We would like to discontinue performing KB stains in our laboratory and perform all fetal bleed determinations using flow cytometry. However, our flow lab is not 24/7. How do others address this issue of turn around time for results?

How far away is your flow lab?  RhoGam just has to be given within 72 hours, and you can always start with a minimum dosage until you get your results.

I understand the 72 hours.   We often have patients in the ED who experienced abdominal trauma and will not be in house for 72 hours. Nor can we guarantee they will follow up with a provider to receive additional doses. In addition, many of our samples are reference samples from remote locations where treatment is being delayed until (currently) the KB results are delivered. I really don't want to continue to offer KBs for times flow can not be accomplished in a timely manner.

 

We've sent our samples out for reference testing for years. You give a vial of Rho(D)Immune Globulin and state that results are pending for the Kleihauer Betke (or in your case, flow). Report how long it will take for the results to be available. If the patient has been discharged and needs additional vials, we call the ordering physician or other physician designated for followup of the patient and notify them that the patient requires  X number of additional vials, documenting the call. In the case of ER/trauma patients, they are instructed that additional vials may be needed. If they choose not to follow up on their care, there isn't much we can do about it. There are plenty of other things that patients are instructed to follow up on - if the instructions are given the same way as for other things that require follow up and the same documentation is signed in the ER or on the floor, that's due diligence. No one can control whether or not the patient chooses to comply or not. You can't hold the patient 72 hours waiting for the test result to come back.

Edited November 27, 20177 yr by AMcCord

We do a rosette test that screens for Fetal Maternal Hemorrhage and if that is positive send it for a Kleihauer. That cuts down on the amount of Kleihauers you would do. The test takes 15 minutes to perform, you just have to draw a new sample from the Rh Negative mother one hour post delivery of all products of conception.

Yes, we do FMH screen on all Rh neg mom's who deliver Rh pos infant. What I want to do is discontinue KB's and opt for flow for those that need quantification or for those ED abdominal trauma patients who have not delivered. 

Resurrecting this topic to ask what CPT code is best to use for flow cytometry for FMH.  Thanks.