Accepting RH type results on OB patients from other facilities

[mollyredone]

We don't have anything to do with RHiG at my hospital, but if we get an FMH request and don't have a record on the patient, OB faxes us a copy of their type from the chart. If we get a positive FMH, we test for weak D and recommend a fetal HGB F. We would not accept a blood type for any other reason.

[MAGNUM]

WE DO NOT, REPEAT DO NOT ACCEPT ANY TYPES FROM ANY OTHER FACILITY. Too many times we get types that disagree with what we get, and it is because they are sent to reference laboratories (not bb reference labs Malcolm), where there are upwards of 2000 - 3000 types done daily, so there will be mistakes. So long and short, I dont accept them.

[tbostock]

Nope.  We had a few discrepancies with prenatal blood types from other labs.  Weirdly, they were all AB Neg.  Found out the doctor's office staff manually types in all blood types to the prenatal chart report.

 

You guessed it....the lab reports all said "Ab screen Neg"...the secretary thought that meant AB Neg.  You really can't make this stuff up.

[Likewine99]

We are the same as Steven Jeff

[R1R2]

We accept a copy of the lab results from a state certified laboratory for the 28wk dose. Interestingly we only get the Rh negatives and would not see the weak D's if reported as Rh positive. Giving Rhogam to a weak D patient is the decision of the attending physician. We recommend giving it to weak D patients but not all our physicians agree. If there is no certified report we perform the T&S prior to giving the Rhogam. Since we do not perform weak D testing on adults, those patients would be reported as Rh negative. Upon admission for delivery, Rh negative moms only have a standard T&S ordered.

  

I totally agree with estiner.  The docs never request antenatal RHIG for an Rh positive pregnant woman.…the worst case scenario is that we issue a RHIG to a Rh positive woman who was mistyped Rh negative by another lab.   We see many women without insurance and they cannot afford another blood type but they need the RHIG.    

Edited April 27, 2013 by R1R2

[Mabel Adams]

This is a bit of a sideline question.  Judd's perinatal guideline published by AABB says to test ABO/Rh on the mother at the time of delivery "to obtain concordant results of tests on two samples..." 

 

Does anyone use a logical way to create orders that say to do this test only on moms without 2 prior types on record?  Maybe this logistical difficulty is why places just test all OB admits?  I am trying to find a cost-effective, meaningful middle ground. 

 

If you do this testing, how do you know that anyone looks at its results instead of what the office sends over with the prenatal results.  Do they provide Blood Bank with what the office sent over so you can compare types or do they ignore the office results and just look at the results you turn out?  Do you monitor to make sure that you get cord blood orders on the babies of all the moms you turn out as Rh neg or do you trust that someone in OB is doing that?

[tbostock]

 

This is a bit of a sideline question.  Judd's perinatal guideline published by AABB says to test ABO/Rh on the mother at the time of delivery "to obtain concordant results of tests on two samples..." 

 

Does anyone use a logical way to create orders that say to do this test only on moms without 2 prior types on record?  Maybe this logistical difficulty is why places just test all OB admits?  I am trying to find a cost-effective, meaningful middle ground. 

 

If you do this testing, how do you know that anyone looks at its results instead of what the office sends over with the prenatal results.  Do they provide Blood Bank with what the office sent over so you can compare types or do they ignore the office results and just look at the results you turn out?  Do you monitor to make sure that you get cord blood orders on the babies of all the moms you turn out as Rh neg or do you trust that someone in OB is doing that?

 

We get a Type and Screen on all OB patients; this was an organization wide decision as we had a couple patients bleed out during delivery. We decided delivery is high risk enough to require it for all. We do not look at prenatal results at all. They are upstairs on the paper chart; we only hear about them if they don't match ours. We have it in our policy that transfusion, RhIg admin, etc are ONLY to be based on results obtained at THIS hospital. And yes, we do monitor cord blood orders down here. They were constantly missing them, or refusing to order them for Rh Pos moms with clinically significant antibodies, etc. So now we have them send down ALL cord samples, Cord Blood Evaluation test is ordered for every baby in their Newborn Order Set. Then we evaluate it in the BB and cancel the ones that do NOT need to be performed based on mom's blood type and antibody status. Yeah, it's complicated, but we just couldn't get OB to understand/cooperate.

[Liz0316]

We don't accept anyone elses results for ABO/Rh. Just now we are revising our policy to get a T&S on all admits where we don't have an ABO/Rh on file. Physicians were upset about the insurance, but I won't report a cord blood evaluation without having the mother's ABO/Rh done at our hospital.