I would like to know what other institutions are doing about this. Are you trying to give only Rh negative platelets to Rh negative women of child bearing age? Are you giving Rhogam if you can't get Rh negative platelets?

I would think you would have to give RhIg if you transfused Rh+ plts to a patient of this type.

We have a very active delivery service.

We defined this in our policies:

"Rh positive platelets must not be given to Rh negative females <50 years of age unless approved by the Medical Director."

We also have a fairly significant inventory, so this is not an issue.

Our facilities (3 hospitals) use only leukopoor single donor pheresis platelets. We do not accept platelets that are bloody. We have a standard which we compare our products against if there is doubt about RBC contamination. We have never found this to be an issue and this is the first time I have ever encountered this question. Am I missing something new?

We're just glad to have platelets most days. We don't hesitate to give an Rh pos plt pheresis to an Rh neg patient becasue that's probably all we have. On the other hand we always "suggest" to the physician of a woman of child bearing potential that they should consider ordering RhIG. Most do.

Our policy is to give Rh Neg platelets to females <50 yo, and if none are available, to give 1 RhIg per 3 Rh Pos apheresis units transfused.

We give very few platelets to females <50 yo, so I don't think this policy has ever been used.

We transfuse Rh pos platelets to Rh neg patients often, however, our policy is to call the nursing unit (or doctor) and let them know when their patient needs Rh(D) Immune Globulin. We check on a daily basis and call when any Rh neg male or female, up to 50 years of age, requires Rh(D)IG after receiving pos platelets. We base this on: 300 microgram Rh(D)IG will suffice for either 30 units of single donor platelets (counting each platelet apheresis as 4 single donor units) OR up to one month from the last dose of Rh(D)IG.

Gail

There is very little published objective information to help guide practice in this area. I was able to find only one paper (Vox Sang, 1990; Vol. 59 (3), pp. 185-9) which reported a 19% incidence of anti-D developing in Rh= patients (lacking anti-D) transfused with Rh+ platelets. A minimum "dose" of 65 single donor platelets was required. The patients all had cancer; the study was uncontrolled.

From the posted responses, it appears that there is sufficient diversity of practice to provide some objective information. While we might have to do some additional investigation (time and personnel are short everywhere) and testing, cooperation may produce something worthwhile. Any interest?

Dr. T