have only been at my Institution for not quite a couple of years, but my guess is they are coming from a place of not wanting to trust the results of outside labs (which is often where the prenatal blood work is done; and I have seen plenty of erroneous results in my years). We want to confirm that the mother is in fact, Rh Negative, and that she is not already sensitized to D. We do get frequent positive antibody screens on mothers who received prenatal Rh Immune Globulin. If we can confirm this, we do the abbreviated Panel indicated on the panels (cells with @ in the row, or [ ] around the cell numbers).

Sometimes, we get an anti-D that just seems a little too strong to represent Rh Immune Globulin. We the discuss the patient's history with the Physician. If there is any question about whether it is immune or passive, we will go ahead and give Rh Immune Globulin, but then recommend the Physician repeat an Antibody Screen after a few months (if they really want to know). But, that's just us.

Brenda Hutson, CLS(ASCP)SBB