XM for a newborn with mom's specimen

[cheru26]

Question for hospitals  that uses cerner PathNet, How do you associate mom sample to perform XM on neonates?   If you don't mind Please share your your workflow or SOP/

 

Thanks'

 

 

[Simon1994]

Which workflow are you want? Please elaborate.

[cheru26]

We would like to know how you document mom sample to transfuse patient under month old?   Where do you enter  the antibody result from the mom?

 

 

[butlermom]

We have Cerner and our test for neonates is called "Baby Type and Screen" and includes 2 orderables: "Baby ABORh," and "Mom ABSC" (mom antibody screen). Our workflow:

1. Transfuse order for RBCs is received in blood bank
2. We go find the pedi lavender from hemo and add-on a Baby Type and Screen and a Crossmatch. The Baby T&S consists of a blood type on the baby-"Baby ABORh" (just a forward type, of course) and the Mom's antibody screen-"Mom ABSC."
3. Usually we have already performed cord blood testing so we have a blood bank comment which shows the mom's name and medical record number (our cords have both mom's and baby's label on the sample and we add the comment to the baby's profile while doing the cord blood workup)
4. We look up the mom's record to see her antibody status
5. If no antibodies, we result the "mom absc" as negative.
6. We select a neonate crossmatch and it is "compatible" once we scan the unit number for the aliquot. No serological crossmatching is done. We only transfuse O pos and O neg to babies.
7. If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required.
8. We use the "neonate protocol" to override the sample expiration so our neonate samples are good for 4 months (Cerner actually calculates it as 120 days from the date of birth.)

I hope this is helpful.

[Malcolm Needs ★]

14 hours ago, butlermom said:

If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required.

I am a little worried about the fact that there is no serological cross-match if the mother has made an atypical antibody.  The reason I say this is because it is well-known that when a person makes one antibody, they often make more than one.  If a mother makes, for example, an anti-K, which is easily detected, she may well also make another antibody specificity, such as an anti-Di^a.  As the Di^a antigen is a low prevalence antigen in most populations, it could well be that the Di^a antigen is not expressed on either the screening cells or the antibody identification panel cells - in other words, it may not be detected.  Even if the baby does not express the Di^a antigen on its red cells, the maternal anti-Di^a will still go through the placenta, and so this anti-Di^a will still be in the baby's circulation.  If, the unit to be transfused is K-, but Di(a+), the baby could well have an unexpected haemolytic transfusion reaction, which could be avoided by a serological cross-match against the mother's sample.  Once the unit has been cross-matched, and found to be compatible, then aliquots from the same unit of blood can be safely transfused without a further cross-match, but I feel that, for the first transfusion from any unit of blood, a serological cross-match should be performed.

[BloodBanker80]

On ‎06‎/‎24‎/‎2017 at 1:59 PM, butlermom said:

We have Cerner and our test for neonates is called "Baby Type and Screen" and includes 2 orderables: "Baby ABORh," and "Mom ABSC" (mom antibody screen). Our workflow:

1. Transfuse order for RBCs is received in blood bank
2. We go find the pedi lavender from hemo and add-on a Baby Type and Screen and a Crossmatch. The Baby T&S consists of a blood type on the baby-"Baby ABORh" (just a forward type, of course) and the Mom's antibody screen-"Mom ABSC."
3. Usually we have already performed cord blood testing so we have a blood bank comment which shows the mom's name and medical record number (our cords have both mom's and baby's label on the sample and we add the comment to the baby's profile while doing the cord blood workup)
4. We look up the mom's record to see her antibody status
5. If no antibodies, we result the "mom absc" as negative.
6. We select a neonate crossmatch and it is "compatible" once we scan the unit number for the aliquot. No serological crossmatching is done. We only transfuse O pos and O neg to babies.
7. If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required.
8. We use the "neonate protocol" to override the sample expiration so our neonate samples are good for 4 months (Cerner actually calculates it as 120 days from the date of birth.)

I hope this is helpful.

Thank you for sharing!  I was wondering if anyone can help with this situation:

Mom:  Anti-D and Anti-c

Neonate:  Positive DAT - Eluate Anti-D and Anti-c

If we result the Eluate as anti-D and anti-c on baby, this will require AHG XM/ honoring of antibodies (Dneg/cneg transfusions) well passed neonatal time period.  

How does anyone else result this to reflect these antibodies as 'passive' or temporary?

Thank you for any feedback! 

[Malcolm Needs ★]

We would report them as "maternal", on the grounds that babies with even the most "mature" immune system at birth will only produce IgM immunoglobulins (and these do not "fit" the cognate antigens very well), but would not,under any normal circumstances produce IgG blood group specific immunoglobulins, and so these would disappear from the foetal circulation pretty quickly.

[seraph44]

If you have Cerner you could probably have an option to report as "see comment". Then put the results as "result comments". To protect the baby from getting antigen positive blood, you might have the feature to add transfusion requirements (these can be added and removed as needed). In this transfusion requirement option you can select something like "Give O neg blood" and "little-c negative RBC). The logic in the system will warn you if you try to give anything that does not meet that requirement. After the neonatal protocol period, you can remove these requirements.