Is it necessary to add the eluate testing to the direct antiglobulin test to improve the detection of maternal erythrocyte alloantibodies?

Espinosa, Leidy Alejandra Toro; Arbeláez, Patricia Jaramillo; Gómez, Mónica Uruburu; Restrepo, Fabio Restrepo; Franco, John Querubín

doi:10.1016/j.transci.2021.103177

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…Although one third of blood group A or B neonates born to group O mothers have a positive DAT with slightly increased rates of phototherapy, the positive DAT alone cannot predict which neonates will require phototherapy or transfusion 12,22,72 . Additionally, routine antenatal maternal RhIG leads to a positive CB DAT results in some cases 5,73,74 …”

Section: Resultsmentioning

confidence: 99%

“…Ordering the DAT to predict hyperbilirubinemia severity is not recommended due to its poor predictive value, high false positive rate, and concerns that it will miss cases of hemolysis from non‐immune causes. Clinical surveillance for jaundice is recommended rather than CB DAT to identify neonates at risk 4,64,73 . Most guidelines suggest that the CB DAT be restricted to situations where (1) mother has clinically significant antibodies (CSA), or (2) unexplained neonatal jaundice when the maternal antibody screen results are unknown/negative/unavailable, (3) when the neonate is experiencing unexplained jaundice and this information would be important in aiding phototherapy decisions 5,6,9,10 .…”

Section: Resultsmentioning

confidence: 99%

“…An eluate may confirm RBC antibody specificity and detect a low frequency antigen when the DAT is strongly positive and the neonate presents with signs of HDN, but the maternal antibody screen is negative (or unknown) 6,16 . Eluate testing on CB is validated 73 ; however, routine testing has a low predictive value to detect HDN and is not generally recommended 63,52,70 . In addition, elution of anti‐A and anti‐B from RBC of ABO incompatible neonates does not help predict jaundice 30,76 …”

Section: Resultsmentioning

confidence: 99%

“…12,22,72 Additionally, routine antenatal maternal RhIG leads to a positive CB DAT results in some cases. 5,73,74 Ordering the DAT to predict hyperbilirubinemia severity is not recommended due to its poor predictive value, high false positive rate, and concerns that it will miss cases of hemolysis from non-immune causes. Clinical surveillance for jaundice is recommended rather than CB DAT to identify neonates at risk.…”

Section: Direct Antiglobulin Test (Dat)mentioning

confidence: 99%

“…Clinical surveillance for jaundice is recommended rather than CB DAT to identify neonates at risk. 4,64,73 Most guidelines suggest that the CB DAT be restricted to situations where (1) mother has clinically significant antibodies (CSA), or (2) unexplained neonatal jaundice when the maternal antibody screen results are unknown/negative/ unavailable, (3) when the neonate is experiencing unexplained jaundice and this information would be important in aiding phototherapy decisions. 5,6,9,10 Studies support this restrictive practice without increased morbidity related to jaundice as well as substantial cost savings.…”

Section: Direct Antiglobulin Test (Dat)mentioning

confidence: 99%

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Immunohematology testing using umbilical cord blood: review of the literature, survey of practice and guidance development

2022

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Background Following delivery, blood tests are performed on umbilical cord blood (CB) to avoid neonatal venipuncture. Despite widespread and longstanding CB testing, no guidelines exist to suggest which immunohematology tests should be performed on CB. Study design and methods We performed a scoping review, surveyed national practice, and developed guidance statements concerning CB testing. Database searches identified relevant articles. A survey was sent to all Canadian hospitals and transfusion laboratories that perform perinatal testing. A national panel of experts was convened to develop guidance statements. Results A total of 116 articles met the inclusion criteria and were summarized. Literature on CB testing is limited; few studies have investigated laboratory testing methodologies or validated CB test results with peripheral samples. The survey was completed by 580/597 institutions (97%); 85% were community hospitals and 16% had a neonatal intensive care unit. There is diversity in the types of CB tests performed and variability in practice. While most centers order appropriately, some laboratories routinely perform CB tests that are not clinically indicated (e.g., direct antiglobulin testing for all neonates) and other do not perform CB tests when results would be beneficial (e.g., phenotype on CB when mother has a clinically significant antibody). Fifteen guidance statements were developed. Discussion This study highlights variability in CB testing, likely reflecting evidence gaps, methodology differences between studies, and lack of guidelines. CB tests should only be performed when indicated and validated on this sample type. The presented guidance statements aim to standardize practice and encourage judicious CB sampling.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Direct Antiglobulin Test (Dat)mentioning

confidence: 99%

Section: Direct Antiglobulin Test (Dat)mentioning

confidence: 99%

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Immunohematology testing using umbilical cord blood: review of the literature, survey of practice and guidance development

2022

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Immunohematological testing and transfusion management of the prenatal patient

Quraishy,

Sapatnekar

2023

Advances in Clinical Chemistry

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Immunhämatologische Untersuchungen und Blutkomponenten-Auswahl bei Früh- und Reifgeborenen

Flommersfeld

Wienzek‐Lischka

Cooper

et al. 2023

Transfusionsmedizin

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ZusammenfassungIn der vorliegenden Übersichtsarbeit diskutieren wir, wie iatrogene Blutverluste durch immunhämatologische Untersuchungen bei Früh- und Reifgeborenen minimiert werden können. Die Hauptursache für die Transfusion von Erythrozytenkonzentraten (EK) sind dabei iatrogene Blutverluste durch diagnostische Blutentnahmen. In einer Beobachtungsstudie betrug der iatrogene Blutverlust bei Frühgeborenen in den ersten 28 Lebenstagen im Median 24,2 mL/kg im Vergleich zum transfundierten EK-Volumen von 30 mL/kg im selben Zeitraum 1. Die Reduktion von diagnostischen Blutentnahmen stellt somit eine effiziente Maßnahme zur Reduzierung von EK-Transfusionen bei Frühgeborenen dar. Rationale und bedarfsadaptierte immunhämatologische Untersuchungen können den Blutverlust reduzieren, Transfusionen vermeiden und die entstehenden Kosten senken. Ferner stellen wir dar, wie durch differenzierte Auswahl von Blutkomponenten das Auftreten unerwünschter Ereignisse bei der Transfusion von Neugeborenen verhindert werden kann und regen an, restriktivere Indikationsstellungen zur Transfusion insbesondere in der Frühgeborenenmedizin zu diskutieren.

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Is it necessary to add the eluate testing to the direct antiglobulin test to improve the detection of maternal erythrocyte alloantibodies?

Cited by 5 publications

References 25 publications

Immunohematology testing using umbilical cord blood: review of the literature, survey of practice and guidance development

Immunohematology testing using umbilical cord blood: review of the literature, survey of practice and guidance development

Immunohematological testing and transfusion management of the prenatal patient

Immunhämatologische Untersuchungen und Blutkomponenten-Auswahl bei Früh- und Reifgeborenen

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