Practice guidelines for prenatal and perinatal immunohematology, revisited

In 1990, a subcommittee of the Scientific Section Coordinating Committee (SSCC) of the AABB formulated guidelines for prenatal and perinatal immunohematologic testing.1 These guidelines were published to provide transfusion service directors and supervisors with an authoritative source for reference in discouraging the use of outmoded tests and practices. Several changes have occurred in the decade since the SSCC guidelines were published. First, with the development of managed-care programs, routine testing is ordered by the primary care giver and often is performed by commercial laboratories. The extent to which hospital transfusion services need to repeat such tests for medicolegal reasons can be questioned, and there is an understandable reluctance on the part of health insurance companies to reimburse for such confirmatory testing. Second, the administration of Rh immune globulin (RhIg) prophylaxis is now often the responsibility of outpatient clinic nurse managers, rather than being under the purview of the transfusion service. Third, changes in regulations disallow reimbursement for laboratory tests not ordered by a licensed physician. Fourth, there have been changes in reagents and test methods, and considerable knowledge has been gained about the molecular basis and structure of blood group polymorphisms, especially those of the Rh blood group system. In light of these changes, it has become necessary to relax some of the previous guidelines and, in other cases, to introduce new ones. The following represents current opinions on prenatal and perinatal testing.