Cord Blood Workups for O Pos Moms

[JClausen]

I would like to know if many facilities are still routinely performing an ABORh and DAT on cord bloods for O positive moms in addition to the routine work-ups for all Rh Neg moms.

Thanks

[rcurrie]

No, we are not. We only perform cord blood workups on Rh neg moms (provided the mom isn't already sensitized to D). We occasionally get a cord blood workup ordered if severe ABO HDN is suspected. We deliver 300-400 babies a month, and might get such an order once a quarter.

BC

[Mabel Adams]

We quit doing that about a year ago. It was a policy put in place by pediatricians concerned when moms started to go home with their babies after only a day or so in the hospital. When we proposed to the current peds that we only do it if they ordered it specifically they went along with no questions and have yet to order a cord workup. They have occasionally ordered a Type and DAT on a baby that was yellow.

[Yanxia]

In China, we often meet the ABO HDN infants' cord blood cell is DAT negtive or reaction is very weak, even they are yellow and need exchange transfusion.

P.S. We do it in tube and check macroscopically.

We don't routinely test the cord cell. We do when the newborn is yellow. And use elution test to diagnose the illness.

[John C. Staley]

Currently we routinely test babies from Rh Neg moms. Trying to get that reduced to just Rh testing. Of course the physician can order anything they want on specific babies.

[Ellie Ross]

I would like to know if many facilities are still routinely performing an ABORh and DAT on cord bloods for O positive moms in addition to the routine work-ups for all Rh Neg moms.

Thanks

At our facility the responsibility to order ABORh on babies of type "O" moms falls to the nurses and this is in the nursing policy. Once ordered if the baby is not type O (as mom) we perform the DAT and record on a backup system until the floor orders it. We will also notify the patients RN to order ABORh/DAT on babies whose mother have an antibody.

[Brad D. Ross]

We are a 4 hospital group in San Diego California. We are still doing the ABO/Rh and DAT (IgG) on all babies of O Pos moms, as well as on all babies whose mother is Rh negative. Try as we might to get away from this practice, our doctors simply do not want to give it up.

[GilTphoto]

We are a for profit hospital (Tenet) and test ALL cord bloods for ABO/Rh and DAT (IgG).

This could enable us to identify low incidence antibodies that were not detected in the mother's antibody screen. If the baby's DAT is positive (not due to ABO) and the eluate is negative, I would request a specimen from the father and crossmatch against the mother, to help identify the low incidence antibody.

Too bad the doctors don't use the information appropriately.

We had a mother with Anti-D (titer 256) and Anti-C (titer 128). Baby's DAT was 3+ with both antibodies in Eluate, but baby was sent home the day after delivery. I called the doctor and asked if he was aware of the results and he said yes, but offered no justification as to why the baby was sent home so quickly.

The bilirubin usually takes a few days to increase. Another baby with anti-D in eluate had his bilirubin go from 3.2 at birth, 6.5 on day 1, 14.9 on day 2, then started dropping. Maybe the bilirubin wan't high enough at birth to be concerned??

[AMcCord]

We had stopped doing cord bloods for O Pos moms until the arrival a couple of years ago of a fresh out-of-school Family Practice doc. He insists on it and he talked one of the other docs at his practice into ordering them also! One of his mentors must have been stuck on ancient history. Other than that, we only do cords for Rh neg moms. If they have an antibody, we often get no orders on baby except CBC and T Bili. Sometimes I get the phlebs to draw me a specimen with that CBC/Bili so I can do a DAT for my own satisfaction.

[Abdulhameed Al-Attas]

Yes,in KAMC- (Transfusion Medicine Dep't),We do perform ABORH and DAT on ALL cord blood samples routinly.Further Evaluations:The DAT is usually strongly positive in HDN due to anti-D or antibodies in other blood groups;however the reactions may be weak or negative in HDN due to ABO.If the DAT is positive,elute and identify the antibody.Compare its specificity to any antibodies identified in the maternal specimen.

If the DAT is positive but the maternal serum is antibody-screen negative,either ABO-HDN or HDN due to a low-incidence antigen should be considered.Perform an eluate from the cord blood and test against A1,B and O cells.

Even if the DAT is negative and ABO-HDN is suspected,perform an eluate and test against A1,B and O cells using an antiglobulin technique.If transfusion is required,use group O,RH-compatible cells even if the diagnosis is not serologically confirmed.

If ABO-HDN has been ruled out,an antibody against a low incidence antigen should be considered.Perform an eluate from the cord blood and test against the father's cells using an antiglobulin technique.Then test the mother's serum against the paternal cells using an antiglobulin technique.

If the DAT is positive and all attempts to characterize it have failed ,consider false positive causes for a DAT(RBC agglutination before washing,cotamination with colloidal silica,improperly cleaned glassware,overcentrifugation,improperly prepared reagent with anti-human species antibodies,cold agglutinins causing complement deposition,silica gel contamination,contamination with IV solutionscontaining dextrose in distilled water,T-activation(polyagglutination)from bacterial sepsis).

[Mabel Adams]

I wonder if so much testing for a baby that isn't even yellow can be a justified use of resources. I think more limited testing was recommended in the Perinatal Guidelines book that AABB put out.

[ABQ bloodbanker]

We do test all cords from Rh Neg mothers as well as type O mothers. The physicians do not want to give this up, try as we might.

[DANDERS]

We perform ABO/Rh & DAT only on cordbloods of Rh negative moms. We keep them all and the doctors can order tests for up to 7-14 days later.

[csjuarez]

We routinely do ABO/Rh and DAT on cords from all type O and Rh negative mothers. If the DAT is positive, it is followed up with Hgb, Hct, and Bili on the cord blood. We do not do elutions if the DAT can be explained by ABO incompatibility between the mother and baby or a positive antibody screen on the mother's sample.

We've had this protocol for many years, so I'd like to re-evaluate it in the near future.

[tracylab]

At our hospital, ALL babies have a cord blood come down to the Blood Bank. Cord Workups (ABO, Rh, DAT) are ordered on babies of Rh neg moms. The rest are "held" for 2 weeks. Once or twice a month we get a request for a workup on a baby to R/O ABO incompatibility. By holding our specimens, the pediatricians can order the testing even after the baby has been discharged.

[donellda]

We work up cord bloods on all mothers who are group O, Rh negative or have a clinically significant antibody.

[ffriesen]

Unfortunately we are still doing the DAT and ABO/Rh on all positive moms. Would love to get this practice changed. Any suggestions for convincing the OB docs would be appreciated.