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Doctor forgot to order DAT on O+ baby with O- mom. How does your lab deal with this?


fuscdis

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Most hospitals automatically order DATs on O moms with A or B babies.  But not O+ babies with O- moms.

I'm reading through the forum and it seems some hospitals do not automatically order the DAT for these O+ babies and there's no quick way to link the infant to the mother in the lab (as they are different patients) to see if there's Rh incompatibility. It falls under the doctor's scope to order the DAT. But we had a case where the doctor forgot to order the DAT with an Rh incompatible baby. 

Are DATs reflexively ordered for O-neg moms with O+ babies at your hospital? If not, how do your labs deal with this situation?

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In our facility, an Rh-HDN Screen (includes DAT if indicated) is routinely ordered by Nursing on all mothers known to be Rh Negative and mothers whose Rh type is not known. DAT is done only (by Transfusion Service) if newborn types as D and Weak D negative.  An ABO-HDN Screen is routinely ordered by Nursing on newborns delivered of Group O mothers and mothers whose ABO group is not known. DAT is done only (by Transfusion Service) on non-group O newborns. 

Based upon the results of the Rh-HDN Screen, Transfusion Services initiates the RHOGAM protocol.

These two protocols (Rh-HDN Screen and ABO-HDN Screen) are ordered by Nursing and testing done is determined by Transfusion Services.  MD is not involved directly ( other than the protocol having been previously approved by hospital obstetricians).

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My institution has an order set for a cord blood panel (ABO/Rh and DAT), which is ordered on all newborns whose mothers are type O and/or Rh negative. A blood type is ordered on all OB patients in labor so we have mom's type. If mom delivers before a type is done, we would get the cord blood order on the newborn based on the type in her H&P. When we do the type on mom post-delivery and she is Rh negative, we would make sure that we have received a cord blood specimen on baby. If necessary, we would contact the nursery to get orders for a blood type/DAT on a capillary specimen.

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Quote

ordered on all newborns whose mothers are type O and/or Rh negative. A blood type is ordered on all OB patients in labor so we have mom's type

How do you link the mother and infant patient records when they have different medical record numbers? What LIS do you use?

At ours, the OB nurse is supposed to handover that information to the neonatal physicians. This step was missed.

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Our admit order set includes performing Newborn Evaluation when Mom is group O, no prenatal care history, or history of positive antibody screen.  Almost 100% moms have an admission ABO/Rh type and antibody screen.

If mom has a negative antibody screen, what are we expecting to find when performing a DAT on ABO identical mom and baby? 

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Our LIS prints out a requisition for the Cord whenever a baby is born. This requisition contains the mother's type and screen results.(Conveniently our LIS connects the Mother & Baby's accounts. We have Meditech and I'm not exactly sure how they do so.) 

The technologist then looks at the printout of every cord we get and automatically does the ABO/DAT if the mother is Rh negative. We have a comment in the mother's specimen(if she is RH negative and  giving birth) that needs to be filled after the baby ABO/DAT is finished, so it will show up on our pending board until the baby specimen is done and the results added to the mom's specimen. 

We do not automatically test the cords if the mother is group O. In these cases it has to be requested by the floor or as reflex from the baby's bilirubin threshold. 

We will also do it for positive antibody screens. 

 

 

 

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21 hours ago, applejw said:

 

If mom has a negative antibody screen, what are we expecting to find when performing a DAT on ABO identical mom and baby? 

I would anticipate that you would be expecting the DAT to be negative.  HOWEVER, I have seen a mother w an antibody to a private ag of the father.  Baby's DAT: 4+.  Mom's ab screen was negative.  Sent to NY blood center:  they could not identify ab either.  As I said, private antigen from father.

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Agreed. We had a recent positive DAT on Group O baby born to Group O mom with negative antibody screen. Eluted anti-Cw.  After we went back and tested Mom with Cw + cells, 3+ reactivity.

Actual practice on testing babies varies from hospital to hospital - and I think most is dependent on the volume of deliveries at that hospital and the Blood Bank workload.

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On 7/1/2019 at 8:43 AM, fuscdis said:

How do you link the mother and infant patient records when they have different medical record numbers? What LIS do you use?

At ours, the OB nurse is supposed to handover that information to the neonatal physicians. This step was missed.

We are Epic/Harvest/SafeTrace.

Our cord blood specimen labels include the mother's name and MR# as well as baby name and MR#. Our facility is also using a naming convention for babies that includes mother's first name (Last Name, Mother'sFirstNameBaby's Sex - example: Jones, BeckyBoy). The names are awkward to look at, but do help connect mother/baby.

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Are you computerized?  If so - build a Cord Blood panel that includes what you want - ABORh and DAT, say.  Then the Dr only has to order that for whichever mother/baby pairs you ordinarily do that work for.

If your orders are on paper - see if you can get a Cord Panel added to the order form - same result.

We just do the Cord panel (ABORh /DAT) on the OPos and all Rh neg mom's babies.  We don't have to evaluate "DAT yes/no"  based on prior work or digging up the Mom's types.  It is DR/Nursing responsibility to get the Cord workup ordered.  All Cords are kept in the Blood Bank (part of our "Abducted Baby security SOP) so we do get all of them sent to us so we can see if they missed a CORD order on one.

Labeling for babies is as AMcCord above (Mom's and Baby's labels on tube) - except the mothers are using so many 1st and last names now - we had to flip the baby name convention to Last name, Male/female Mom's 1st name (Smith, Female Sissie) - otherwise we ran out of label space before we got to the baby's sex.

:P

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