Sharing information today to save the lives of tomorrow.
Isoimmunization: An Intro to Antibodies in Pregnancy
Empowering women to be partners in their prenatal care.
Sharing information today to save the lives of tomorrow.
Sharing information today to save the lives of tomorrow.
After Birth Blood Testing – All About Baby
You made it! On this page, you will find many of the things that you will need to know about after you've delivered an Iso baby. There is so much to be done after you have a baby, and a lot to educate yourself about. Be sure to keep a notebook and write down all your questions (and the doctor's answers) and baby's test results. Also, make sure they will have antigen negative blood ready for baby. If you've got anti-Kell, baby needs Kell negative blood. If he needs a transfusion, you don't want to wait several hours and risk brain damage while they find blood. Don't forget to pop over to the Printables page for the care record to help you keep track of all of baby's test results. There's even a copy of all the referenced normal laboratory values. You'll also find the pages on complications and interventions helpful.
After Birth Blood Testing - All About Baby
Direct Coombs Test
Hemoglobin
Hematocrit
Ferritin
Reticulocyte Count
Bilirubin Test
Neutrophil Count
Platelet/Thrombocyte Count
Newborn Blood Screening
Note: If your baby has had IUTs, the state required newborn blood screening may be off (it may be testing donor blood and not baby’s blood), and should be repeated at 1 year of age.
These photos are all of umbilical lines. These lines may be put in to get accurate draws and IVs if necessary. These can be an alternative to heel sticks for testing.
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This baby also has swelling from an enlarged liver.
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Direct Coombs test (DAT)
What is it?
Also called the Direct Antiglobulin Test (DAT)
The direct antiglobulin test (DAT) is performed to determine whether an anemic patient with evidence of hemolysis has isoimmune hemolytic anemia. If baby has a positive direct coombs test, there are antibodies already bound to and attacking the red blood cells. These antibodies can be removed from the RBC and each specific antibody can be identified. While the indirect coombs test shows if Mom is making antibodies and has them floating around loose in her blood, the direct coombs test shows if the antibodies are present in the baby’s blood and bound to the red blood cells. (22)
When is it done?
This test should be run at birth.
Where is it done?
This test will usually be done in the hospital.
Why is it done?
This test is done to see if there are any of mom's antibodies bound to and attacking the baby's blood.
How is it done?
This test can be done by taking blood from the umbilical cord or through a heel stick.
How often is it done?
For iso babies, this test is usually only performed once at birth.
What do the results mean?
A negative Direct Coombs means that there are not antibodies bound to the baby's blood.
A positive Direct Coombs means that there are antibodies attacking the baby's blood. A positive result will mean that your baby needs additional testing and monitoring.
Additional Information
Occasionally, especially with IUTs, the baby may have a negative direct coombs. In this case, an indirect coombs may be run to see if there are antibodies in the blood that aren't bound and attacking the cells. Indirect coombs should also be run in the case of anti-C/anti-c.
Hemoglobin
What is it?
Hemoglobin is a protein in red blood cells that carries oxygen. A blood test can tell how much hemoglobin you have in your blood.23 It is usually abbreviated Hb or Hgb and is measured in grams per deciliter. It is usually done as part of a complete blood count (CBC).
When is it done?
Hemoglobin should be tested at birth, and frequently thereafter.
Where is it done?
This test is usually done in the hospital or at a laboratory.
Why is it done?
Hemoglobin is checked to make sure that the baby is not anemic.
How is it done?
This test can be done by taking blood from the umbilical cord or through a heel stick.
How often is it done?
How often hemoglobin is checked depends on each case. Usually it is checked every 1-2 days in the hospital, or if baby is showing symptoms of being anemic. If baby's Hgb is dropping, more frequent checks will be needed. As baby gets older, less frequent checks are usually needed. Because ISO babies are at risk for developing late onset anemia, hemoglobin levels should be checked until at the baby is at least 12 weeks old.
What do the results mean?
Selected Normal Pediatric Laboratory Values – Hemoglobin (24)
Age | Females (g/dL) | Males (g/dL) |
Newborn
|
12.7 - 18.3
|
14.7 - 18.6
|
6 months - 2 years
|
10.4 - 12.4
|
10.3 - 12.4
|
The calculated minimum acceptable hemoglobin concentration is 6 g/dl for children and adults, 12 g/dl for preterm infants and 11 g/dl for full-term neonates at birth. The minimum hemoglobin concentration should be 2 g/dl higher in patients who require increased oxygen or suffer from other serious disorders. Because of how the baby deals with oxygen, the minimum value of 12 g/dl or 11g/dl decreases by approximately 1 g/dl each week for 5 or 6 weeks until the minimum of 6g/dl for children and adults is reached. (25)
If numbers are high
If the hemoglobin is above 10 g/dL (in the absence of specific risk factors related to the patient’s clinical characteristics) there is no need to transfuse red blood cells. Hemoglobin should still be checked regularly.
If numbers are low
Depending on how low the numbers are, treatment may be non urgent or urgent. If non-urgent, the baby will be monitored to see if he will start to make his own blood cells and recover from anemia on his own. If treatment is urgent, a blood transfusion will be performed.
Subjects with Hb concentrations below 6 g/dL almost always require transfusion therapy. In stabilized patients with Hb values between 6 and 10 g/dL, the decision whether to transfuse is based on an evaluation of clinical status; patients with values above 10 g/dL rarely require transfusion.
Indications for transfusion: Hemoglobin concentration of 4 g/dL or less (or hematocrit 12%), whatever the clinical condition of the patient or Hemoglobin concentration of 4-6 g/dl (or hematocrit 13-18%) if any the following clinical features are present: Clinical features of hypoxia, Acidosis (usually causes dyspnoea), Impaired consciousness (27).
Additional Information
You should be wary of giving your ISO baby iron supplements. Most ISO babies have normal or high iron levels and serious damage or death can occur if they are given iron supplements. Unless the Ferritin level is specifically tested, DO NOT GIVE IRON.
IRON IS NOT AN ACCEPTABLE TREATMENT FOR AN ISO BABY (47). The anemia faced by an iso baby is caused by red blood cell destruction, not iron deficiency. Many iso babies have normal or even high levels of iron and can be easily overdosed and killed from supplements. Your baby should never be given iron supplements without having his ferritin levels checked. Normal Ferritin levels are 25-200 ng/mL (46).