Cord Blood Testing

[Keystone]

I am wondering how different hospitals handle cord bloods? Currently, we type only cords from mothers who are Group O or who are Rh negative. We are researching going to only testing cords from Rh negative mothers. I would appreciate any feedback or references to articles on this subject.

[Malcolm Needs ☆]

Sorry to be incredibly thick Keystone, but are you talking here about all cords, or just those from mothers not known to have atypical alloantibodies in their circulation?

If it is the former, I would be worried about cords from mothers with anti-c or anti-K, in particular.

[Gkloc]

We do a cord blood workup on all cord bloods when the mom is O, Rh negative, or has a history of antibodies

[Yanxia]

Sorry to be incredibly thick Keystone, but are you talking here about all cords, or just those from mothers not known to have atypical alloantibodies in their circulation?

If it is the former, I would be worried about cords from mothers with anti-c or anti-K, in particular.

Malcolm, I need your help again, would you please tell me more about the reason testing anti-c and anti-K in particular? Thank you very much.:meditate:

[Malcolm Needs ☆]

Hi Yanxia,

It's only that, after anti-D, anti-c and anti-K are the two most common maternal antibodies in the western world that cause clinically significant.

There are, of course, other maternal antibodies that cause this condition, but these are the two most common after anti-D.

[L106]

Our Nursery routinely orders an ABO/Rh on all newborns. I have been told that they report the info when registering the baby's birth certificate.

[KKidd]

Our OBs have a standing order for a cord blood workup on the babies of all Rh negative mothers. We also get orders on most O positive ones but it is the responsibility of the pediatrician to write the order. It is very seldom that we have orders on non group O samples.

:meditate::meditate:

[tbostock]

We do a cord blood workup on all cord bloods when the mom is O, Rh negative, or has a history of antibodies

Same here.

[Deny Morlino]

Our Nursery routinely orders an ABO/Rh on all newborns. I have been told that they report the info when registering the baby's birth certificate.

Same situation here. Not sure about the birth certificate portion , but probably 98% of cord samples receive an ABO/Rh and DAT.

[David Saikin]

We have standing orders for type/dat on babes from Rh= mothers . . . tend to do at least ABORh if a newborn's bili is rsiing (sometimes a dat too).

[Keystone]

Sorry, I should have been clearer. We type cords from babies whose mothers have allo antibodies always...no matter the ABO/Rh. As for the cords of the mothers who do not have allo antibody, we are typing if the mother is group O and/or Rh negative. We are considering not typing cords for mothers who are group O unless there is an allo antibody present.

[Brenda K Hutson]

We "routinely" only perform (and get an Order for) a Type and Coombs when the mom is group O and/or Rh Negative. I can't even say we have always had an Order on a baby when mom has an antibody, but if we did the mom's work-up (which is not always the case; sometimes they are only performed during pregnancy at an outside reference lab) and found an antibody, we would request that they order the appropriate testing. There have been times when either the doctors have not known the mom had an antibody (no prenatal testing by woman; outside Lab "missed" it; etc) and we have had to surprise them with this news (so we get orders and a specimen on baby; so they can monitor the baby; so mom knows of potential problems for next pregnancy).

That was the long answer of saying we do it as you stated in your initial message.

If I were going to try and make a change at my current Hospital, it would be that we perform a Type and Screen on ALL women in the Hospital to deliver (instead of doctors relying only on outside Lab testing; have seen too many errors from these outside Labs in my career). Adding that to our current protocol, should catch almost all potential Neonatal problems (the only other one coming to mind being the baby with a Positive DAT because mom has an Antibody to a Low Incidence Antibody).

Brenda Hutson, CLS(ASCP)SBB

[ffriesen]

We went to doing only the ABO/Rh on babies born to Rh negative mothers about a year ago. The birthing center is also supposed to order a DAT when the mother has a history of antibodies. The nursery does a Bili-Check on all newborns and if it is rising they will order an ABO/Rh and DAT to investigate HDN. We haven't found any positive DATs this way in the past year.

[pbaker]

We do ABO/Rh on all cords and a DAT on babies of O or Rh negative moms and those with clinically significant antibodies. Only elutions for babies of antibody moms with a positive DAT (not ABO).

[ejsommers]

The majority of our cord bloods are Rh- Moms also. We may get the occasional cord blood work-up (AboRh/Dat) from an Rh+ mom if the baby's Bili is on the rise.

[Mabel Adams]

AABB's Perinatal Guidelines recommends testing only Rh on babies of Rh neg moms for RhIG determination. The predictive power of a positive for other testing is too low to be of value unless the baby is symptomatic of HDFN. My favorite question is this: what will the doctor do differently in treating the baby if an asymptomatic baby has a pos DAT or is ABO incompatible with Mom? If nothing, can we justify charging for the test if the baby has no symptoms?

[Brenda K Hutson]

You make a good point in that if they are jaundice, they will put them under the lights anyway.

Brenda

AABB's Perinatal Guidelines recommends testing only Rh on babies of Rh neg moms for RhIG determination. The predictive power of a positive for other testing is too low to be of value unless the baby is symptomatic of HDFN. My favorite question is this: what will the doctor do differently in treating the baby if an asymptomatic baby has a pos DAT or is ABO incompatible with Mom? If nothing, can we justify charging for the test if the baby has no symptoms?

[MAGNUM]

Currently we perform an ABO/Rh and Direct coombs on ALL cord blood specimens, our neonatologist and a few of the other pediatricians have gotten together and are requesting that we limit testing to only babies of Rh negative mothers and babies of Group O mothers, but until they manage to convince my medical director why their plan would be best we will continue to test status quo.

[Brenda K Hutson]

Wow...sounds like your Medical Director is not quite up to date on current standard of practice?? Not that your facility is the only one doing this; I imagine we could come up with about every possible scenario if we asked every Hospital.

Brenda Hutson, CLS(ASCP)SBB

Currently we perform an ABO/Rh and Direct coombs on ALL cord blood specimens, our neonatologist and a few of the other pediatricians have gotten together and are requesting that we limit testing to only babies of Rh negative mothers and babies of Group O mothers, but until they manage to convince my medical director why their plan would be best we will continue to test status quo.

[GilTphoto]

We currently test all cord bloods for ABO/Rh & DAT.

low incidence antibodies not detected in the mother would be detected by the DAT.

(I also work for a "For Profit" hospital)

[Mabel Adams]

And antibodies in the mom against low incidence antigens will be very nicely detected if the baby turns yellow--and you will know clinical significance to boot.

[Brenda K Hutson]

You are correct regarding your comment about Low Incidence Antibodies. That being said, Low Incidence Antibodies do not show up on most adult Antibody Screens either; but we don't therefore perform a complete panel on all patients hoping to catch that Cw, V, Kpa, Jsa, etc etc.

Brenda

We currently test all cord bloods for ABO/Rh & DAT.

low incidence antibodies not detected in the mother would be detected by the DAT.

(I also work for a "For Profit" hospital)