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Which babies do you do "Cord Blood Workups" (Type and DAT) on routinely?


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Which babies do you do "Cord Blood Workups" (Type and DAT) on routinely?  

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  1. 1. At your hospital. which babies do you do "Cord Blood Workups" (Type and DAT) on routinely, as a policy? (Not including cord work ups ordered "as needed" by a pediatrician).

    • Babies of Rh Negative moms only - as part of a RhoGam workup.
    • Babies of Rh Negative moms - (as part of a RhoGam workup) AND babies of O moms.
    • All babies regardless of mom's blood type.


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Hello. We have been looking at our policy regarding when the nursery orders Cord Blood Workups (Type and DAT) on babies. Currently we do all babies of Rh Neg moms (of course), as well as of O moms. I have read that many blood banks have dropped performing these on babies of O moms, and only do them as part of the RhoGam workup. 

In talking to a few of our pediatricians, none of them seem to care much when we call them to inform them of the positive DATs and they shared that they do not treat differently based on the result.

This article states that testing babies of O moms is not required (American Academy of Pediatrics):

https://pediatrics.aappublications.org/content/pediatrics/114/1/297.full.pdf

What are your thoughts? What do you do at your facility? We are discussing this currently at ours and appreciate your feedback.

 

 

Edited by bowerj1
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1. Babies of Rh negative moms.

2. Reflex testing from cord bilirubin >150 umol/L

3. Any others upon request.

This system doesn't seem to cut down much on the amount of ABO/DAT we do on babies to Rh Positive moms since nurses will order it most of the time anyway. 

I would like to hear a physician's input on their reasoning behind ordering them and what the results would do to influence their clinical decision making. 

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This is a scan taken from Petz LD, Garratty G.  Immune Hemolytic Anemias.  2nd edition 2004, Churchill-Livingstone.

George may not have been medically qualified, but Lawrie Petz most certainly is, but the two of them were regarded as the world authorities in this kind of thing.  The chapter on HDFN was added to the second edition.  It was not in the first.  It shows what a waste of time, money and reagents it is to perform a DAT on all babies born to group O mothers.  This has not changed within the last 15 years.

Petz 535.jpg

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I've uploaded a Canadian Report from earlier this year that you may find interesting.  Pages 11-12 have discussion and recommendations.  Some of the discussion includes the following:

Unnecessary testing:
 Performing mid-pregnancy screens on Rh positive mothers
 Testing DATs for all cords, or from all group O mothers or all Rh negative mothers, regardless of hemolysis indications

sandra

Obstetrical and Pedatric report -COPTN-Survey-Report-2019.pdf.pdf

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On 11/15/2019 at 3:32 PM, bowerj1 said:

Hello. We have been looking at our policy regarding when the nursery orders Cord Blood Workups (Type and DAT) on babies. Currently we do all babies of Rh Neg moms (of course), as well as of O moms. I have read that many blood banks have dropped performing these on babies of O moms, and only do them as part of the RhoGam workup. 

In talking to a few of our pediatricians, none of them seem to care much when we call them to inform them of the positive DATs and they shared that they do not treat differently based on the result.

This article states that testing babies of O moms is not required (American Academy of Pediatrics):

https://pediatrics.aappublications.org/content/pediatrics/114/1/297.full.pdf

What are your thoughts? What do you do at your facility? We are discussing this currently at ours and appreciate your feedback.

 

 

We had stopped doing cord blood panels on O Pos moms for several years. Then a Family Practice physician took over as chair of OB/Peds and insisted that we resume cord blood testing on all O Pos moms. Why? ... because his children were born with elevated bili levels and his spouse is O Pos. Was there a difference in the treatment of these infants because their DAT was positive? ... probably not. We need to revisit this issue because we do a lot of cord blood panels on O Pos moms and it adds to their bill w/o adding much, if any, benefit to the infants care.

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On 11/18/2019 at 8:10 AM, NicolePCanada said:

If we only do D typing on babies from D negative mothers and a weak D or Du test needs to be performed, the results of the weak D is only valid if the DAT is negative, so a DAT would need to be performed. Therefore, an ABO and DAT would be a good place to start. Just my thought.

And just how often are you doing the weak D test on theses newborns?  Is it often enough to justify the additional testing?

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Thank you all for your comments and answering the poll question.

It seems like many of us are still doing this even though the value of the test is pretty limited.

We'll be discussing this at our facility...but the final decision depends on the pediatricians of course

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56 minutes ago, bowerj1 said:

We'll be discussing this at our facility...but the final decision depends on the pediatricians of course

That is very sad.  The final decision should depend upon a clinical discussion between the pediatricians, who know about babies, and the pathologists, who know about the value of the test results.

No one discipline knows everything about everything.

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  • 2 weeks later...

Our peds actually agreed to stop doing the babies of O moms! They said they want to do a Type and DAT as part of a bilirubin check - so if the baby is getting drawn for a bili, they will add on the Type and DAT. This sounds like a good compromise.

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It does bowerj1, except you are doing yourself, and the rest of us down.  Peds never did "do" the babies of O moms.  Most of them wouldn't have a clue how to "do" the babies of O moms.  It is people like you, me and many thousands of scientists within the Blood Bank who "do" the babies of O moms.

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