The hospital in which I am newly employed performs routine cord blood testing on all babies born regardless of the mom's blood type or antibody status. I am trying to change this to where we only perform this testing on Rh neg moms, and moms with significant antibodies. I'd like to gather information from y'all on articles or any form of communication that would help me accomplish this task. I will need good documentation for this project.

I believe that there will be cost savings to the hospital if this "just 'cause we have always done it this way" thinking can be changed. I am in the process of determining how many cords were done in a year and the cost and how many would have been done if we only did them on Rh neg moms and moms with antibodies and the cost savings.

Has anyone else done this and what was the outcome? How many of y'all's hospitals are still performing this test on all babies?

Appreciate your help with this.

Pat Houck

Edited January 6, 200916 yr by phouck

We do what ever the physician orders, unless they order nothing and the mom is Rh negative. As to cost savings, I suppose it depends who your clients are. If you're doing testing that private insurance companies are paying for, I would guess there is not a cost savings to be had but rather a gain. Are the majority of your clients are in a health plan from your facility? At my previous workplace, it was a university hospital that did not deliver babies, so can't give any further references. I personally think cord testing is not fun, and would love to decrease it as much as possible!

See the Perinatal Guidelines AABB published for your supporting documentation.

That said, we have a neonatologist that instituted testing of all babies of O moms in addition to Rh neg moms last year as a part of a hyperbilirubinemia detection protocol. It seems to me if they just made sure the baby wasn't yellow, that would cover it, but the solution is to look at something secondary rather than at the real problem--jaundice.

At our facility, the pediatricians want the cord blood results on ALL babies. I have not been successful in eliminating cords on Rh positive moms.

We only do cord bloods when mom is Rh neg, O, or has antibodies. I would like to get away from doing O mom's (unless Rh neg or has antibody) and let jaundice speak for itself! I'll see if the perinatal guidelines support my thoughts.

I remember having the same problem years ago. You need to get your director or pathologist-in-charge to approach the dept, with data, to back up the plan that testing is not indicated. If they disagree, go to administration & tell them you will be saving the hospital $$

How did you get them to just do it on those 3? I have a medical director that is interested in what I am doing and will most likely talk with the physicians after I get some data. Of course, the other hospitals around here are doing them on all moms. When I asked why? the answer was "we have always done it this way".

"we have always done it this way" is the easy way out. Start small, for ex,

you will be stopping the DAT's unless specifically requested. Find data from journals and don't worry what the other local hospital are doing. Maybe when they see what you have accomplished they'll come around too.

The hospital in which I am newly employed performs routine cord blood testing on all babies born regardless of the mom's blood type or antibody status. I am trying to change this to where we only perform this testing on Rh neg moms, and moms with significant antibodies. I'd like to gather information from y'all on articles or any form of communication that would help me accomplish this task. I will need good documentation for this project.

I believe that there will be cost savings to the hospital if this "just 'cause we have always done it this way" thinking can be changed. I am in the process of determining how many cords were done in a year and the cost and how many would have been done if we only did them on Rh neg moms and moms with antibodies and the cost savings.

Has anyone else done this and what was the outcome? How many of y'all's hospitals are still performing this test on all babies?

Appreciate your help with this.

Pat Houck

In our Facility, cord bloods are tested only if mom's is either O Pos or O Neg. This is what the Nursing Dept has implemented eversince and posted as their protocol.

I think the key is what is the relevant of DAT with the HDFN in ABO . We don't routinely do cord blood DAT if the mother is antibodies neg. And I don't think we need do DAT if the mom is neg and has no antibodies.

We use to do all cord testing as well at my facility and again because it easier then making change. I changed this practice back in 2006. We now only do cords from Rh Negative mom's, mom's with clinically significant antibodies and when cinically indicated. I didn't find this to hard to change. I talked with the pediatricians and Medical Director.

It helped that we had a recent survey(QMPLS) as I am in ontario on cord blood testing. A good Reference that may help you Judd WJ for the 2003-2004 Scientific Section Coordinating COmmittee. Guidelines for prenatal and perinatal immunohematology.

Hope this helps

Danielle

The hospital in which I am newly employed performs routine cord blood testing on all babies born regardless of the mom's blood type or antibody status. I am trying to change this to where we only perform this testing on Rh neg moms, and moms with significant antibodies. I'd like to gather information from y'all on articles or any form of communication that would help me accomplish this task. I will need good documentation for this project.

I believe that there will be cost savings to the hospital if this "just 'cause we have always done it this way" thinking can be changed. I am in the process of determining how many cords were done in a year and the cost and how many would have been done if we only did them on Rh neg moms and moms with antibodies and the cost savings.

Has anyone else done this and what was the outcome? How many of y'all's hospitals are still performing this test on all babies?

Appreciate your help with this.

Pat Houck

Pat,

We are considering the possiblity on changing the cord blood testing practice at our healthcare system. How is your progress in this matter? Do you have any information that you can share?

Please e-mail to Harriet Lai --- hlai@mhs.net

Thanks!

Harriet

Although, of course, not relevant to any other countries, if you go on to the website of the British Council for Standards in Haematology (BCSH), you will gain access to all their guidelines. These include the tests to be performed during and immediately after pregnancy, and these fully support NOT performing a DAT on all cords.

What is the point of testing all cords? You will detect positive DATs in cases where you know there is a known chance (i.e. where Mum has an antibody- and these MUST be done), you will, extremely rarely, detect a positive DAT in a case where the mother has made an antiboy against a low incidence antigen, the gene for which has been passed on by the father (but you'll probably go years before you detect one (and there is no guarantee that it will cause clinically significant HDN), you may pick up a positive DAT if the Mum has been given anti-D immunoglobulin prophylaxis during the pregnancy, where she is D Negative and the baby is D Positive (but, again, this will not be clinically significant), but you most certainly WILL NOT pick up all cases of ABO HDN, becaus emany of these will have a NEGATIVE DAT.

It is a very over-rated test, although it may serve to alert the Paediatician/Obstetrician to the possibility of HDN, but in most case, unless the Mum is known to have an antibody likely to cause HDN (specificity AND strength) you will detect sub-clinical cases of HDN (is this HDN anyway?) at best.

There is an article about this in the May 2009, Vol11 No.5 issue of AABB News on page 6.

Hi Mary,

Is there any chance you could scan it and send it to my home email address?

malcolm.needs@blueyonder.co.uk

I would be glad to, but I can't seem to get our scanner to work. Do you have a Fax machine number I could send it to?

Hi Mary,

That is really kind of you. I have a fax number at work. The number is 0208 258 8350. Of course, it's in England, so I think that you have to put 44 in front (but I'm not sure)!

We do cord ABORh/DAT on babes from Rh= mothers . . . and if/when the child gets jaundiced.

Well, that didn't work either! How about the mail?

Back when we were delivering babies here, we tested all and ended up working up an awful lot of DAT+ A/B babies born to O moms. The problem is most had subclinical cases of HDN and needed no treatment. We switched to the AABB guidelines and only tested if the Moms were Rh neg or had antibodies. Had no problems, got no flack.

I'm sorry I'm causing you so much trouble Mary. If you really don't mind, the address is:

Mr.M.E.Needs CSci FIBMS

Reference Service Manager

Red Cell Immunohaematology Department

NHSBT-Tooting Centre,

75, Cranmer Terrace,

Tooting,

SW17 0RB

England

If I am causing you too much hassle, don't worry about sending it.

It is on it's way!

Mary, you are an absolute star!

Thank you!

It´s hard tochange that policy... I was mother recently and though I informed the obstetrician that I and the father of the child were O Rh positive and my PAI was negative they still typed the cord and did a DAT. I believe that a huge group of the obstetric staff in my hospital doesn´t know the meaning of the tests...

Hi Mau Feitio,

I have sympathy. This is such a waste of time, money and resources. What could a DAT possibly add to any diagnosis in this situation.

If the mother has an antibody, great, do a DAT, but if that is positive, it means absolutely nothing, unless the baby's Hb is low or the bilirubin is high. In other words, it is a confirmatory test.

If there is no known atypical alloantibody, what on earth is the point of doing a DAT unless and until the bay is showing early signs of HDN.

I think that it is a combination of ignorance on the part of the Obstetric team (because they now have to know so many other things in detail that they no longer learn the basics) and the fear of being sued if they forget a particular test, so they order every test under the sun.