RhIG Antenatal Eval at Small Facility

[sarara26]

I want to start performing Rh typing at a small emergency room facility, just to determine if a patient is eligible for RhIG.  Currently if they have a <12 wk antenatal patient with a miscarriage they send out all blood bank testing and the patient waits hours for the result.  Obviously many times they are Rh positive and don't even need RhIG.  Does anyone out there perform Rh testing only? 

[David Saikin]

While I don't perform Rh testing only I don't see any reason that you could not do so.  Seems like a good idea esp from the pt's point of view.  Think about the survey you will have to enlist in.  May be cost prohibitive from your admin's point of view.

[goodchild]

I'm guessing it would still be considered high complexity testing and all applicable regulations would need to be met for individuals performing the test.

[gilmanch]

I have a similar situation/question: What is the best practice for RHIG and patients who come into the ER pregnant and as a vaginal bleed? We do not offer the Kleihauer Betke at my hospital, only the fetal bleed screen. If any fetal bleed screen is positive we send to another hospital for the Kleihauer. This is practice for our postnatal cases. I am concerned about the ER patients and not giving them enough RHIG because right now, no fetal bleed or Kleihauer is being done to see how much of a bleed. So far in my studies I have found early in the pregnancy, the baby is so small, the blood volume of the growing baby is not over what 1 vial of RHIG can cover. But at a certain point, the baby is now big enough and the blood volume, if all of its blood volume was released into the mother’s circulation, the 1 vial of RHIG would not cover it. I think it might be 13 weeks (and by sarara26's post I feel little better about that number) that you should begin to worry about 1 vial not covering it, but not 100% sure. At my previous employer, any ER *** bleed we did TS and KB and gave RHIG based on that. Should I suggest we do the fetal bleed on any ER *** bleed and send out if positive? Or if the mom is 13 weeks and over, must send out for KB? Any suggestions would be appreciated, thanks!

[David Saikin]

fetal bleed only detects Rh Pos cells.  A lot of times, esp if there is abdominal trauma in a pregnancy, the docs will want to know if the placental circulation is compromised.  We do KBs for these.  Rarely do we do a rosette test for the ED, however, if they want RhIg and the pregnancy has gone 12 weeks or more we do perform the rosette.