Emergency Transfusion O pos or O neg?

[macarton]

Our policy in a shortage is all males and females over 55 will get Rh pos of their ABO group.

We use a rating system in trauma cases. We are level 2, UAB and Huntsville Level 1, so the worst cases went there. LifeSouth our blood supplier was on a generator plus had refrigerator problems for 6 days that started in the AM. The worst tornado's occurred that afternoon. Thy had divided up a lot of their blood between the hospitals in North Alabama which came in handy later after the victims started in. A code D was called the night of April 27 with the media and we had several employees which came in to help.

I was on vacation getting ready for my high school reunion that Saturday, part of it was a visit to my house before the main dinner for lemonade and cookies. What could go wrong did during the entire week. I have 2 stories about that on GRIT magazine at GRIT.com, blogs, look for Rosedale Garden. I have several links to stories about the tornado's there and also on my Mother's Day post. One link I have here is that some of the first responders went through:

http://www.timesdaily.com/article/20110509/NEWS/110509796/1011/NEWS?Title=Doctors-set-up-makeshift-morgue-after-tornado-strikes-Franklin-County-town

[KKidd]

Are there circumstances when you offer to give a patient Rh Immune globulin after the transfusion of O pos?

:work::work::work::work:

(I've been on vacation!)

[Malcolm Needs ☆]

Yes, if it were only one or two units (because you had run out of D Negative) and it was a female patient of child-bearing potential - but it would have to be a massive IV dose.

[Mabel Adams]

And no one is sure that giving RhIG for units of D+ blood will work. I read once of a case where they inadvertantly gave a teenage girl Rh + when she was Rh Neg. They did a red cell exchange via apheresis then measured the amount of D+ blood in her sample afterward (flow cytometery I suppose) and gave her the amount of RhIG to cover that. This was a letter to a journal and I don't think there was any follow-up to see if she made antibodies so can't recommend it--just throwing it out there. Extra donor exposures too.

[KKidd]

And no one is sure that giving RhIG for units of D+ blood will work. I read once of a case where they inadvertantly gave a teenage girl Rh + when she was Rh Neg. They did a red cell exchange via apheresis then measured the amount of D+ blood in her sample afterward (flow cytometery I suppose) and gave her the amount of RhIG to cover that. This was a letter to a journal and I don't think there was any follow-up to see if she made antibodies so can't recommend it--just throwing it out there. Extra donor exposures too.

Thanks Mabel,

I am tightening the loose ends on my policy. We have never given RhIG to anyone following transfusion of Rh positive blood. That being said, we decided to state that the medical director would determine if RhIG therapy is indicated.

:meditate::meditate::meditate::meditate:

(I'm trying to reach that no stress zone - does it exist for us?)

[L106]

(I'm trying to reach that no stress zone - does it exist for us?)

I reach that no stress zone whenever I walk out of the Lab at 5 PM (or 5:30 PM or 6 PM or whenever.)

Donna

[Brenda K Hutson]

Not necessarily. At 1 large Trauma Center I worked at, we kept 2 Trauma baskets ready to go in the refrigerator. 1 basket had 6 units of O NEG RBCs; the other had 6 units of O POS RBCs. When the trauma alarm would go off, we would call the ER and ask if it was a male or female; and if female, did they have any idea of the age. If they could confirm that it was either a male, or a woman past child bearing years, we would take the basket of O POS RBCs in a cooler to the ER.

If a patient is actively bleeding to the extent that they cannot wait for crossmatched blood, there is a good chance they will not make the anti-D. That is because the Rh POS units (assuming now we are talking about having given them to an Rh NEG patient) are not in the body long enough for the immune system to detect these "foreign" Rh POS cells; so they rarely make the antibody. But once the bleeding slows down, you would definitely want to switch them to the Rh NEG (if it was determined once you received a specimen that the patient is in fact Rh NEG). And that is the "trick;" catching them before they slow down (you just don't always know the exact point at which that occurred). Having done that many times at numerous Insitutions, I have only once seen a patient make anti-D. The supply of O NEG RBCs just does not lend itself to being able to give O NEG RBCs to all bleeding patients with unknown blood types.

Brenda Hutson, CLS(ASCP)SBB

if we dont know the Rh of the pt then best choice is o neg if we have available .if you dont have then o pos age of the pt will be considered later

[Brenda K Hutson]

Yes,Doctors only receive 1 hour of bloodbank training and signing an emergency release form with a little knowledge is unsettling for them,have your path enlighten them on protocol and product availability.Education is the key,don't give up.

Yes, their amount of Blood Bank training can also be evidenced if one looks under the "Just for Fun" Thread and counts how many people noted that when telling a Physician that blood was not ready yet because the patient has antibodies (or has a positive Antibody Screen; etc) that they respond with "well just give me O Negative then!

Brenda