In fact i want to have your point of view in the new neonatal screening they want to add in ksa ..to take cord blood sample for direct coomb test in delivery room to all neonate whatever healthy or not ..even if the blood groups of mother and bb are comptable ..if the baby get positive test he is considered for early diagnosis and management of hemolytic diaease caused by incompetability ... what do you think this will add ? I think RH and ABO can be expected ..? Is there any probability to have hemolysis even with comptable bl.groups? Does it really needs to be screened ?

I admit I am a bit sceptical to this approach, but I also acknowledge I do not know about the background for this in KSA.

I have some experience from a previous work place, where the delivery unit started to blood group all infants whose mother had blood group 0. We saw rather many positive Coombs tests (or DAT we we call it) in infants not developing any or just mild jaundice, and this all led to extra blood tests, sometimes prolonged stays in the maternity and unnecessary worries too. This screening practise was later stopped as it did not add anything in that hospital.

What is the underlying reasons to implement this routine where you work?

Thank you 1st for your concern DR.Stefan ..i kept asking them till they explain for me that the Ag presentation on RBCs surface of neonates is weak and they cant depend in accurecy of blood typing test and it remains inaccurete in 1st 4 months of life ..so they went for coomb test  from cord blood as screening for all neonates to overcome the falsies that may happen if depneds on blood typing tests ...i feel kind comfortable now 😁

If mother blood group O or Rh negative only.

otherwise no need

3 hours ago, Neon said:

If mother blood group O or Rh negative only.

otherwise no need

Yes, depending on antenatal care screening programs, I think screening infants of Rh-negative mothers can be helpful.

But our experience from screening mothers with blood group 0 was not too good, we found a lot of Coombs+ infants that never got jaundiced. The ones with jaundice, and especially those needing treatment, "showed up" with clinical signs as usual. Having said that, I also think theses decisions are context-dependent, but suggest any implementation goes with a QI project that evaluates what the program adds to current practises.

I agree with you Dr. Stefan that some babies with DAT positive do not become jaundice. But if DAT is positive with ABO incompatibility, we will be more cautious and we will monitor more closely and we advice more close follow up after discharge.

Most likely the blood sample will be sent to 1 - 2 central labs in the country which may take at least few days (5 - 7) to get the results back. So it may not have any practical value. 

We started a few years ago with testing every cord blood for DCT change than to analyse  O and rh neg. Now we only analyse rh neg. There were only positiv effect on our daily work, less confusion and less painfull blood sampling for our patients. Never missed a Problem.

On 1/21/2022 at 2:15 AM, Dr.Smah said:

In fact i want to have your point of view in the new neonatal screening they want to add in ksa ..to take cord blood sample for direct coomb test in delivery room to all neonate whatever healthy or not ..even if the blood groups of mother and bb are comptable ..if the baby get positive test he is considered for early diagnosis and management of hemolytic diaease caused by incompetability ... what do you think this will add ? I think RH and ABO can be expected ..? Is there any probability to have hemolysis even with comptable bl.groups? Does it really needs to be screened ?

I have tried many times but it’s a good suggestion I always wanted to do it coz of time frame and not missing other hemolytic issues 

Dr A Jaleel Ahamed 

We only check cord blood DCT for babies of mothers with known antibodies during pregnancy. Their routine use, or even in mothers with O blood group is very unlikely to be of benefit. For mothers with RH-ve blood group, routine antenatal anti-D administration does result in positive DCT but this in invariably of the mildest degree (trace or 1+).