Cord Blood Testing other than ABO/Rh and DAT

[QCDan]

Hello everyone,

Just a quick question to the Blood Bankers on here. I have been searching for articles and/or research pertaining to the performance of Antibody screens on Cord Blood samples of very low birthweight neonates. Since the hopspital I work for collects a cord blood sample and then draws the patient again for a venous sample for Blood bank type and screen, these extremly tiny patients can sometimes loose up to 10% of their calculated blood volume. Which in most cases lowers the H&H to a point that they have to be transfused (donor exposure, along with the typical transfusion risks thus apply).

I was wondering of other facilities out there a) use the cord blood sample to perform an antibody screen or use moms antibody screen result (performed within 3 days of delivery) as a valid result for very low birthweight neonates (25-30 weeks gestation).

Thanks and I'm looking forward to some responses.

Dan

[Malcolm Needs ☆]

I have been out of hospital blood bank work now for over a decade, but, unless things have changed drastically in those years, as far as human physiology and immunology are concerned, there is absolutely no reason why blood should be taken from the baby for antibody screen at that age, and thus causing iatrogenic anaemia.

Of course this should be performed on the mother's sample.

One wonders about the knowledge of the paediatricians concerned.

[Bill]

Here, all Blod Bank testing other than ABO/Rh & DAT is performed on mother's blood.

[Mabel Adams]

I have heard of some children's hospitals always testing the baby rather than the mom but that was because the babies get shipped in and mom's sample may not be available. If you have the cord blood, I am betting you have the mom! We use mom's sample.

[LAURAA80]

We only do ABORH and DAT on cord sample. All other testing is done on the mother's sample

[MAGNUM]

Ditto for mom, it is after all probably the best specimen.

[Barbarakym]

Hello everyone,

I was wondering of other facilities out there a) use the cord blood sample to perform an antibody screen or use moms antibody screen result (performed within 3 days of delivery) Dan

Cord Blood: Baby ABORh and DAT; Baby Antigen Typing if mom has an antibody.; Biliruben if at risk baby.

HOWEVER: IF BLOOD NEEDED:

We verify Baby Cord blood result with ABOrh done on Baby (very little specimen needed). We take the Mom's ABS but if mom is not available (Transfer in): Then we DO need to use the Baby (our method is gel, not so much needed as for tube).

If mom has an antibody we do crossmatch to AHG on mom's specimen. Later on baby specimen until antibody (usually passive) is gone from the baby's plasma. Though we use sterile docker, so that first unit is good for the life of the unit or until gone. So repeat ABS would be done only if new unit of blood was needed.

Neonates without moms with positive ABS or whose own ABS was initially negative do not get further workup during that hospital stay even if they receive blood. Until 4 months of age. Hope I didn't overlook something. But I think thats it in a nutshell.

[DOGLOVER]

We do ABO/RH and DAT on cord blood. If baby needs blood it is done from baby's sample ( just 2 little hemettes) and is good until 4 months of age no matter how many units are given. All neonates receive group O red cells except for the rare occassion when we have to deal with a directed donor. We get a lot of transfers so don't have Mom's sample, also cord blood labeling has the Mom's sticker and ID on it rather then the baby. If Mom has an antibody we would be using the Mom's sample for antibody ID.

[webersl]

We only see babies who are born here, and only during the neonatal phase, so we always have both mom and cord to work with. Once a baby is discharged, they do not come back - they would be refered to the nearby children's hospital. We only transfuse about one newborn a month. ABORh and DAT are done on the cord and not repeated for 4 months. We ALWAYS give O neg to ALL babies; that allows us to never stick the baby (for blood bank) and reduces the on-hand inventory. For transfusions, we use the mom's antibody screen result (within 3 days of birth). If mom has an antibody, we give antigen negative units. We do not perform a crossmatch.

[Malcolm Needs ☆]

We ALWAYS give O neg to ALL babies; that allows us to never stick the baby (for blood bank) and reduces the on-hand inventory.

What if Mum has an anti-c????!!!!!!!!! You can't get hold of r'r' that easily can you?

:devilish::devilish:

[webersl]

Dear ,

OK, yes, there is a comment in the footnote of the SOP on how to handle it if you can't give O for some reason. "Giving non-group-O RBC’s to neonates requires special testing and would require written permission from the Transfusion Service Medical Director for an exception to this SOP." Special testing is [from my head - this is not in SOP]: If mom and infant's types don't match, check for mom's non-matching antibody (anti-A or anti- in baby's sample by AHG (use cord, or if too old/not available, use infant periferal draw). Make sure donor type is of a compatible type with any antibodies (anti-A or anti- detected by AHG.

:tongue:

[Malcolm Needs ☆]

Dear ,

OK, yes, there is a comment in the footnote of the SOP on how to handle it if you can't give O for some reason. "Giving non-group-O RBC’s to neonates requires special testing and would require written permission from the Transfusion Service Medical Director for an exception to this SOP." Special testing is [from my head - this is not in SOP]: If mom and infant's types don't match, check for mom's non-matching antibody (anti-A or anti- in baby's sample by AHG (use cord, or if too old/not available, use infant periferal draw). Make sure donor type is of a compatible type with any antibodies (anti-A or anti- detected by AHG.

:tongue:

Sorry webersl, but it wasn't giving group O bit that I was being devilish about, it was the NEG bit!

[webersl]

Ooops. I answered too hastily. Of course, if they couldn't aquire the unit, my techs would be forced to "request permission to deviate from SOP", and then it would be evaluated on a case by case basis to determine the best course of action. Sure - there are exceptions to ALWAYS and ALL, but they are not listed in my SOP, which is geared toward rotating generalists at a hospital that rarely dispenses units to infants.

:surrender