Performance of blood bank testing for obstetric patients at delivery

A colleague asked what others in the e-Network Forum are doing regarding performance of blood bank testing (such as ABO/Rh and antibody screens) for obstetric (OB) patients at the time of delivery. Currently the inquiring member's hospital determines the ABO and Rh on ALL OB patients admitted for term delivery. However, the inquiring colleague's laboratory does NOT do an antibody screen on OB patients unless the patients are Rh negative. What do others in the e-Network do and/or advise?

The following responses were submitted:

1. A blood banker in Texas reported that at her hospital routine OB patients in labor are not tested by the blood bank, except for a blood typing whenever there is no record in the prenatal chart that a blood typing was done by an accredited laboratory. Patients scheduled for C-sections (and presumably at risk of needing transfusion) are tested for ABO/Rh and for unexpected antibodies (Type and Screen). Additional blood bank testing of OB patients is only done if a physician specifically orders the additional testing. Cord blood studies are done on all babies who are born to Rh negative mothers (see related discussion).
   
   
2. At the Web Master's institution, routine OB patients in labor are tested for ABO/Rh and unexpected antibodies (Type and Screen), both as a precaution in case of unanticipated obstetrical bleeding and to determine the Rh type of each mother, in case RHIG might be indicated. C-section patients are tested for ABO/Rh and for unexpected antibodies (Type and Screen); at the physician's discretion, some C-section patients may be crossmatched with one or more units of RBCs.

ADDENDA Sept. 8, 2001

3. A blood banker in Detroit wrote that at her hospital, (where there are about 4,000 deliveries per year), they were requested to drop the routine ABO/Rh testing on all OB patients as a cost-saving measure. Once this was done, however, determining whether a patient had been tested for ABO/Rh by an accredited lab (and which lab) was a mess. The process of discovering the OB patient blood types was very time-consuming. The responding blood banker performed an audit of how accurately the admitting notes recorded the outside test results, and there was an unacceptable error rate in the recording of the Rh type, such that RhIg eligibility was in question. The responding blood banker's hospital has since resumed ABO/Rh typing (no screen unless C-section) on all OB patients.

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Ira A. Shulman, MD
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