PMID- 30230552
OWN - NLM
STAT- MEDLINE
DCOM- 20190325
LR  - 20190325
IS  - 1537-2995 (Electronic)
IS  - 0041-1132 (Linking)
VI  - 58
IP  - 11
DP  - 2018 Nov
TI  - Anti-D from alloimmunization versus RhIG: detective work in the blood bank and 
      transfusion medicine services.
PG  - 2490-2494
LID - 10.1111/trf.14872 [doi]
AB  - BACKGROUND: The blood bank and transfusion medicine services (BBTMS) engages with 
      electronic health records (EHRs), clinicians, and outside hospitals (OHs) to 
      obtain comprehensive patient history to optimize care. Detection of anti-D in a 
      pregnant patient underscores this work. Differentiating passive anti-D due to 
      RhIG administration versus alloanti-D affects clinical decision making. The 
      objectives of this study were to identify the required steps, barriers, and 
      outcomes of anti-D investigations in obstetric patients. STUDY DESIGN AND 
      METHODS: This retrospective case series reviewed nine pregnant patients over 24 
      months, for whom anti-D was identified with no reported RhIG history. Six steps 
      were performed to ascertain anti-D history: 1) review the on-site EHR; 2) contact 
      the on-site obstetrician, 3) review history from the automatic health information 
      exchange (HIE) with OHs using the same EHR platform, 4) request information from 
      OHs with a shared EHR platform and without automatic HIE, 5) contact the OH 
      BBTMS, and 6) communicate with the outside ambulatory practice (OAP). RESULTS: 
      The investigations revealed that eight of nine patients received RhIG before 
      their presentation. Five patients received RhIG at an OH's emergency department 
      and three at an OAP. One patient's history remained unknown after initial 
      investigations; however, a subsequent sample unveiled a confounding alloantibody. 
      CONCLUSION: In the absence of a national HIE, continuity of care suffers through 
      omission of critical information. Strategies to avoid confusing passive anti-D 
      and alloanti-D include expanding HIE capabilities and use of patient 
      identification cards with critical BBTMS information to include RhIG 
      administration dates.
CI  - (c) 2018 AABB.
FAU - Berry, Debra
AU  - Berry D
AD  - Department of Pathology, University of Virginia Health System, Charlottesville, 
      Virginia.
FAU - DiGuardo, Margaret
AU  - DiGuardo M
AD  - Department of Pathology, University of Virginia Health System, Charlottesville, 
      Virginia.
FAU - Mo, Yunchuan Delores
AU  - Mo YD
AD  - Department of Pathology, University of Virginia Health System, Charlottesville, 
      Virginia.
FAU - Wehrli, Gay
AU  - Wehrli G
AD  - Department of Pathology, University of Virginia Health System, Charlottesville, 
      Virginia.
LA  - eng
PT  - Journal Article
DEP - 20180919
PL  - United States
TA  - Transfusion
JT  - Transfusion
JID - 0417360
RN  - 0 (RHO(D) antibody)
RN  - 0 (Rho(D) Immune Globulin)
SB  - IM
MH  - Adult
MH  - *Blood Banks
MH  - Electronic Health Records
MH  - Female
MH  - Hospitals
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Rho(D) Immune Globulin/*immunology
MH  - Transfusion Medicine/*methods
MH  - Young Adult
EDAT- 2018/09/20 06:00
MHDA- 2019/03/26 06:00
CRDT- 2018/09/20 06:00
PHST- 2018/03/06 00:00 [received]
PHST- 2018/06/21 00:00 [revised]
PHST- 2018/06/21 00:00 [accepted]
PHST- 2018/09/20 06:00 [pubmed]
PHST- 2019/03/26 06:00 [medline]
PHST- 2018/09/20 06:00 [entrez]
AID - 10.1111/trf.14872 [doi]
PST - ppublish
SO  - Transfusion. 2018 Nov;58(11):2490-2494. doi: 10.1111/trf.14872. Epub 2018 Sep 19.