Tranfusion of Rh+ platelets to Rh neg patients

[RoseM]

What is your hospital policy regarding transfusion of Rh+ platelets to Rh neg patients who are of child bearing age, neonates and pediatric patients regardless of sex, and bone marrow transplant patients with a special need of "Rh neg platelets only".

The argument is that if rbc contaminants on plateletpheresis is almost negligible, is it necessary to give RhIg? Do you still ask for MD approval to give Rh incompatible platelets?

Edited May 7, 2010 by RoseM

[adiescast]

We don't worry about it unless we can see blood in the platelet bag (pink tinge). In that case, we will not accept the platelets at all and return them to the blood center. The blood center does a very good job of providing platelets without red cells. (Good job guys!)

[RoseM]

Hi adiescast,

I am not clear about your policy. If you have no Rh- plts in your inventory, what do you do?

[adiescast]

We will give Rh positive patients to an Rh negative patient if the red cell burden is too low to see visually. We try not to, but if we have no Rh negative platelets in inventory, then there isn't much of a choice. We do not recommend the use of RhIg unless there was visible red cell contamination (and, as I said above, we don't accept those products). We ask for the medical director's approval for *any* out of type platelet transfusion.

[Lcsmrz]

We try not to give Rh Pos platelets to any Rh Neg patient, but if we do, we append a comment suggesting RhIg (1 vial per 5 apheresis units in a 3 month period). Our oncologists never give it ...

[Eagle Eye]

we need MD approval to release RH POS platelet to Rh Neg patient of child bearing age. We also recommend 1 does of RHIG after giving first RH Pos SDP. Most cases our clinician do give RHIG. (most of the time these are trauma or liver patients).

[tbostock]

Our policy is if the patient is a child or a woman in child bearing years, we give Rh Neg. If it's impossible to get one, we give Rh Pos with a dose of RhIg.

[rravkin@aol.com]

We give Rh specific platelets to females of child bearing years. We try to maintain a stocked inventory.

[RoseM]

Thank you all for the valuable information you shared with me. I posted a Thank You note but i don't know where it went (I am new to the forum).

[LaraT23]

You actually under CAP have to have a policy that adresses giving RH pos to RH negative patients, however negligable the red cell content may be. Ours says that one unit of Rhogam should be sufficent to cover up to 8 units of platelets as each one has 2ml or less of RBCs. One vial of Rhogam covers about 15ml of red cells, so with that math, we say at the 8th unit, think about giving another vial.

[RoseM]

Hi Lara. Thank you for your comment.

We are revisiting our policy and we want to know what is the common practice, specifically if MD approval is required and if RhIg is recommended given the argument that the rbc contaminant is negligible. The counter argument is that the risk is low but the consequence is significant.

[adiescast]

You actually under CAP have to have a policy that adresses giving RH pos to RH negative patients, however negligable the red cell content may be. Ours says that one unit of Rhogam should be sufficent to cover up to 8 units of platelets as each one has 2ml or less of RBCs. One vial of Rhogam covers about 15ml of red cells, so with that math, we say at the 8th unit, think about giving another vial.

The CAP does not require that you give RhIg in this circumstance. It only requires that you have a policy. Your policy can state that you do not give RhIg. I found this out when I was performing an inspection at a location that had such a policy (they did not give RhIg if they gave Rh positive products to an Rh negative patient). I had never seen such a policy and called CAP about it. They told me that it met the requirement. Go figure!

[Kimster]

Remember that <0.1 ml of RBC's can cause sensitization to a Rh negative person.

[JEMarti]

We notify the patient's attending if we dispense Rh Pos to an Rh neg patient, but only rarely does anyone decide to give RhIg. Apheresis platelets contain so few RBC's that this is not really a big issue with those products. Actually, with more emphasis on extracting the most volume out of whole blood for plasma I have seem far more bloody plasma units recently. We actually had a case of a 21YO female who received 6 units of Rh pos plasma along with 8 Rh Neg rbc's and subsequently developed an anti-D and C. The only explanation was RBC stroma contained in the plasma products for the D as she received no other exposure.