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RhIG Evaluation – Postpartum

RhIG Evaluation – Postpartum, RhoGam, Rh Immune Globulin Evaluation

Test Codes

EPIC: LAB5287, Beaker: RHGPP

Department

Blood Bank

Instructions

This specimen must be collected after delivery and is only available to inpatients.

Specimen Collection Criteria

Collect: One Pink-top EDTA tube from an obstetrical patient for fetal bleed screening (FBS) and possible Fetal Maternal Hemorrhage testing or Acid Elution (Kleihauer-Betke) testing.

It is extremely important that blood samples are accurately labeled. Labels must include the following information:

1. Patient's Name: Complete name, last name first. If the patient uses a first initial followed by a middle name, both must appear in proper order on the label.
2. Wrist Band Number:  Include the prefix letters, 4 numbers, and a suffix letter (example: BR1234T). Specimens lacking this complete information cannot be used for blood transfusion purposes and requires recollection.
3. Hospital Identification Number: The seven-digit medical record number must be included on the label.
4. Date and Time Collected
5. Identification of Collector: Employee ID number or first initial and complete last name must be on the sample tube or documented in the computer system.

Rejection Criteria

• Improperly labeled specimens.
• Specimens with inadequate volume.
• Specimens collected in inappropriate collection tubes.
• Specimens contaminated with IV fluids.
• Grossly hemolyzed samples will be tested only in emergency situations.

In-Lab Processing

Centrifuge the specimen upon receipt in the laboratory.

Storage

Specimen Stability for Testing:

Room Temperature (20-26°C or 68-78.8°F): 24 hours
Refrigerated (2-8°C or 36-46°F): 72 hours
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): Specimens are held for a minimum of 7 days.

*Once a sample arrives in Blood Bank, it cannot be shared with other laboratories.

Laboratory

Farmington Hills Transfusion Medicine Laboratory (Blood Bank)
Grosse Pointe Transfusion Medicine Laboratory (Blood Bank)
Royal Oak Transfusion Medicine Laboratory (Blood Bank)
Troy Transfusion Medicine Laboratory (Blood Bank)
Dearborn Transfusion Medicine Laboratory (Blood Bank)
Trenton Transfusion Medicine Laboratory (Blood Bank)
Wayne Transfusion Medicine Laboratory (Blood Bank)

Performed

Sunday – Saturday, 24 hours a day.
Results available within 24 hours for routine requests without unexpected antibodies.

Test Methodology

Various. Work-up for RhIG-Postpartum includes Type/Screen of mother, Newborn Rh Type, Fetal Bleed Screen (rosette test), and may include the Fetal Maternal Hemorrhage test or Acid Elution (Kleihauer-Betke) test.

Interpretation

• Candidates for Rh Immune Globulin (RhIG) must be identified in order to prevent immunization to the potent D antigen. All obstetrical patients are considered RhIG candidates until proven otherwise. RhIG is not indicated in the following cases: newborn Rho (D) negative, mother Rh (D) positive, or anti-D in mother's serum when mother has not had prenatal Rh Immune Globulin.
• RhIG may be indicated for obstetrical patients who miscarry, abort, or have amniocentesis. The dose of RhIG administered is determined by the gestation period, and amount of fetal bleed if any.
• RhIG may also be administered prophylactically at 28 weeks gestation to prevent immunization during the third trimester of pregnancy.
• Royal Oak: Following the Fetal Bleed Screening (FBS) if a positive rosette test is observed or if the infant is a weak D variant the maternal sample will be sent to the Analytical Flow Cytometry Laboratory for the Fetal Maternal Hemorrhage test or the Hematology Laboratory for the Acid Elution (Kleihauer-Betke) test.
• Farmington Hills, Troy, Grosse Pointe, Dearborn, Trenton and Wayne: Following the Fetal Bleed Screening (FBS) if a positive rosette test is observed or if the infant is a weak D variant the maternal sample will be sent to the Hematology/Blood Bank Laboratory for the Acid Elution (Kleihauer-Betke) test.

Clinical Utility

RhIG is given to Rh negative women postpartum, after termination of pregnancy, abortion, ectopic pregnancy, or trauma in pregnancy (i.e., fall, or amniocentesis) to prevent development of Anti-D, which may cause erythroblastosis fetalis (hemolytic disease of the newborn) or later, lead to transfusion reaction.

CPT Codes

85461 (FBS). Kleihauer-Betke and Flow fetal RBC may include 85460.

Contacts

Last Updated

10/29/2023