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Specimen for Fetal Screen


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I was in "Word" at the time (which was why I had to do it as an attachment).

When in "Word", if you go to "insert" on the tool bar, and look at the drop down menu, you will come to something labelled as "symbol...". If you press on that, you are given a whole load of different alphabets, symbols (such as smily faces, etc), and you just press on one of those and, "Bob's your uncle"!

:):):):):)

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Malcolm -

Personally, I think Mabel was just teasing you!! :giggle::giggle:

Donna

Hmmm. Maybe she's after a job at my place then. She would fit in well with the rest of my staff, all of whom, from the most junior to the most senior, spend every spare moment taking the micky out of me; and they're a superb bunch - I wouldn't have it any other way!

:D:D:D:D:D

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We test our cord bloods asap upon receipt so we can get the sample drawn for the fetal screen. After some education our L+D nurses try to get the cords down to us in a timely fashion. When a sample needs to be drawn for a fetal screen we have it drawn right away but do not necessarily test it stat.

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I tend to agree with L106. The test is very sensitive, and in my opinion will catch any large bleeds. Our protocol here is that pregnant RH negative women ( I happen to be one) get one dose of Rhogam at 28 weeks and one Post partum. What we are telling them is whether or not they need to give more.

Secondly, the nurses and docs usually know when a large bleed has potentially occurred and give us a heads up that certain cases are not the normal ones. Large bleeds of greater than 30ml generally go not happen unnoticed.

So, really we have the same challenges, the cord never gets here and then we type it and then order the FM screen if needed.

Have not had a problem with one in 6 years of being here. We acutally had one mom who did not get her post partum does due to a nursing mistake. We did titers on her for 3 months and never got past picking up a bit of rhogam just after. Her Fetal screen was negative.

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[quote

This Supervisor stated that she had used a references that stated that it should not be drawn less than 1 hour post partum, but should then be drawn ASAP.

/QUOTE]

The package insert for the Immucor fetal screen kit references a John Judd article from a 1990 (I believe) Transfusion article that states this. Every place I have worked has always drawn the fetal screens with the next morning's lab work. However, since my current location does not perform cord blood testing on deep nights, a cord blood collected at 2200 will be reported after the morning collections so the fetal screen might not be collected until 32 hours post delivery. I read the reference for the insert hoping to find a specific number of hours to collect the sample. Since ASAP was not defined, I just said that the sample should be collected between one and 24 hours post-delivery. I never heard of any problems with drawing the sample for the test the next morning, but the 32 hour window for drawing the sample seemed a little long for an ASAP. We do type all OBs when they are in labor so I asked the techs to gie the phlebotomists.the Rh negative moms so they can get us a sample for a possible fetal screen test when they do the post-delivery morning collections. If they are candidates, they don't have to be recollected for the fetal screen. Not a perfect solution, but we have a policy signed by the Medical Director.

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I tend to agree with L106. The test is very sensitive, and in my opinion will catch any large bleeds. Our protocol here is that pregnant RH negative women ( I happen to be one) get one dose of Rhogam at 28 weeks and one Post partum. What we are telling them is whether or not they need to give more.

Secondly, the nurses and docs usually know when a large bleed has potentially occurred and give us a heads up that certain cases are not the normal ones. Large bleeds of greater than 30ml generally go not happen unnoticed.

So, really we have the same challenges, the cord never gets here and then we type it and then order the FM screen if needed.

Have not had a problem with one in 6 years of being here. We acutally had one mom who did not get her post partum does due to a nursing mistake. We did titers on her for 3 months and never got past picking up a bit of rhogam just after. Her Fetal screen was negative.

Congratulations Lara!

:D:D:D:D:D:D:D:D:D:D

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Thank Heavens someone figured out I was teasing--I was starting to get worried that I had insulted all the rest of the English speaking world there for a bit. Fascinating about the diphthongs--I was only taught that forms like "ch", "th" & "ng" were diphthongs. I looked it up and it looks like there are actually way more vowel diphthongs than consonant ones even in American English. Also very interesting about the spleen sequestering. I had suspected that a large volume transfusion would play by different rules. Thanks for the education.

About excessive bleeds--the only non-trauma case that needed extra RhIG that I have seen in the 25 years we have been doing testing for excessive bleeds was in a case where they had no reason to suspect it. These cases must be the reason we do the test--otherwise they could just give extra RhIG whenever there are risk factors.

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[quote

This Supervisor stated that she had used a references that stated that it should not be drawn less than 1 hour post partum, but should then be drawn ASAP. Every place I have worked has always drawn the fetal screens with the next morning's lab work. However, since my current location does not perform cord blood testing on deep nights, a cord blood collected at 2200 will be reported after the morning collections so the fetal screen might not be collected until 32 hours post delivery..

32 hours post delivery?? Seriously? Please re-read Malcolm's post about the spleen sequestering the fetal rbc's after a short while. Waiting 32 hours, in my opion, could lead to a false-negative fetal screen result.

Have you done any studies that have proven your 32 hr time frame to be safe?

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'Thank Heavens someone figured out I was teasing--I was starting to get worried that I had insulted all the rest of the English speaking world there for a bit.'

Hi Mabel, in know way did I feel insulted, certainly amused in the differences of language and in particular how we describe things differently. If it wasn't for the american series ER I wouldn't know what a CBC is. Like you I was fascinated about diphthongs (I thought you might wear them!!!), what an education I just received. I did not know about the role of the spleen in blood sequestration. This is what makes this site so wonderful, you can learn an awful lot from around the world (TimOx on spiders, mind blowing), and at the same time rease and have a bit of fun.

Regards

Steve:):):)

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Regarding the differences in languages.....

Just last night I was watching a home improvement show on television. The hostess of the show (who has a British accent) was explaining what repairs needed to be done on a house before putting it up for sale. She said "We need to fix the such-and-such, and we need to do this-and-that, then Bob's your uncle!!!"

Thanks to Blood Bank Talk, I understood what she meant!

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Thank Heavens someone figured out I was teasing--I was starting to get worried that I had insulted all the rest of the English speaking world there for a bit.

I didn't feel insulted either; maybe I should have done!!!!!!!!!!!

Having said that, if you had been for real Mabel, everyone's opinion is as valid as everyone else's, as far as I'm concerned, and I'm not easily insulted anyway. I have a "hide like a rhinosaurus" (and many say the looks)!

:D:D:D:D:D:D

Edited by Malcolm Needs
Still can't spell (even simple words)!!!!!!
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OK. Glad to hear we are all good. Sometimes it is hard to be sure in writings like this and I would rather assume the worst and apologize than be thought too much of a clod. (oh, no, I've used another "z"-- but don't they accumulate from all that snoring going on so we Americans are just doing our part to use them up--kind of like AB pos units?)

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While reading all these threads several thoughts came to mind. [not all related to anti-D]

If a significant number of repeat pregnancys started exhibiting anti-D, then the investigations would more than llkely yield up data that supports the need to draw the FMH specimen in a timely manner.

Then another thought was about the fact that it was not too long ago that there was significant pressure to get Cord Blood ABORh/DAT results in a timely manner, and not so much now. I can remember the lab getting excited when newborn CBC's yielding a high number of nucleated rbcs but not so much now. And, we no longer use that test to prove the DAT was caused by ABO incompatatbility, we just assue that it is when the mother is O and the baby is not. We use to do the HDN workup on any positive CORD DAT, but now only on babys with positive DAT's whose mothers have antibody present.

And, I am also thinking there may have been some clinical advances in the newborn nursery that gives the Dr and nurses some better advance warnings related to hemoglobin/oxygen levels and therefore there is less reliance on the laboratory blood bank cord blood results.

D Stoever

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Regarding testing for administration of RhIG, when ordered due to an amniocentesis, miscarriage, or abortion, where is it stated that a Fetal Screen should be performed if the patrient is =/> 20 weeks gestation. I kmow it is there, I just can't find it. No memory here. :-(

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We 'fetch' the cord bloods from OB as soon as we are notified of their presence (that unit if FAR FAR busier than any other unit in the hospital - in their opinion - so we fetch all their samples) and that is usually within 15-20 minutes on days and evenings. On nites it may be 2 hours. The cord bloods are tested as quickly as possible. We then draw our RhoGAM workups - the urgency is less for testing them - and most of our patients received their RhoGAM in less than 12 hours post delivey. Most nite time deliveries get their RhoGAM the next morning. Our policy states that Mom will be drawn 1 hour post delivery or as close to one hour as possible. Most of the time we are between 1 and 2 hours. It was that way when I came here many many many years ago and it still works for us. Everybody is used to it, I suppose. Though we did have one nurse practioner who works here with a Family Practice group who insisted on being redrawn for her fetal screen. She insisted on exactly one hour post delivery and she felt that we had drawn her 7 (yes, 7) minutes too early. We obliged.........the customer is always right (in her mind).

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Though we did have one nurse practioner who works here with a Family Practice group who insisted on being redrawn for her fetal screen. She insisted on exactly one hour post delivery and she felt that we had drawn her 7 (yes, 7) minutes too early. We obliged.........the customer is always right (in her mind).

Don't you just love 'em - and she will be teaching others!

:eek::eek::eek:

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Thank you Malcolm. But why is it that we have this convention in practice that a blood specimen for H&H should be drawn 2hrs post transfusion?

From what I understand there is typically a two day time frame for which the injection of RhoGam is to be administered post delivery. This may account for the testing lag time at some facilities and may account for floor staff practice in aquiring the specimen as well.

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Thank you Malcolm. But why is it that we have this convention in practice that a blood specimen for H&H should be drawn 2hrs post transfusion?

From what I understand there is typically a two day time frame for which the injection of RhoGam is to be administered post delivery. This may account for the testing lag time at some facilities and may account for floor staff practice in aquiring the specimen as well.

Sorry, but being English, I'm not familiar with the term H&H.

Please could you explain?

Thanks!

:redface::redface::redface::redface::redface:

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