ABIDer Posted March 15, 2011 Share Posted March 15, 2011 Can anyone give me a resource to show that routine ABO testing of baby's from O moms is not necessary and a waste of money? I have to produce evidence as to why we are not doing it and why we don't need to be and I need it quickly. Any help is appreciated.Thanks :mad: Link to comment Share on other sites More sharing options...
AMcCord Posted March 15, 2011 Share Posted March 15, 2011 Rossi's Principles of Transfusion Medicine - Fourth Edition, aabb Press 2009 p 420-421 ABO Incompatibility.Partial quote of this source....."Antepartum and postpartum serologic tests are poor predictors of ABO hemolytic disease. .....". Says exactly what you need it to say. Good luck! Link to comment Share on other sites More sharing options...
L106 Posted March 15, 2011 Share Posted March 15, 2011 Quoting from "Modern Blood Banking and Transfusion Practices" by Denise Harmening, 5th edition, page 391, regarding ABO HDN:"...destruction of fetal RBCs leading to severe anemia is extremely rare. More commonly, the disease is manifested by the onset of hyperbilirubinemia and jaundice within 12 to 48 hours of birth. The increasing levels of bilirubin can be treatd with phototherapy. Severe cases requiring exchange transfusion are extremely rare." Link to comment Share on other sites More sharing options...
DPruden Posted March 15, 2011 Share Posted March 15, 2011 (edited) From "Guidelines for Prenatal and Perinatal Immunohematology" from AABB: see attached PDF. We only workup Rh negative moms and we are no longer routinely doing DATs on any baby, unless clinically indicated.Scan001.PDF Edited March 15, 2011 by DPruden more info Link to comment Share on other sites More sharing options...
SMW Posted March 15, 2011 Share Posted March 15, 2011 Depending on who you are trying to convince, you may also want to take a look at Clinical Practice Guideline from the American Academy of Pediatrics titled Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation [PEDIATRICS Vol. 114 No. 1 July 2004]SECONDARY PREVENTIONRECOMMENDATION 2.0: Clinicians should perform ongoing systematic assessments during the neonatal period for the risk of an infant developing severe hyperbilirubinemia.Blood TypingRECOMMENDATION 2.1: All pregnant women should be tested for ABO and Rh (D) blood types and have a serum screen for unusual isoimmune antibodies (evidence quality B: benefits exceed harms).RECOMMENDATION 2.1.1: If a mother has not had prenatal blood grouping or is Rh-negative, a direct antibody test (or Coombs’ test), blood type, and an Rh (D) type on the infant’s (cord) blood are strongly recommended (evidence quality B: benefits exceed harms).RECOMMENDATION 2.1.2: If the maternal blood is group O, Rh-positive, it is an option to test the cord blood for the infant’s blood type and direct antibody test, but it is not required provided that there is appropriate surveillance, risk assessment before discharge, and follow-up20 (evidence quality C: benefits exceed harms).20. Madlon-Kay DJ. Identifying ABO incompatibility in newborns: selective vs automatic testing. J Fam Pract. 1992;35:278–280 Link to comment Share on other sites More sharing options...
Mabel Adams Posted March 16, 2011 Share Posted March 16, 2011 Funny, our new neonatologist made us start routinely testing the cord blood of the babies of O moms and quoted the above clinical guideline as justification! I think he just wanted to do what they did where he came from because otherwise he is saying that they don't have the ability to provide the "surveillance, risk assessment and follow up" as mentioned to detect hyperbilirubinemia adequately. Sad. I would like to gather data on how many of those tests actually provided any meaningful information that was acted upon, but I have too much to do already. Link to comment Share on other sites More sharing options...
AMcCord Posted March 16, 2011 Share Posted March 16, 2011 All of our pediatricians and family practice folks had stopped doing cord bloods on O Rh pos moms - we'd gone 3 or 4 years without doing any - then we got a new, young family practice doc in town. He started ordering on the O Pos moms and then after about 3 months, he'd talked one of his older partners in the practice into doing it, too. Heavy Sigh! I'm sure his reason was that his mentor told him to and his mentor's practices were probably well rooted in history. One step forward...2 steps back... Link to comment Share on other sites More sharing options...
DOGLOVER Posted March 16, 2011 Share Posted March 16, 2011 We test cord bloods from group O mom's. Trouble is that if a positive DAT is found, then (at least at one of the smaller facilities in our system) then they want an elution which of course doesn't tell us anything we didn't already know. Good luck in getting rid of this testing. Wish I could. Link to comment Share on other sites More sharing options...
John C. Staley Posted March 17, 2011 Share Posted March 17, 2011 Sad. I would like to gather data on how many of those tests actually provided any meaningful information that was acted upon, but I have too much to do already.Mabel, have I got a deal for you!!! Make up a new job postion that does all the things that you would like to do but don't have the time to do them. Then hire me to do them. I'm really good at those kind of projects and helping those in the dark see the light.:bored: Link to comment Share on other sites More sharing options...
David Saikin Posted March 18, 2011 Share Posted March 18, 2011 JohnUse me as a reference for that job . . . Link to comment Share on other sites More sharing options...
L106 Posted March 18, 2011 Share Posted March 18, 2011 JohnWill you be needing an assistant???Donna Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted March 18, 2011 Share Posted March 18, 2011 John and/or Donna, are you willing to do the jobs I don't like doing, as opposed to those I don't get time to do??????????????!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
Mabel Adams Posted March 18, 2011 Share Posted March 18, 2011 John, does this mean you are retired and doing consulting or looking to relocate again? Link to comment Share on other sites More sharing options...
profbaud Posted March 20, 2011 Share Posted March 20, 2011 How good is your prenatal testing on Mom? friday we had a cord blood from an O Pos Mom and the Baby was O pos with a weak positive DAT. Mom had a negative antibody screen at her prenatal visit last fall. [We only do blood types on all delivering moms.] Guess what! Mom had a 4+ Anti-E! Just when it doesn't seem practical to do all this cord blood testing, something like this happens. Baby's bili was only 7.0 so no exchange transfusion needed. Link to comment Share on other sites More sharing options...
tbostock Posted March 20, 2011 Share Posted March 20, 2011 We only do blood types on all delivering moms.So did we but we changed our policy to do Type and Screens on all delivering moms. Your example is a really good reason to do the screen, as well as having the screen done if the mom starts to hemorrhage during or after delivery. Link to comment Share on other sites More sharing options...
L106 Posted March 21, 2011 Share Posted March 21, 2011 John and/or Donna, are you willing to do the jobs I don't like doing, as opposed to those I don't get time to do??????????????!!!!!!!!!!!!!!!!!Probably not. Oh, well......back to the drawing board.Donna Link to comment Share on other sites More sharing options...
John C. Staley Posted March 21, 2011 Share Posted March 21, 2011 John, does this mean you are retired and doing consulting or looking to relocate again?I would be willing to negotiate the things you "don't want to do" but only if Donna comes along. The semi-retired move to rural Wyoming isn't working out quite as we had hoped. Because of the crash in the ecomony we were unable to sell the house so wife is still in UT 3.5 hours away so I'm home on weekends. Looking for something else, possibly closer to home or more up my alley. This would be a great semi-retirement job, little or no stress but even less challenge or fullfillment. I've had a couple of interviews and if I could prove it I'd probably have a good case for age discrimination. Oh well that just the bitter old man in me. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted March 21, 2011 Share Posted March 21, 2011 I'm happy for Donna to come along too.There are enough bits of my job that I don't like doing for two people!!!!!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
L106 Posted March 21, 2011 Share Posted March 21, 2011 Thanks for making me feel wanted, guys!John, I'm sure sorry that the semi-retirement hasn't worked out as well as you had hoped. You mentioned you are in a rural area, so I imagine that there aren't a lot of job options, are there? I hope something shakes out of the bushes for you soon.Donna Link to comment Share on other sites More sharing options...
redwiner Posted March 22, 2011 Share Posted March 22, 2011 http://www.clinlabnavigator.com/Test-Interpretations/cord-blood-studies.html Link to comment Share on other sites More sharing options...
John C. Staley Posted March 22, 2011 Share Posted March 22, 2011 I'm happy for Donna to come along too.There are enough bits of my job that I don't like doing for two people!!!!!!!!!!!!!!!!!Malcolm, sounds like a deal. I would, of course, need the "Glorious 12th" off. If you are not familiar with that phrase it refers to the 12th of October which is the start of the Red Grouse season. If I were in the British Isles it would be a sin for me to miss that. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted March 22, 2011 Share Posted March 22, 2011 Malcolm, sounds like a deal. I would, of course, need the "Glorious 12th" off. If you are not familiar with that phrase it refers to the 12th of October which is the start of the Red Grouse season. If I were in the British Isles it would be a sin for me to miss that.Couldn't agree more. Mind you, I have broken a tooth on a piece of shot before now. Link to comment Share on other sites More sharing options...
Mabel Adams Posted March 23, 2011 Share Posted March 23, 2011 For that rare anti-E found for the first time at delivery, it probably would not have significantly changed the outcome if you had waited to do the testing once the baby turned yellow. The cost/benefit ratio for doing screens on Mom and routine cord blood testing for non-RhIG situations is pretty poor--even if it makes us BBers feel better to have found it. Link to comment Share on other sites More sharing options...
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