A couple of days ago we had a patient in OT who had a major obstetric haemorrhage and required 12 units of blood. Unfortunately she was O negative and because of the shortage of O negative blood, 8 of these units were O positive. She eventually had a hysterectomy and seemed to recover okay. I have just checked her Hgb this morning and it has dropped to 7.3, so it is very likely that the doctors may request blood again.

So the question is: Is it okay to keep transfusing with O Positive blood if the antibody screen remains negative? O neg blood is in very short supply here so it would be a problem.

Of course, if anti-D does develop then I have no choice but to give O neg, but until then...........

She is not likely to develop an Anti-D so quickly. I would continue giving O Pos red cells, especially since there is no chance for another pregnancy.

Some suggest that, once an Rh negative patient gets large amounts of Rh positive units, you should continue giving Rh positive for the short-term, with the hopes that the immune system becomes temporarily tolerant and does not form an Anti-D.

I agree with Lcsmrz. I have also seen this done with massively bleeding, female open heart patients.

Thanks for the replys. Our transfusion - happy doctors have not decided to transfuse yet so everything is okay at the moment. They will probably decide to transfuse in the middle of the night and I will have to be woken up to explain to them why its okay to still give O Pos blood.

You may want to explain the situation to them now. It will give them something to think about and may consider the need to transfuse much more closely than they would other wise. Over the years we have discovered that if you are prepared for the worst it seldom if never happens. It only seems to happen when you are not prepared.

We would always continue to transfuse Rh+ red cells. I don't think I ever had a patient get sensitized that received an overwhelming volume of the +blood. It is when you only give one or two that they make the antibody (maybe throw in a couple of + plts too).

We caused panic on ward recently by issuing 4 units RhD Pos to male nearly 80years old who was RhD negative and bleeding, actually refused to use it . his Hb was ok in end and received no transfusions . very frustrating when trying to conserve RhD Neg and we will be focussing again training in this area

LIke the idea of the more RhD Pos the better

In cases like this, would any of you consider giving Rh Immune Globulin? At what point would you?

BorCliff,

John C Staley gave good advice here but I would also add that, most probably, the majority of the 12 PC's tranfused pre-hysterectomy bleed out and now post hysterectomy, we are working with a closed system where sensitization would have a greater potential to occur. If, indeed, your O Neg PC inventory is too depleted to transfuse for this case then you would have no choice but to transfuse O Pos PC's but I don't agree that it is less likely the patient would now be sensitized because the system is now closed once again. Of course, the development of an allo-D, now, is of no relevance to a future prenancy.

Thanks for all the interesting replies. For this particular case our O Neg inventory is extremely depleted and we would have to give O pos if required. It would be interesting in one way to see what would happen if we actually did transfuse - would anti-D develop or not? But my practical mind outweighs my scientific mind and I hope the patient doesn`t actually need any more transfusions.

I have actually followed Johns advice and spoken to the doctors this morning concerning this topic (thanks John). I`ll have to wait and see what happens now.

In cases like this, would any of you consider giving Rh Immune Globulin? At what point would you?

As a unit of RhIg covers only 15ml of blood per 300ug (1500 IU) dose, the number of doses necessary to attempt to counter a single unit would be large. To attempt to counter multiple units would seem to be an effort in futility! Just my thoughts

Edited August 20, 201014 yr by Deny Morlino
wrong units

In cases like this, would any of you consider giving Rh Immune Globulin? At what point would you?

Generally, RhIgG is not considered in cases where large volumes of Rh-positive blood are purposely transfused to an Rh-neg patient. Although I am aware of it being utilized for the inadvertent transfusion of an Rh-positive unit to an Rh-negative patient (young, female).

I have never seen RhIg prevent sensitization when following RH+ transfusions - those pts always get sensitized (usually 1 or 2 unit transfusion). Works for plts . . .

In cases like this, would any of you consider giving Rh Immune Globulin? At what point would you?

We would not give Rh Immune Globulin after transfusing multiple units of Of Positive donor red cells. We would not give Rh Immune Globulin in any situations when we purposedly transfused Rh Pos RBCs to male patients or female patients beyond child-bearing age (or other factors that make future pregnancies unlikely.)

We would consider giving Rh Immune Globulin in certain situations involving young Rh Neg female patients who have received Rh Pos Plateletphereses or a limited amount of Rh Pos donor RBCs (for example, if the wrong unit of blood was issued to the patient.) We would involve our Pathologist/Medical Director in this decision.

Donna

Just curious, did the patient receive any other products? 12 red cell units is a lot without any plasma or platelets.

As far as giving RhIg, I think there are way too many red cells there to consider that.