Should a hospital dispense Rh Immune Globulin (RhIG) for a patient, in the absence of a current Rh determination on the patient?

A Transfusion Services Supervisor at a hospital in Nevada wonders if his transfusion service laboratory is compliant with federal and state regulations if they honor a physician's request to dispense Rh Immune Globulin (RhIG) for a patient, in the absence of a current Rh determination on the patient. Such requests originate from their Emergency Department as well as from their Out-Patient Infusion department, whenever a patient is "known" to her doctor to be Rh negative, and the doctor decides to 'spare' the patient the expense of the Rh typing test. This situation has created tension between the laboratory and the clinical areas because the blood bank laboratory, which does NOT accept external records to determine a patient's Rh type for blood transfusion, is responsible to dispense the RhIG (their pharmacy does not), and in the absence of a current patient sample (or historical record) of the patient's Rh typing, there is no way for the blood bank laboratory to independently verify the patient's Rh type, or if a single 300 microgram vial of RhIG is a sufficient dose. The Nevada colleagues asks if others are experiencing a similar situation, and if so, how have they addressed it?

Editor's note: Colleagues may find the discussions:

• Recommendations for storage of RHIG (Rh Immune Globulin)
• Should the hospital pharmacy participate in the dispensing of Rh Immune Globulin (RhIg)?
• Should a test for fetomaternal hemorrhage (FMH) be done before administering Rh Immune Globulin to Rh-negative women at risk of FMH in early pregnancy?

to be germane to the discussion of the above question.

The following comments have been received.

ADDENDA Feb. 7, 2006

1. A Blood Bank Supervisor at a Medical Center in El Paso, Texas acknowledges that when a physician orders a dose of Rh immune globulin for a pregnant outpatient, the transfusion service will accept printed results of Rh typing and antibody screening tests in lieu of performing new testing, provided the prior testing was done within the previous six months at a College of American Pathologist's (CAP) accredited and CLIA certified laboratory. However, when a pregnant woman is admitted to the hospital to deliver her baby, Type and Screen testing must be done on a newly collected blood sample, and if the woman is Rh negative and her baby is Rh positive, the mother's blood is also screened for evidence of fetal-maternal bleeding, for purposes of determining if more than one vial of Rh immune globulin needs to be administered for Rh immunoprophylaxis.

ADDENDA Feb. 15, 2006

2. A colleague in Michigan reports that her hospital transfusion service's policy is NOT to dispense RhIG without a current specimen on which an Rh type has been determined. They have found many Rh typing discrepancies between a doctor's office record and the Rh typing results for a current specimen. She wonders if some Rh typing discrepancies might be due to potential insurance fraud, when a patient tries to gain access to medical care using the identification card of another person. She asks the question: "Is the patient really who they say they are when they present to the ER?"

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