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Elution on DAT positive Neonates


AB123

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Recently I started working at a lab in the UAE and here the process for all positive DAT's on neonates is to do an Elution and antibody ID, from my experience in the UK this practice is unheard of and I have not come across any site I've worked at before doing this.  However I appreciate different parts of the world have different standards that they follow. As here we follow CAP I wondered what other sites in the US are doing with DAT positive babies? 

As a side note I asked the lead pediatrician if the antibody ID is useful to them and was informed they treat all positive DAT's the same regardless of what antibody it is.

Thanks Steve

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Under routine circumstances, we do not prepare an eluate from positive DAT cells from a neonate because identity of the antibody can be determined from the mother's sample.

Of course, if a neonate with a Positive DAT arrived without a mother, no maternal sample, or from a Group AB mother with a Negative Antibody Screen, we would likely prepare and test an eluate to aid the pediatrician with his/her care plan.  (For the latter case we would request a sample from the father to determine if the mother is producing an antibody to a low incidence (aka private) antigen passed on to the infant by the father.)  But, that's a whole 'nother conversation!

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Do you know how the treatment would differ say for DAT due to anti-D compared to ABO incompatibility? I can see the benefit of knowing prior to delivery as they can asses the risk based on what antibody is present and at what titre but post delivery surly monitoring Bilirubin and HGB will give them far more information about what the neonate needs than what antibody is bound to the cells. That seemed to be the response from out pediatricians when I asked them. 

Steve

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When I started here we performed elutions on all positive DATs as well, but when I became supervisor we put an end to that.  Busy work for no real benefit; like your Pediatrician, they treat the babies the same.  Just this year, our Pediatric Subsection decided to start performing cord blood evaluations on all babies of O Pos moms.  I know there are several facilities that do the same, but we never have.  I asked our Mother/Baby nursing coordinator for the evidence they used to make this change and have had no response.  I have never understood the long standing practice of performing the cord blood workups on jaundiced babies either.  It seems to me this is all academic and of no real clinical value, but what do I know.  Does anyone have any Best Practice guidelines with supporting evidence for any of these practices?  The only thing I can come up with is that if the baby turns out to be O as well, that may steer them to investigate alternate explanations for the jaundice; but even then, unless the baby is having continued problems, is the information actually used to determine treatment?

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6 minutes ago, BankerGirl said:

When I started here we performed elutions on all positive DATs as well, but when I became supervisor we put an end to that.  Busy work for no real benefit; like your Pediatrician, they treat the babies the same.  Just this year, our Pediatric Subsection decided to start performing cord blood evaluations on all babies of O Pos moms.  I know there are several facilities that do the same, but we never have.  I asked our Mother/Baby nursing coordinator for the evidence they used to make this change and have had no response.  I have never understood the long standing practice of performing the cord blood workups on jaundiced babies either.  It seems to me this is all academic and of no real clinical value, but what do I know.  Does anyone have any Best Practice guidelines with supporting evidence for any of these practices?  The only thing I can come up with is that if the baby turns out to be O as well, that may steer them to investigate alternate explanations for the jaundice; but even then, unless the baby is having continued problems, is the information actually used to determine treatment?

I agree that, in most cases, if not all, the clinical treatment of the baby will be the same.  However, in one case with which I had dealings, where Mother and Baby had different ABO blood groups, the baby required an exchange transfusion.  It was very easy to find compatible blood for the baby, as the antibody was directed against a low prevalence antigen, but showing the specificity was not ABO helped with giving the couple counselling concerning further pregnancies.  This, I will admit, was a VERY unusual case.

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On 1/18/2019 at 4:34 PM, Mabel Adams said:

Same as AMcCord. 

 

To BankerGirl's point: I have tried to convince our neonatologists that they don't need to do routine cord workups on O pos moms but have made no traction.  It is in their national guidelines as an option and they are more comfortable keeping it.

Mable,  if you can figure out a way to convince your providers to skip the O Pos moms, let me know!

Our OB/Gyn practice is OK with not doing the O Pos moms (and they delivery 90+% of the babies here), the pediatricians are Ok with it. Our problem is one family practice provider and he's not budging. We offered to make it an optional order - he wants it, he can order it, but that didn't work either.

 

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  • 7 months later...

Does anyone have the title of the national guidelines so I can search for it?  I have desperately wanted to stop investigating the positive DATs when the treatment is the same.  But, I'd like to review the reference prior to stating my case.  Or more likely, having the reference to use when my Medical Director notifies them we are no longer performing certain testing.  This would save us lots of time when it doesn't add any value. 

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I attached our algorithm, the two codes translate to the following:

PABO:  Positive DAT presumably due to ABO incompatibility (external comment code).

PALLO:  Positive DAT presumably due to maternal alloantibody (external comment code)

we will do elutions if specifically requested by the physician, but most of the time they don't order them.

POS DAT.jpg

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