I have a patient that has a plt count of 14 and is B Neg. He has been receiving many products in the past week. The hematologist/oncologist is now insisting on giving fresh, SDP that are ABO AND Rh matched. I was unable to get a B neg pheresis today but did get a B Pos exp 4/20. The MD will not even consider giving this product, he is insisting on only giving B neg plts. I even suggested giving RhIg just in case, but he won't budge. We'll be lucky to get another B Neg phere this week, but he is determined to hold out. Does this seem a little overboard to anyone else?

Is the patient young female? If not, and doc is just trying to get better response to plts, you might want to find in a book where it says that plts don't have Rh antigens. Oh, and a recent issue of Transfusion had an excellent, practical article on refractory plt pts. Not the one that just came but one or two before that issue.

I wouldn't say that the doctor is going overboard, but it does seem like some education is in order. It's always best to give ABO and Rh specific products, but in cases with platelets it is sometimes necessary to give what you can get when it is available. It depends on the clinical situation.

Does the patient have a history of not responding (refractory) to platelet transfusions? Is the patient a female of child-bearing age? Is the patient actively bleeding? Obviously a count of 14,000 warrants a transfusion. But what the physician needs to know is that unless the pheresis unit you have is grossly bloody, there is little risk in giving an Rh pos unit of platelets to an Rh neg patient. And giving a full dose injection of Rhogam should protect against Rh-positive transfused RBC's in a minimum of 30 units of Rh-positive platelets or 7 units of pheresis platelets. Our policy is to administer Rhogam to any patient, male or female, when an Rh negative patient receives Rh positive platelets.

If the doctor feels the patient is clinically stable and the doctor is willing to wait for ABO/Rh compatible products, then that's their call. But the doctor also needs to know that giving Rh pos platelets to an Rh neg patient is not unheard of and is sometimes necessary.