I wanted to ask this question again because I am trying to decide if help or make things more confusing. I asked about using the Gel modified antibody Id panel when a patient has had Rhogam. My problem is this is not always documented at the time of the order. When I review the antibody panels and I see a Labor room patient with an Anti-D I do investigate and see if she had Rhogam. It is not always there and so I have to make phone calls. Do those of you that do the modified antibody Id panel

have the patient's Rhogam injection history readily available? I'm wondering if the evening and night shift techs will spend more time checking the patient's history then they would just doing the complete antibody Id panel. Do some of you assume the patient had Rhogam if they are Rh negative and the screening cells look like an anti-D?

Thanks

Antrita

Hi Antrita,

If you find it difficult within your hospital to know the patient's history regarding Rhogam, spare a thought for those working in a geographically remote area from the patient, such as the Reference Laboratories! Getting this information is sometimes harder than pulling a tooth.

:cries::cries:

Our OB Clinic injects the 28-wk RhIg, and the PreNatal info is on the chart.

I call them if the lady is discharged.

We call the patient's nurse to get the date of last RhIg injection, document this on patient record and then perform the mini-panel. If nurse does not have a record of recent RhIg and we do not then we stop there and do the standard ab. ID.

If we see a pattern of Anti-D that is 1-2+ on any L&D patient we immediately call the floor and get the date of the last rhogam injection. If the injection date was within the last couple months we would then result the antibody ID as "Passive Anti-D presumably due to Rhogam given on _____". Without further identity of the antibody. Of course, we use our judgement....if there is any doubt whatsoever as to the date of injection/and or Rhogam status in general then we do a full antibody work up.

Sounds good. My procedure would read the modified antibody Id can be used if there is documentation the patient had Rhogam. Without documentation, do a full work-up. Thanks

Antrita

Hi Antrita,

If you find it difficult within your hospital to know the patient's history regarding Rhogam, spare a thought for those working in a geographically remote area from the patient, such as the Reference Laboratories! Getting this information is sometimes harder than pulling a tooth.

:cries::cries:

Been there done that......

The reference lab environment is totally different than the hospital environment (As you already know). Even in a hospital setting we often times have to call the OB DR's office directly to get the information we want.

In the reference labs I have worked in, we simply called the referring hospital and told THEM to ascertain this information and call us back. Then it was up to them to get the info.

We have Rhig history about 50% of the time. We assume it is passive (depending on the strength of reaction), set up a modified panel, confirm with the ward where/when patient rec'd Rhig and them do additional panel cells if required.

It is very rare that we unable to discover the source of the anti-D.

We have recently added the queary, " Date of last rhogam?" to ordering fields in our computer system. The queary is attached to the fetal cell screen order. This does not cover everyone who might have received rhogam, but it does get the rH neg mom's who are here to deliver. --The amount of phone calls regarding when rhogam was given has drastically decreased.

We have that query also, but it doesn't always help. We had to allow a unknown category, so of course anyone in a hurry picks that (even if the patient is male and they know he didn't get RhIg!).

Our evening and night techs do check the history and our OB nurses are great about getting it for us.

We do the modified panel, in gel and we result the antibody as "anti-D, RhImmune globulin administered"

If no definite history, full panel, resutled as "anti-D".