Ok, so I posted a very brrroooaaad post yesterday that was titled "Multiple Questions".....but had responses to none of the questions.  So, let me narrow it down a little (sorry about that   ).  What I most want to know about is what all of you are doing with your pregnant patients that type 2+ with Anti-D?  Are you sending them out for molecular testing?  Or do you have a lower cut-off for that?  Just curious because I currently have one.

Thanks,

Brenda Hutson, MT(ASCP)SBB

Our cut-off for those patients is a 1+.  For a W+ we would normally use AHG testing to determine the RhD status.

Scott

We are not currently sending out any patients for molecular testing.  We accept 1+ as Scott indicated and anything weak would have a Weak D test performed.

  We are sending out our patients with a 2+ for molecular testing.

We are not sending any patients out for molecular testing at this time. My medical directory wants to see more published on different populations before he bases recommendations for RhoGAM  adminstration, etc on molecular types. He's pretty cautious. Until then he doesn't see any point in asking for an expensive test that we are not going to base treatment decisions on. So, if our patients are not 2+ or greater with all 3 anti-D reagents we use (one traditional, two different reagents on the Echo), we call them Rh negative and transfuse accordingly. We would recommend RhoGAM for OB patients in this category as well.

We send ours out for molecular if </= 2+ in gel and no increase in incubated tube.  The vast majority do come back as being eligible to receive Rh+ blood and not RhIg candidates.

Only send out if immediate spin is negative and weak D test is positive. 

13 hours ago, CarrieM said:

We send ours out for molecular if </= 2+ in gel and no increase in incubated tube.  The vast majority do come back as being eligible to receive Rh+ blood and not RhIg candidates.

We are trying to get this started here, though we usually test the ones that are negative on the ECHO and then have a positive Weak D and are usually positive (weak) in tubes.  Have sent out 2 patients so far, both came back OK for RH pos units and no RhIg.

Where do you send them?

1 hour ago, Okie said:

Where do you send them?

Any molecular testing we've sent out goes to Blood Center of Wisconsin. They have very good turn around times and their pricing is a bit less than some other options.

We send out our pregnant patients for D molecular testing if they have a specimen sent out to a reference lab that ID's them as Rh Negative and then when they come here for their RhIG injection we test them as Rh Positive in Gel. So far everyone of them we have sent has come back as not being candidates for RhIG.

Thanks.  I am thinking we will move towards sending out < 2+; but suspect most will not be Rhogam candidates.

Brenda

We were using BCW, but now we have a genomics lab about 2 hours from our hospital.  http://nybloodcenter.org/about-us/press-room/new-innovative-national-center-blood-group-genomics-created-nybc/

Both facilities provide transfusion/RhIg recommendations in the report.

We send women who are pregnant or have potential to be.

Edited March 8, 20178 yr by CarrieM

On ‎3‎/‎7‎/‎2017 at 6:36 PM, CarrieM said:

 

Sorry - did not mean to pick up a quote -

We send our molecular testing to United Blood Services reference lab in Tempe AZ and they send it on to a Grifols Lab in San Marcos TX - 855-600-7101.  UBS said they had the best pricing and turnaround time.  The Grifols report states RH genotype and UBS interprets it as to RhIg or not / Rh pos blood or not.

 

seems like a great deal of expense for what end?  To determine if a patient is a RhIg candidate? OR WHAT.

I was a member of  a TAC for one of the BB vendors last summer.  We discussed Rh molecular testing.  The company thought it was  valuable, the committee members thought it was not worth the bang for the buck.  Unless the price has come down significantly.

On ‎3‎/‎11‎/‎2017 at 6:22 PM, David Saikin said:

seems like a great deal of expense for what end?  To determine if a patient is a RhIg candidate? OR WHAT.

I was a member of  a TAC for one of the BB vendors last summer.  We discussed Rh molecular testing.  The company thought it was  valuable, the committee members thought it was not worth the bang for the buck.  Unless the price has come down significantly.

So what is YOUR cut-off grade for considering the woman a rhogam candidate?  Completely Rh NEG; or are their some weak reactions that you consider and just take the conservative approach and give rhogam?

Inquiring Minds Want to Know!

Thanks

Brenda Hutson

P.S.  How are you liking it out in Santa Barbara?  I am VERY jealous and really miss California.

On 3/17/2017 at 9:49 AM, Brenda Hutson said:

So what is YOUR cut-off grade for considering the woman a rhogam candidate?  Completely Rh NEG; or are their some weak reactions that you consider and just take the conservative approach and give rhogam?

Inquiring Minds Want to Know!

Thanks

Brenda Hutson

P.S.  How are you liking it out in Santa Barbara?  I am VERY jealous and really miss California. 

I like a cutoff of 1+ though I have seen/documented dome 2+ gel rxs that were classic weak D (if I was doing tube Ds I'd fgive the RhIg.  I think this is the Medical Director's call.  Whatever is comfortable for them would work for me.

I Loved Santa Barbara but am back in NH now.  Actually I retired from the lab field after a very brief medical problem.  My body said i t was time to stop so I listened.  Now I'm just playing music, substitute teaching down the street from my house, and doing an occasional BB consult.  

 

If we get a 2+ on a pregnant patient or woman in child bearing years we confirm the 2+ in tube. If the patient is still a 2+ we interpret the patient as Rh Negative and send the patient out for molecular testing.

You may need to keep your patient population in mind.  Our hospitals are in cities with very global populations and we do see women who appear D Pos, but have developed an Anti-D.   So we see value in having this testing performed.

We're doing pretty much the same as the majority - <1+ is presumptive Rh Neg and gets RHIG for pregnant patients. 

Very rarely will we send out a sample for molecular (BCW) but we have a very diverse mix of immigrants, so we do that occasionally on a case by case basis.

My medical director and I agree that the cost of molecular does not justify testing on a routine basis.  As David says, not worth the bang for the buck.