A colleague in Nevada reports that at his facility they routinely test all non-group O newborns delivered of group O mothers for ABO hemolytic disease of the newborn with a direct antiglobulin test using a mono-specific anti-IgG reagent. He wonders if it would be acceptable practice to discriminate between babies who are group O versus non-group O by using a single forward typing test with anti-A,B reagent. If a baby is group O, no further ABO testing would be done. If the baby is non-group O, anti-A and anti-B reagents would be used to determine if the baby is group A, group B or group AB. He wonders if this approach would be acceptable for neonates NOT needing transfusion, given that the 21st edition of the AABB standards, 5.15 Special Consideration for Neonates states: "The initial pretransfusion sample shall be tested to determine ABO group and Rh type. For ABO, only anti-A and anti-B reagents are required". The December 2002 (web version) of the CAP Transfusion Medicine Checklist TRM.40550 states, "Is there a test of each patient's blood sample with anti-A, anti-B, anti-D and A1 and B red cells?" This checklist question is in the Compatibility Testing Section of the checklist and it also states at the beginning of the section, "This section applies whenever crossmatching is performed". The CAP does not appear to address neonatal ABO grouping in this checklist.

The following comments have been received.

ADDENDA Sept. 2, 2004

1. A colleague in Michigan is of the opinion that there is nothing wrong with the Nevada hospital's approach to testing infant's of group O women for fetal maternal ABO incompatibility using only anti-A,B. The issue he has is with selective testing, and testing when there are no clinical signs and symptoms of neonatal jaundice. The first two of the following articles serve to support (in his opinion) that selective testing is inappropriate, as is testing in the absence of jaundice. The third article contains a recent AAP position statement on selective testing of infants born to group O women that he believes is not supported by scientific data. To the contrary, he points out that severe ABO HDN can occur in infants born to A or B women, and the DAT is not a good predictive test; the classic texts of Issitt and Anstee (Applied Blood Group Serology) and Mollison (Blood Transfusion in Clinical Medicine) should be consulted.

• Leistikow et al. Wasted Health Care Dollars: Routine Cord Blood Type and Coombs' Testing, Arch Pediatr Adolesc Med 1995;149:1147-51.
• Madan et al. Readmission for newborn jaundice: the value of the Coombs' test in predicting the need for phototherapy. Clinical Pediatrics 2004;43:63-8.
• Clinical Practice Guideline, American Academy of Pediatrics: Management of hyperbilirubinemia in the newborn infant 35 or more weeks’ of gestation. Published in Pediatrics. Vol. 114 No. 1 July 2004, pp. 297-316.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator