Immunohematology testing using umbilical cord blood: review of the literature, survey of practice and guidance development. Issue 4 (23rd March 2022)

• Record Type: Journal Article
• Authors: Hajjaj, Omar I.; Clarke, Gwen; Lieberman, Lani
• Is Part Of: Transfusion. Volume 62:Issue 4(2022)
• Page Start: 871
• Page End: 886
• Publication Date: 2022-03-23
• Subjects: blood banks -- cord blood -- direct antiglobulin test -- hemolytic disease of the newborn -- jaundice -- neonatal screening; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.16834
• Languages: English
• ISSNs: 0041-1132

Abstract

Abstract: 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.