Sorry, for so many questions. Can you help me please on this?

[trisram]

The patient is a newborn boy with a low hemoglobin. The doctor wants to do a transfusion. Here is the blood typing results:

Anti-A = 0

Anti-B = 4+

Anti-D = 4+

Is there anything special we should do here? Besides just issuing B+ units?

Thank you all so much!

[Bill]

What type is mother, remember the baby has circulating maternal antibodies.

[trisram]

What type is mother, remember the baby has circulating maternal antibodies.

Thanks! I didn't think about that! Okay, her mom is B pos too. So I give her 37 degree crossmatched compatible B pos units and that should be okay, right? What about amounts? Do you think I should split the bag?

[L106]

Well, what does the doctor want to do?

[trisram]

Well, what does the doctor want to do?

He's a newbie doc. He is asking us for suggestions.

[JOANBALONE]

Hi trisam,

It sounds like you are either having a bad day in the blood bank (based on your other questions today) or you are taking a proficiency test. Anyway, you need to perform an antibody screen on mom, baby or both depending on your hospital's policy. At our hospital we would provide antigen negative blood if maternal antibody is detected in baby's plasma. Before issuing non group O blood, you should also test the baby's plasma for any passively acquired anti-B. This test should include the AHG phase. According to your situation this would not be a problem since mom is also group B.

As for amounts of blood to transfuse - this should come from the docs.

JB

Edited December 26, 2009 by JOANBALONE

[L106]

He's a newbie doc. He is asking us for suggestions.

Joan has given you good advice of what testing to do and how to select appropriate donor blood. Regarding the newbie doc "wanting advice", do you have a Pathologist or Medical Director who could call and consult with the doc (if the doc is new and unsure of what needs to be done.)?

[trisram]

Hi trisam,

It sounds like you are either having a bad day in the blood bank (based on your other questions today) or you are taking a proficiency test. Anyway, you need to perform an antibody screen on mom, baby or both depending on your hospital's policy. At our hospital we would provide antigen negative blood if maternal antibody is detected in baby's plasma. Before issuing non group O blood, you should also test the baby's plasma for any passively acquired anti-B. This test should include the AHG phase. According to your situation this would not be a problem since mom is also group B.

As for amounts of blood to transfuse - this should come from the docs.

JB

Thank you Joan. You're right, I am taking a test. I already written all my answers down, it is just that I am just double checking them and looking for any corrections or extra suggestions I can add to them. I usually work microbiology and hematology. They have me cross training in blood banking now, so I am just trying to get more familiar and more knowledgable.

Okay, let's see. So basically this is what I have right now:

1) Do an ABO/RH and DAT on baby

2) Do Ab screen and AB ID(if neccessary) on mother

3) If DAT and Ab screen is both negative, issue 37 degree crossmatch compatible units

4) If DAT is positive, then prewarm and wash several times, and retest.

5) If Ab screen is positive, antigen type for corresponding antigen for both patient and donor cells. Then issue only the antigen negative, 37 degree crossmatched compatible units

Does this sound about right?

[trisram]

Joan has given you good advice of what testing to do and how to select appropriate donor blood. Regarding the newbie doc "wanting advice", do you have a Pathologist or Medical Director who could call and consult with the doc (if the doc is new and unsure of what needs to be done.)?

Yes, you're right, thank you.

[L106]

Okay, let's see. So basically this is what I have right now:

1) Do an ABO/RH and DAT on baby

2) Do Ab screen and AB ID(if neccessary) on mother

3) If DAT and Ab screen is both negative, issue 37 degree crossmatch compatible units

4) If DAT is positive, then prewarm and wash several times, and retest.

5) If Ab screen is positive, antigen type for corresponding antigen for both patient and donor cells. Then issue only the antigen negative, 37 degree crossmatched compatible units

Does this sound about right?

You don't need to do Step #4. If the DAT is Positive, you need to figure out WHY. Is it due to an ABO antibody or due to some other (ie: "unexpected") antibody from the mother? (Sorry....I forget what ABO/Rh you said the baby and mother were.) (But there is no reason to prewarm, wash, or repeat the DAT.)

[trisram]

You don't need to do Step #4. If the DAT is Positive, you need to figure out WHY. Is it due to an ABO antibody or due to some other (ie: "unexpected") antibody from the mother? (Sorry....I forget what ABO/Rh you said the baby and mother were.) (But there is no reason to prewarm, wash, or repeat the DAT.)

You probably assumed I washed the cells before I tested them with AHG. The DAT could be a false positive. You need to wash cells because there may be Wharton jelly on it.

[L106]

You always have to wash the red cells before you test them with AHG. That is a basic principle of the Direct Antiglobulin Test.

[LaraT23]

Just keep thinking to your self that newborns do not have their own Immune systems up and going yet, so that is the reason that you are doing maternal type and antibody screen and that you would do your crossmatch using the mother's plasma as well. My own criteria is that we give group O, CMV neg units that are as fresh as possible.

As for the dosage, you need to know the desired hematocrit that the doc wants to get to and the current wieght of the baby, and remember that many times with these little ones you may be making up whole blood to tranfuse using a calculation to combine FFP and Packed cells. Both neutral groups of course ( AB FFP and O red cells).

Don't worry about the number of questions, that is what this list serv is here for. I can only speak for myself, but being a blood bank geek, I love questions.

[Malcolm Needs ☆]

Just keep thinking to your self that newborns do not have their own Immune systems up and going yet.

Well, that's not quite true Lara; it is just the case in the overwhelming number of newborns. You do come across the rare newborn that has an ABO antibody that could not possibly have come from the mother (e.g. mother AB, baby A, with an anti- - but they are very rare.

:redface:

[LaraT23]

However, as I always tell my students in here, "If you hear hoofbeats don't look for zebras".I suppose you know better than anyone that we could be here all day discussing the rare occurences of this or that. I really do try to speak to the common sense approach to try to get a thought process going for those who are unfamiliar with blood bank. True, there is never a real constant but there are truths that are greater than 75% that can really help to guide decisions. I have staff who waste valuable time chasing off after those rare occurences bunny trails. Meanwhile our patient is becoming more and more hypovolemic, and is nine times out of ten NOT one of those rare whatevers.

[Antrita]

We recently had an O positive baby with a B positive mom. They wanted to transfuse the baby. The baby had a 4+ direct coombs. The mom had an Anti-c. We transfused c-negative O positive units. We usually transfuse O just so we don't have to worry about the Anti-A or Anti-B from the mom. We have always had specimems from the mom. I am not looking forward to a time when we have a baby with a 4+ direct coombs and no maternal specimen.

Antrita

[Malcolm Needs ☆]

However, as I always tell my students in here, "If you hear hoofbeats don't look for zebras".I suppose you know better than anyone that we could be here all day discussing the rare occurences of this or that. I really do try to speak to the common sense approach to try to get a thought process going for those who are unfamiliar with blood bank. True, there is never a real constant but there are truths that are greater than 75% that can really help to guide decisions. I have staff who waste valuable time chasing off after those rare occurences bunny trails. Meanwhile our patient is becoming more and more hypovolemic, and is nine times out of ten NOT one of those rare whatevers.

A very fair comment Lara. I stand corrected and you are completely right in what you say.

:):redface::)

[Malcolm Needs ☆]

We recently had an O positive baby with a B positive mom. They wanted to transfuse the baby. The baby had a 4+ direct coombs. The mom had an Anti-c. We transfused c-negative O positive units. We usually transfuse O just so we don't have to worry about the Anti-A or Anti-B from the mom. We have always had specimems from the mom. I am not looking forward to a time when we have a baby with a 4+ direct coombs and no maternal specimen.

Antrita

The only thing that you can do in such a situation (unless, of course, there is a history of atypical alloantibodies detected in the Mother's plasma during the pregnancy) is make an eluate from the baby's red cells to ascertain what specificity/specificities is/are causing the positive DAT, and then give group O, ABO high titre negative blood, suitable for exchange transfusion, that is also negative for the implicated antigen/antigens.

Good luck!!!!!!!!!!!!

:eek::eek:

[adiescast]

We occasionally have babies transferred in from smaller hospitals. We do not have Mom's sample in those cases, so we have to rely on the eluate and careful management of a few drops of plasma from the baby. Sometimes we can get a lead from the referring hospital if Mom had prenatal work done (or we might have done it - even better!).

[Antrita]

We are adding a new patient wing to our hospital and will have a 32 bed NICU. Right now we have only 4 beds designated as NICU. Our patient population is such that we have a lot of women having a lot of babies and we see a lot of antibodies. One of my part-time techs works in a hospital in a college town 30 miles north. She says she wants to work here because we get antibodies she has never seen before. I think we get more zebras than most.

[jcdayaz]

What we do at my facility is get weekly from our blood supplier a "baby unit". It is an O neg, CMV-, irradiated unit of CPDA red cells that has been sterile docked with pedi-packs. When we get an order for blood on a neonate, we then aliquot into the pedi-packs what we will need to make two syringes (based on physician order). Normally we issue one syringe and 8 hours later issue the second.

If there is a transfuse order we request a heel-stick from the baby. If we detect antibodies in that heel stick we do the work up on mom's blood to identifiy the specificity.

[Yanxia]

We will transfuse the baby B cells in this case, and so many years no heamolysis sign have been found.

[Townsend]

The patient is a newborn boy with a low hemoglobin. The doctor wants to do a transfusion. Here is the blood typing results:

Anti-A = 0

Anti-B = 4+

Anti-D = 4+

Is there anything special we should do here? Besides just issuing B+ units?

Thank you all so much!

Hi trisram,

You should check your blood bank SOPs to make sure that there is a detailed procedure on how to handle neonatal testing and blood administration. Since this is a proficiency/competency test, you should be able to find the answers in your procedure manuals.

If not, you should definitely bring this up with your supervisor to ensure that your policies and procedures cover this.

With that said, it is good that you are looking for more information on the theory behind the testing - that is the purpose of postings like this one! Just make sure that you are not looking for answers to your test alone - these would vary by institution. Good luck..... I hope that you find that you enjoy working in the blood bank!