I am working a procedure to address CAP question TRM .40710, "Does the transfusion service have a policy for the transfusion of Rh-positive red cell containing products to Rh negative patients?"

We do have a statement in the "emergency release of uncrossmatched blood procedure which reads, "O RhD positive units may be given to male patients and to female patients not of child bearing age".

Problems are encountered when, for example, an Rh D negative patient begins to "bleed out" during surgery. After how many units is it acceptable to begin transfusing Rh D positive blood? I've seen thresholds in the literature ranging from 6-12 units.

I should point out that this is a Veteran's Affairs facility, so the vast majority of our patients are males or females greater than age 50.

I want a policy that is flexible; which addresses the necessity of maintaining a community supply of Rh D negative that is sufficient to meet the needs of female patients of childbearing age and children.

Of course, what the transfusion service staff wants is a "carved-in-stone" policy that after "x" number of units, the Rh D negative male patients will receive Rh D positive red cells; a statement they can point to when a physician challenges them on this topic.

Examples of SOP's would be extremely helpful, if your facility has a separate policy addressing this issue. If not, pertinent verbage in other SOP's is appreciated as well. Thanks!

Afraid I won't be much help. Our policy has no set numbers. It depends on the patient and their condition, the current Rh neg inventory and what is happening throughout the facility. We must get medical director/pathologist on-call approval before switching but they are very good at realizing that the staff wouldn't be asking if there was any reason not to switch. I know a black and white world would be nice but your staff needs to understand that shades of grey is the real world.

If your patient population is such that future pregnancies are not an issue then you probably could set a number based on your medical directors comfort level and your suppliers ability to keep you supplied with Rh negs.

Our facility's policy is just like John's. We have no set in stone number- it depends on how many units the patient has used, expected usage, our inventory, and also the supplier's inventory. For instance, if O neg units are in shorter than normal supply then the threshold will be lower than normal as well.

We also need approval from the pathologist but that isn't a problem.

We have a policy to switch to Rh positive when we have 6 units of O negative remaining on shelf for males and females> 50. We normally stock 12 O negatives.

We normally stock 15 O Negs and our policy states that when we are down to 6 on the shelf, we will switch the person who is using (males and females over child bearing age). We have limited the use to 6 O Negs during open heart or trauma when their is anticipation of greater use. I'd love to send my procedure but I don't know how to get it onto this page.