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CMCDCHI

Using mother's specimen for infant type and screen

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I am trying to move my department's procedure towards using the mother's antibody screen (and ID) results rather than the baby's.  The question that I am getting hung up on is the timing of that screen since there can be multiple screens during pregnancy.  My feeling is that it should be at the time of admission for delivery or after, but I can't find guidance.  Help please!

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4 minutes ago, CMCDCHI said:

I am trying to move my department's procedure towards using the mother's antibody screen (and ID) results rather than the baby's.  The question that I am getting hung up on is the timing of that screen since there can be multiple screens during pregnancy.  My feeling is that it should be at the time of admission for delivery or after, but I can't find guidance.  Help please!

You are quite correct.

I don't actually think that it is in most guidelines, but what one should remember is that a foeto-maternal haemorrhage is just another form of transfusion for the mother, and she is capable of being sensitised by the baby's blood right up until the baby is born.  Therefore, the mother's sample should be as fresh as is possible for use as a "baby's sample".

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9 hours ago, gagpinks said:

If baby'sDAT is negative and mother antibody screen is negative at the time of birth or  within 72 hours. There is no need to perform antibody screen on baby sample and that result is valid for up to 4 months. 

 

Quite true.

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We have been doing this for years. We only only have to use the mom's IAT results if they think they might give blood products to the infant. We do not use the cord blood for baby transfusion because they could be contaminated with mom blood. They must order a specific test for the baby transfusion workup. We use a current baby hemo specimen to perform the baby ABORh off of a "clean " specimen and use the mom's IAT results. The DAT would have already been performed on the cord. Our computer is set up to enter MOM IAT results when we enter the baby's results. They baby is spared being stuck again.

Our baby transfusion population has dropped off to almost nothing in the last year or two. Any baby that might need blood is shipped off. I'm not too sorry about that either.

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We do not perform antibody screens on babies, only a forward type and a IgG DAT. We use the mom's results when considering transfusion.  What is your particular concern for using one screen versus the other? If a mom has always had negative screens, never demonstrated an antibody, great, that was easy.  If the mom was previously demonstrating an antibody, even if she is negative now, you would still need to honor that antibody if transfusing mom or baby.  To me, it's no different than any other patient. Their current antibody screen is important, of course, but you still need to honor any previous antibody IDs. 

 

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We were discussing this recently, wondering what we would need to do if mom was drawn on admission for induction but didn't deliver for 2 days and then baby needed an exchange transfusion on day 3 of life (5 days after Mom's specimen collected).  My argument was that the baby couldn't be affected by any antibody mom made after delivery so we mostly care that the mom was drawn in the 3 days before delivery (and screen done then).  Then, if we need to use mom's sample for an IgG XM (Ab to a low inc antibody maybe) then we want mom's specimen to be fresh enough for the antibody to still react in the crossmatch.  I think it depends on whether her anti-Jsa (or whatever) was 4+ or 1+ when the sample was fresh plus some other variables that I think we would consider on a case by case basis.  Any common antibodies, we would be able to get antigen negative units and aren't even required to do an IgG XM on them for neonates (although it makes everyone squeamish--maybe we would have 2 people do the antigen type).

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Mabel,

Just curious in your scenario above, if you don't draw a fresh specimen and perform the screen on mom at the time of the exchange transfusion, how would you know if mom DID develop an antibody after delivery?  I would think you would remain blissfully ignorant of any new developments in mom.

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It would certainly nice to find out about mom making a new antibody after delivery for transfusions or her next baby.  Like with most OBs whom we have no reason to test in the days after delivery, we would expect to detect any new antibodies on the prenatal testing for the next pregnancy.  If we needed to transfuse her, we would expect to find them on the crossmatch sample.  I recognize that the titer could drop below detectable level by the time testing is done for a later baby.  If we are worried about that, we should do screens on all post-partum moms.  Also, the odds that she would show a new primary response antibody within a couple of days of delivery are small enough that I wouldn't feel too worried about it.  If we wanted to detect new antibodies, about 2 weeks post-partum might be optimum, but that is not current standard of care anywhere that I know of.

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On 8/25/2016 at 3:46 PM, DebbieL said:

We have been doing this for years. We only only have to use the mom's IAT results if they think they might give blood products to the infant. We do not use the cord blood for baby transfusion because they could be contaminated with mom blood. They must order a specific test for the baby transfusion workup. We use a current baby hemo specimen to perform the baby ABORh off of a "clean " specimen and use the mom's IAT results. The DAT would have already been performed on the cord. Our computer is set up to enter MOM IAT results when we enter the baby's results. They baby is spared being stuck again.

Our baby transfusion population has dropped off to almost nothing in the last year or two. Any baby that might need blood is shipped off. I'm not too sorry about that either.

Do you use Cerner for your LIS ?  how do you associate/link mother and baby sample? 

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Only way we could do it was to double check with floors regarding the mother/baby medical record numbers and put a Blood Bank comment on the neonate's medical records number with the Mom's information and when it was performed. 

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Sorry for the delay in replying. I am not receiving this newsletter in my email anymore for some reason.

Yes we use Cerner. I don't think the baby and mom are linked. If they are, the lab can't see it on our side. We used to put the cord blood workup under the mom's number. That changed when the EMR came along to foul things up. Now the baby is ordered under their own medical record number. We have L/D wrap a mom's chart label sideways on the top of the cord blood and the baby label is placed up and down in the normal way. That way we have the mom's name and number when we are putting in the baby results. We look up the mom to make sure we have a current blood type. If current, we type the mom's type into the results. If it is not current, we get a new specimen. Blood Bank history is not always reliable. Unfortunately, the computer doesn't compare the baby type to the mom type, we have to do that.  

Talking about the history is not always reliable..... a patient came in to have a baby. The blood type didn't match the history. Had her collected again. It still didn't match her history. Started digging in the computer. Turns out, she had a baby 3 months earlier. (???) Called L/D to see if this was some type of weird OB case. No, it turns out the one that gave birth 3 months earlier had a Medicaid card and it worked so well when she gave birth that she loaned it to her friend. Just a little bit of fraud. Go figure. Never rely on computer history

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On 6/8/2017 at 1:54 AM, Malcolm Needs said:

Have you tried going to Help/Extras?

Yup, she has contacted me and we're working with her IT department.

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Occasionally we have neonates who are still in the NICU after they become 4 months of age. At that point we begin treating them like any other patient in that we must do an antibody screen on the baby's blood every 3 days if they are receiving RBCs. My practice has always been to use the pedi lavender in hematology or maybe a pedi red from chemistry to do the baby type and screen. One weekend the blood bank tech actually was able to have a phlebotomist collect a small sample on a 4-month old NICU baby and place a blood bank armband on the baby too---we have NEVER armbanded babies in the NICU. (Had the 4 month old baby been in our pediatrics center he would have been armbanded.)

I'm just curious how others handle neonates who are still in NICU after 4 months. Do you go find their other lab samples to perform the screen or have the baby stuck again? Also, if you have a BB armband system, do you armband babies in the NICU?

Thanks!

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We use an armband system on our NICU babies although they are allowed to keep the band on the isolette (do they still call them that?) so it may be more for consistency's sake than the usual function of the BB band. Because of that we wouldn't use a sample from Hem or Chem. We give only O neg in NICU (unless it would be incompatible with mom's Abs which hasn't happened yet). We have not had a NICU baby need transfusion after 4 months of age so far. If it happened, we would have to go to drawing a new specimen on baby every 3 days.  We keep the same band on patients for their whole stay so that # would be checked and recorded on specimen at each redraw but the band not replaced.

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