Rhogam for Outpatients

[flaminredfirebird]

We have a nurse midwife who has just opened an office adjacent to our hospital. When she needs Rhogam for the 28 weeks gestation dose she brings an order to us and we give it to her. On most patients we have already done an Rh type in house but on a few they are going on the results from the state health department. My question is, do we need to have an Rh type done on the patient in house? and is there a certain time period that the Rh type should be done in relation to the patient getting the dose?

[David Saikin]

When my docs request RhIg for an outpatient I release the product to them . . . whether I have a type on file or not. We are obtaining a TS on the patient and to date have had no problems (5 yrs).

[estiner]

We require an antibody screeen within 7 days and a blood type for current pregnancy for the prophylactic dose per National OB-GYN guidelines. The State of Florida allows us to accept results from a state-certified laboratory so we require a copy of the prenatal report with the blood type and the original antibody screen plus a copy if the 2nd antibody screen was performed elsewhere - if not, we test before releasing the Rhogam.

[webersl]

CAP permits you to accept on outside lab's Rh type for this purpose.

[John C. Staley]

This is a subject that comes up from time to time and I've yet to find a definitative answer. In some respects you might just consider your facility as a simple supplier/middle man for the RhIG. The nurse midwife would shoulder all responsibility for it's ultimate use. You don't do any testing, just supply the RhIG.

Now, depending on your location there may be state and/or local regulations that require you to carry some of that responsibility in which case a minimum of an Rh type would be required. The simplest solution for you would be to have the nurse midwife purchase her RhIG directly from the supplier but that gets very expensive for her and therefore her patients because she probably would not want to buy in bulk.

[L106]

I agree with John's comments.

Donna

[Barbarakym]

\....Now, depending on your location there may be state and/or local regulations that require you to carry some of that responsibility in which case a minimum of an Rh type would be required.

Here in CA: CA state law follows AABB standards, whether you are AABB certified or not: As such actually now and for the past several years there are several requirements for issue of rhogam. Minimum testing is RH and ABS. IF there is an antibody you need to know it is not Anti D (not just by pattern, so must rule out) and must verify it is not allo as opposed to passive. You also need to know if you are giving enough. Which for prenatal that statement in dr request would be enough. But if patient is having a bleed as opposed for prophalatic you must also do a fetal screen of some type at some point (we chose 16 weeks.. others have 12 weeks, others have 20 weeks).

So forms if done as outpatients should have some of these questions answered (Reason, weeks pregnant). IF you are doing testing and issuing rhogam. However if outside source does the testing and pharmacy dispenses I don't know the nuences of the law. A local hospital near us just needs a prescription dubmitted to pharmacy. If that passes all standards if checked, I don't know.

[Mabel Adams]

I believe that a baby less than 20 weeks gestation is not believed to have sufficient blood volume to require more than one dose of RhIG even if it exsanguinated. Of course, if there were twins I suppose that might not hold true.

[Sandy L]

Our cut-off to start doing Fetal Screen is also 20 weeks. Beyond 20 weeks Fetal Screen is required except for routine antenatal RhIg (e.g. at 28 week) without invasive procedure, trauma or bleeding. Rh type is required.

[Nisar]

It will be better to performed blood grouping of Rh negative girls's husbands before giving them Rhogam

[Barbarakym]

1. I have some trauma references that recommend 16 wks. But most hospitals where I am do >12. Just cuz of risk. We chose 16 wks. Previously was 20 wks since 1990s. I am sure it is just being extra cautious.

2. Re: testing women's husbands is not safe. While we would like to think women don't mess around on hubby or boyfriend and would tell the truth if needed but I can tell you from experience at more than 1 hospital where i have worked they don't all. Which is why, I am sure, a woman's medical treatment is recommended based only on her results and her babies once born, per AABB recommendations.

[webersl]

It will be better to performed blood grouping of Rh negative girls's husbands before giving them Rhogam

Anyone have a 10 foot pole? Yes? Thanks.

In the USA, the women have many oportunities to choose to become pregnant by someone who is not their husband. Many women do not choose this, but some women do. Or, a woman might have been raped by someone who was not their husband. Whether it was by their choice or not, they may be too embarrassed, ashamed, (or afraid) to admit that the father of the baby is not the husband. That is why (at least in the US) we do not use the husband's type to determine Rhogam administration.

[Malcolm Needs ☆]

Same in the UK.

[Nisar]

yes y0u r right i didnt think ab0ut the cultural difference and i think y0u r right

[Nisar]

yes y0u are right

[Liz0316]

We are a mid sized community hospital, so most likely the mother will be delivering at our hospital. I will not release a RhIg dose unless the patient has a blood type on file in our system. I have received too many erroneous blood types from physician offices to trust their results (usually a typing error) but nonetheless, wrong. I do not accept results from any other lab.

[Mabel Adams]

The sad thing is that the erroneous types from elsewhere that can cause harm are the ones typed falsely as Rh pos and they won't be asking you to provide RhIG for them.

[Malcolm Needs ☆]

The sad thing is that the erroneous types from elsewhere that can cause harm are the ones typed falsely as Rh pos and they won't be asking you to provide RhIG for them.

Those are the dangerous ones.