We are getting ready to go live with Meditech in November. Pray for us.

The system has some prompts to selectively pick certain cord bloods for routine testing such as: 1. Is the mother group 'O', and 2. Is the mother Rh Negative? We would like to cut back on the 100% cord blood testing (Blood Type and Direct AHG) that we have done since Athens and Sparta fought. What is your policy for testing cords?

The other question: Is it better to centrifuge the post delivery Rhogam Profile sample or work with a well mixed uncentrifuged post delivery Rhogam Profile sample when preparing for the Rosette Test (Fetalscreen)? The package insert for the Immucor/Gamma product does not address the issue and nobody at tech support had a thought.

I am not aware of any studies, but if someone knows of any information on this item, please share.

A really good project for some poor SBB student would be to Chromium tag some Rho Positive group 'O' cord cells, add a specific amount to tubes of 'O' Rho Negative blood, centrifuge some samples, and just mix others, take samplings from each and see how the two compare to providing a harvest of the cord cells by checking for the amount of Chromium isolated by both techniques. Where do those fetal cells reside? They are supposedly lighter in weight than adult cells so they should hover near the buffy coat layer of a spun sample. Should we be skimming the top layer of the centrifuged maternal sample to catch as many fetal cells as possible? Does this really matter? Would the contamination with white cells from the buffy coat cause more problems?

The reason this whole mess came up was because I was looking to streamline our testing workflows for the new system, and I thought we could use the unspun Rhogam Profile sample to perform a quick A/B/O Rho check with no reverse group and also do the Fetalscreen at the same time. This would save 5 to 10 minutes of specimen prep time. All L&D patients receive a full Type and Screen on admission so we have full data that is less than 24 hours old. My older techs went bananas when I suggested the shortcut. To prevent the need to increase their doses of nitroglycerin, I decided to take the question to my peers. Please have at it, and give me your thoughts. Thank you.

We test all Rh negative mothers and mothers that are type O

Our policy is the same as Seveet's.

We test all Rh negative mothers. We had a few physicians routinely order testing on all O mothers, but it seems we are doing less lately.

Interesting thought about the spun vs unspun sample. What about doing parallel testing?

All of our L+D patients have a CBC and BB hold sample drawn on admission. We add on the T+S if needed.

I'm curious why your techs are having such a hard time with the proposed changes? It sounds like a good idea to me, I think I'll bring it up!

We perform Cord Type on all NICU babes, those with Rh neg moms and/or O moms. Also for the immucor fetal screen we use a well mixed EDTA tube.

PS - We really really like Meditech. Except for a few months back when we had a scheduled downtime and someone at corporate entered the wrong DATE in the computer in took hours and hours to manually restore all the lost data that occured when they had to erase everything and fix the date problem. So - faithfully print and store your weekly reports. And always always print and keep reports handy before every scheduled downtime.

To prevent the need to increase their doses of nitroglycerin

Your facility uses nitroglycerin for Rhogam-type protection?:confused: I have never heard of this practice before.

We test the cord bloods from all O moms and all RH Neg moms and any other baby the Dr might request (very rare). We also use a well mixed EDTA specimen for the Fetal Screen test - that seems to be the most logical choice, since we do not know exactly how the mom's and baby's cells might differentially separate as they spin down.

Your facility uses nitroglycerin for Rhogam-type protection?:confused: I have never heard of this practice before.

I believe the nitroglycerin is for the older techs who were having palpitations over the proposed change...

The sample for fetal screen should be well mixed whole blood. We only do cord bloods on babies of Rh negative mothers and type O mothers.

I think your idea sounds fine, particularly since you have a full type and screen in hand already.

:cool: