Pathologist Role in Transfusion Reactions and/or RhIG administration

[SBriggs]

I am just posting this questions as it has come up by our pathology group. Are your pathologists allowed to order a Transfusion Reaction Workup or RhIG for an Rh negative patient who has received Rh pos platelets?

I ask this just because we have had instances where a patient's physician has not ordered at times when they probably should have. We then consult our pathologists and some will order and some refuse.

Thank you in advance for sharing your practice with me.

[Dr. Pepper]

RhIG - we have it in our hospital's transfusion policies, approved by the medical Executive Committee, that RhIG is dispensed by the blood bank for Rh neg patients receiving Rh pos platelets. Blood bank is the gatekeeper here since we're the ones doing it. We keep a flow sheet posted when we have one of these patients - our policy is to repeat the shot of RhIG after 30 units (or equivalent) of platelets and it helps to keep track.

Rxn - same thing, hospital policy to do a workup after any of the list of symptoms (fever, chills, etc etc) is noted. Nursing discontinues the transfusion, does the clerical check, draws the patient for the workup and sends everything down to the lab. The patient's MD (or the house officer) is notified, not to decide in their infinite wisdom if a rxn has taken place or not, but rather to initiate therapy if need be (benadryl, tylenol, etc). If they had the symptom we work it up.

[David Saikin]

Yea verily!

[tbostock]

RhIg: no, the physician would have to order it because our pathologists do not have the ability to order tests in our EMR.

Rxn: it is part of our hospital policy that nurses order it; no physician order needed. Although we put a statement into our Blood Administration order set in our EMR that the physician orders that essentially gives the nurse pre-approval to order the tests if the patient has a reaction to the unit.

[AMcCord]

RhoGAM - No. Our pathologists will talk with the physician about ordering RhoGAM for his/her patient, but the order decision comes from the patient's physician.

Transfusion reaction workups - Yes. The nurses report all suspected transfusion reactions to us and the patient's physician. If the physician does not order a reaction that we (Blood Bank/pathologist on call) think may be indicated based upon symptoms, then a workup is ordered by the pathologist.