Surrogate Mothers

[dstoever]

Hi

we would like to address surrogate mothers in our procedures concerning cord bloods

and neonatal transfusions

has anyone seen any references concering surrogate mothers or have updated your procedures

D Stoever

[Mabel Adams]

I have only heard of cases where the baby has a blood type that makes it appear that it can't be its mother's child. For us it would be so rare that it is only worth a mention in the Notes section of the SOP.

[rcurrie]

Let's reason this out. Wouldn't your concern be for circulating maternal antibodies? If so, then it makes no difference that I can think of if the mother is biological or surrogate.

BC

[Mabel Adams]

If the mom is O and the baby is AB with a pos DAT, I guess there could be more than the usual circulating antibodies involved--both anti-A and anti-B (or more probably anti-A,. I guess it's more a matter of the same antibodies having more antigens to attack and the techs wondering if there is a specimen mix-up. Also, a baby can be homozygous for an antigen the mom has antibodies to if she is not the genetic mother. That's about all I have ever heard of about it. It might be more difficult to find units for an exchange transfusion that are compatible with the baby as well as the mom's antibodies--but that happens with genetic moms sometimes too.

[rcurrie]

Mabel, remember- we are talking about a neonate, so there is no further concern other than the antibodies already in the baby's circulation. We don't care what the mother's blood type is, or what antigens she has. Our only concern is with circulating antibodies directed against the baby's antigens.

BC

[bbbirder]

Well, Bob, yes and no.

We had a case not too long ago of a woman delivering from an egg donor, she had anti-c, baby was Rh neg. Fortunately, the baby did not require transfusion. Finding Rh neg units negative for c-antigen would be next to impossible.

Not that your statement about caring only about the antibodies vs antigens isn't true, it's just that with surrogacy, you can encounter more unusual cases than you might normally expect.

Sometimes nursing staff in OB can be less than forthcoming with the details, not realizing the confusion BB staff is facing, such as the one Mabel suggested with a group O mom having an AB infant.

But I still don't know that any policies or procedures can help you. BB staff just needs to be aware of the possibilites.

Linda F

[Mabel Adams]

I know of a place that did a test on all cord specimens to verify that they were entirely cord blood and not partly maternal blood (a fetal hgb test of some sort--kind of like the old APT). A mixture of mom and baby's blood could also give some interesting results at times. I bet it's pretty rare.

I hope my techs are paying attention to the mom's blood type--certainly in RhIG situations and if DAT is pos.