When you get a request for "RhoGam", do you run a fetal screen...

Only post partum?

After an amniocentesis?

After abdominal trauma?

Only if Dr orders?

Currently we do a fetal screen Postpartum or after any abdominal trauma (injury, amniocentesis, etc.) if the patient is at greater than 20 weeks.

We do not run a fetal screen if less than 20 weeks or for routine 28 week injection.

Thanks for your input...

Linda Frederick

That's exactly what we do also.

Linda, do you do a KB stain regardless of the results of the FBS whenever there is trauma? If the baby is Rh negative, the FBS won't tell the physician how much of a bleed there is (if any). A lot of doctors don't know this and will order a FBS thinking it will tell them how much of a bleed there was. Scary, but true.

BC

I vaguely remember that a 20-wk-old fetus has less than 30 mL of blood volume, so a complete exsanguination into the maternal circulation would still not cause a positive fetal screen.

We do fetal screens for events after 20 wks gestation.

Our cut-off for fetal bleed detection is 13 weeks. (I don't even want to get into where that came from.) Essentially our FMH testing occurs for RhIG candidates and trauma when ordered. Traumas are always K-B because they are more worried about a bleeding fetus than a Rh neg mom and obviously most of the moms will be Rh pos anyway.

we run a fetal screen with any rhogam order we receive.

Wow, Nikki, since you are doing fetal screens on any RhIg order you receive, I bet the techs sure hate it when the mom is Rh positive ;-)

In what part of the Sportsman's Paradise are you located? Even though I am a Texan, I have worked all over Louisiana, and I trained at St. Patrick in Lake Charles.

BC

i'm sure they would be mad, if they started the fetal screen before the rh was done.

i'm in new orleans.

We do perform a KB stain, and we need to remind the docs (especially from ER) of the difference between the Fetal Screen and KB.

The issue I am having recently is that a physician objected to us doing a Fetal Screen with a Rhogam request after amniocentisis, to determine if more than one dose might be required. The Doc felt the Fetal Screen wasn't necessary.

I am can't get much information on this. In the AABB News, JAN 2007 there was a good summary of RhIG workups in the Q&A section. The authors suggested that amniocentis is a "minimal risk clinical event" with a low likelihood of significant FMH, while something like external version is a high risk event. They were talking more about timing of doses, and don't mention fetal screens.

I am trying to simplify the ordering process for RhIG, considering all the possible locations (ER/OB) that order it.

Thanks for your input.

I think your doc might have a good point. However, you may want to read a practice guideline recommendation at the following URL:

http://www.guideline.gov/summary/summary.aspx?doc_id=3955&nbr=003092&string=amniocentesis

I learned in law school that what a doctor says is standard of care and what actually is standard of care are not necessarily the same. A resource that I have used quite often in the past to make this point to a physician is the National Guideline Clearinghouse, which has hundreds of practice guidelines (www.guideline.gov).

BC

We only perform a FMH test(Rh positive infants, negative Mom) postpartum. The Gamma/Immucor kit insert does not recommend testing infant's possessing a weak D antigen sine the test may not detect a FMH exceeding 30 ml. We send all other requests to the Heme Lab for a KB

If ONLY Hematology would do our KBs. ;-)

BC

Currently, we perform the Fetal Screen routinely following the delivery of the newborn(s). All other requests for Fetal Screen are the responsibility of the physician. If we encounter an instance where a physician does not order the test when the situation warrants, we let the medical director handle it.

Third and long......punt!

Hate to restart this discussion.....but.....I have night techs who are literally picking my procedure apart about fetal screen testing for miscarriages. They don't want to do the fetal screen for any miscarriages. My procedure is under 13 weeks no fetal screen needs to be done and over 13 weeks, do fetal screen & if pos do K-B stain. I've looked this up in the Tech Manual and find 20 weeks mentioned. Please let me know what your policies are in regards to fetal screen and should I change to 20 week cut off for testing. Also, we have one ER doc that will order RhIg for any woman presenting with preg & bleeding (threatened abortions) Do you give RhIg or are they referred to their OB doc to follow up.

Do you require documentation of the number of weeks or do you accept a verbal (possibly unverified) report from the caregiver?

Thanks,

Carol

We usually just ask the nurse or doctor, so it could be inaccurate, based on what the women tell us. Most of the time they will order a Quant. HCG.

In the UK, the Guidelines state that before 12 weeks gestation, anti-D immunoglobulin is only given for surgical terminations.

Between 12 weeks and 20 weeks, we are to give 250IU anti-D immunoglobulin for a potentially immunizing occurrance.

After 20 weeks gestation, we have to perform an estimation of the foeto-maternal haemorrhage, but give 500IU anti-D immunoglobulin as a minimum.

You can now view these guidelines easily in the 'New Document Library' that Cliff has set up for BBT. Just look in the BCSH area of the UK documents section