Am I thinking correctly -- or just tired from working extra covering for vacations?

An associate -- gotta love students and new employees! -- remembers being cited at a past facility for not collecting a Fetal Screen shortly after delivery, immediately after Stat cord blood testing confirms baby is Rh positive. Those of us reading product inserts know the wording is close to "at least 1 hr after delivery, but as soon as possible thereafter". I've always defined that as "with the next AM CBC." Injections are always given within 24 hrs.

A quick google search for something later than 1990 and rereading Bowman's more recent talks yielded nothing. So, other than a fading memory of something I read in the past, I have no quick evidence that the citation was in error. (Personally, I think it sounds more like a CYA statement, prevalent in many product inserts.)

While I'm not disputing that an expeditious RhIg injection is probably advantageous, the logistics of testing Stat cord blood, a Stat phelbotomy and a Stat Fetal Screen 24/7/365 seems a bit exagerated for the low clinical benefit. And I'd rather give the new mom a few hours rest before disturbing her with an unneeded blood draw.

BTW, this person is definitely a Democrat: "If we can prevent just one mother from forming Anti-D ..."

The Technical Manual says "preferably within 1 hour after delivery".

I had a PA (pediatric practice) deliver here who made us come back and redraw her because we got our sample about 50 minutes after delivery and she insisted upon 'exactly' 60 minutes post delivery of the placenta. Whatever - we aim to please!

That's exactly what I was trying to avoid in the future ...

There's a discrepancy between the Tech Manual and the product insert. Can you tell me here it's located in the Tech Manual? Doesn't seem to be in the FMS section ...

Edited June 29, 200817 yr by Lcsmrz
Stupid computer -- can't be the user!

That is on pg 548 of the 15th ed of the Tech Manual under Postpartum Administration/Postpartum Evaluation (chapter on Perinatal Issues in Transfusion Practice).

The Technical Manual says "preferably within 1 hour after delivery".

I had a PA (pediatric practice) deliver here who made us come back and redraw her because we got our sample about 50 minutes after delivery and she insisted upon 'exactly' 60 minutes post delivery of the placenta. Whatever - we aim to please!

Smart Alec Me would have had to ask what about the word "within" she didn't understand.

BC

With the Tech Manual recommending "within one hour" and the product insert saying "wait 1 hr, then ASAP thereafter". the only time to be in compliance with both is EXACTLY at 60 mins post-delivery -- just what the PA wanted!

The next question is at what point of the delivery process does the timer start ...

I'm hunting down the original reference to this recommendation. We've been drawing with the AM CBC for ages, as is everyone else I contacted in Indianapolis. While nucleated cells and ABO-incompatible cells are probabably cleared within a few hours, compatible fetal RBC's have a relatively normal lifespan in the maternal circulation. Waiting 71.9 hrs is probably not good, but a 8-12 hrs delay to save an extra venipuncture seems like compassionate care to me.

If the worry is about accurately quantifying incompatible fetal RBCs before the maternal antibodies destroy them, isn't that what the RhIg is designed to do anyway?

I think one concern is when mom is incompatible with baby ( O mom, A baby) and mom is destroying baby cells. You might not get a good count on your fetal bleed screen if you wait to long. If, at one hour she might have needed 2+ vials of RhIG but at 18 - 24 hrs she now needs only one.

Now this is all hypthetical because there is also a thought that in this scenerio mom will be afforded additional protection from the fact she is destroying the baby's cells fairly rapidly.

The other question is how long does it take for baby cells to disperse throughout mom's system so you can get a good indication of the extent of the bleed? I would think that 1 hour should do it for an average.

With all this being said, we are not in control of mom's sample being drawn. That is the nurse's call and we usually get it the next morning with the routine CBC.

We do the fetal screen next a.m. with morning draw as does everyone else I know. We have horrible, horrible compliance problems with L/D anyway concerning specmens; there is just no way that they would either notify us when the baby is born so we could time it and draw it, or keep up with it themselves. I agree in that in a perfect world, the post-partum specimen would be drawn sooner, but we just have to do the best we can. If someone can get this to work out, good for them!