CORD BLOOD SPECIMEN: COLLECTION

DOCUMENT TYPE: PROCEDURESite Applicability

Cord blood collection occurs in the Birthing and Surgical Services areas of the Maternal Newborn Program.

Practice Level/CompetenciesBC Women’s Hospital new staff orientationLabour and Delivery orientation (basic)

Policy Statement(s) Cord blood specimens are collected for the following conditions including:

Umbilical cord blood gas analysis Rh Negative or Unknown Rh type Investigation- Postnatal Investigation (PNI) Maternal Antibodies (alloimmunization) or other antibodies that may cause Hemolytic Disease of

the Newborn (HDN) Any additional blood work required related to maternal or fetal indicators

RN or delegate: Collect and label cord blood specimen.

Procedure

1.0 For Umbilical Cord Gases Draw Umbilical Cord Gases first when multiple collections of cord blood are required See Umbilical Cord Blood Gas Analysis Policy for collection process

2.0 For Postnatal Investigation

2.1 For Rh Negative Mother Collect cord sample when the mother is Rh negative, or unknown Rh type, above the gestational

age of viability Complete relevant sections of the Postnatal Maternal-Fetal Investigation Request form. Send cord blood specimen to 2J17 specimen receiving. A postpartum maternal venous blood specimen is ONLY collected if the cord blood is Rh positive, as

notified by TML. If the cord blood is Rh negative, no postpartum maternal sample is required to complete the Rh PNI.

2.2 For Known Maternal Antibodies (Alloimmunization) and suspected Hemolytic Disease of the Newborn Collect cord sample when the mother is Rh negative, or unknown Rh type, above the gestational

age of viability Complete relevant sections of the Postnatal Maternal-Fetal Investigation Request form. Send cord blood specimen to 2J17 specimen receiving. Collect a maternal Group & Screen specimen and send to transfusion medicine laboratory: If there is no current specimen in TML

3.0 Additional bloodwork CBC and bilirubin from cord blood may be required for infants with specific indications such as

o Mother with thrombocytopeniao Suspected fetal anemiao Maternal Alloimmunization

C-06-12-60385 Published Date: 04-Oct-2019Page 1 of 6 Review Date: dd-Mon-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

CORD BLOOD SPECIMEN: COLLECTION

DOCUMENT TYPE: PROCEDURERequisition Forms

Test Requisition VolumeDetermination of Maternal Eligibility for Rh Immune Globulin

Postnatal Maternal-Fetal Investigation Request (00055594)

1 mL

Investigation of Suspected Hemolytic Disease of the Newborn (HDN)

Postnatal Maternal-Fetal Investigation Request (00055594)

1 mL

Blilrubin Hematology and Chemistry Requisition (L 1050) Total Volume needed 1 mLCBC Hematology and Chemistry Requisition (L 1050)

NOTE: Use one requisition if both specimens are required

All Specimens Biohazard specimen transport bags Needle, 22 gauge Syringe, 5 mL

Assessment Identify the cord vessels; there are two arteries and one vein. In some babies, there is a two vessel cord: one artery and one vein.

Collect the specimen from both the umbilical artery and vein for umbilical cord gases. If only one sample can be collected, the umbilical artery sample is the priority.

Collect the specimen from the vein for all Postnatal Investigations Collect the specimen from the artery for CBC and Bilirubin

STEPS RATIONALECord Blood Collection for Umbilical Cord Gas1. Cord blood sampling of both umbilical arterial (UA)

and umbilical venous (UV) blood is recommended for ALL births.

This is in alignment with SOGC and PSBC guidelines

2. See Umbilical Cord Gas Collection policy

Cord blood collection for Rh Negative/ Unknown Rh Type Specimens and Maternal Antibodies (Alloimmunization). **Have the Delivery Suite Unit Clerk print one page of labels for the Newborn

1. Prepare the Postnatal Investigation Requisition complete the “ordering provider’ section

Select test required2. Compare the mother’s identifiers, see below, on the

Postnatal Investigation Requisition against the mother’s identification band;

first and last name medical record number (MRN) date of birth (DOB)

Always add the maternal label to the requisition

If there are any discrepancies, do not proceed until the discrepancy has been resolved.

3. Collect cord blood specimen and insert into EDTA purple top tube as per BCW policy.

1 mL of umbilical venous cord blood is required

Laboratory requirement

4. Label the specimen tube in the presence of the patient and immediately after collection.

Patient safetyTransfusion medicine standards.

C-06-12-60385 Published Date: 04-Oct-2019Page 2 of 6 Review Date: dd-Mon-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

CORD BLOOD SPECIMEN: COLLECTION

DOCUMENT TYPE: PROCEDUREThe specimen must be labeled by the collector. See

appendix B.Use the “cord blood” label BCW275Include: Last name Mother’s MRN Baby’s MRN Date and time of collection Collector’s signature6. Check that the label is complete before you leave the

bedside.Patient safety issue.The specimen will be rejected if: information is incorrect, missing or illegible the collector does not sign the label

There are no exceptions.7. Ensure the label is free from blood. Universal precautions8. Complete the Postnatal Investigation Requisition, see

appendix A.a. type of blood specimenb. collection datec. collection timed. collector name (print)e. collector signature or tech ID

Patient safety issue.Transfusion medicine standards.To avoid delays in processing.

9. Check that the requisition is completesee appendix A

The specimen will be rejected if information on the requisition is:a. incorrect, missing or illegible the collector does not sign the form the collector’s signature on the specimen tube

and requisition do not match10.Compare the mother and baby identifiers’ on the

specimen tube against the identifiers on the appropriate requisition.

If there are any discrepancies, do not proceed until the discrepancy has been resolved.

Patient safety.The specimen will be rejected if there are any discrepancies.There are no exceptions.

11.Place the labeled specimen tube in a Biohazard bag. Laboratory requirement

12.Place the completed requisition in rear pouch of same Biohazard bag

Laboratory requirement

13.Send to 2J17 specimen receiving, as soon as possible.Tube station numbers: 4 inch tube station number is: 343 6 inch tube station number is: 221

To avoid delays in processing.

From CedarFrom TACC –OR and Labour & Delivery

Cord blood collection for CBC and BilirubinEquipment: All Specimens

Biohazard specimen transport bags Needle, 22 gauge Syringe, 5 mL

Use a new needle and syringe. One sample can be collected for both specimens

Prepare the Hematology/ Chemistry requisition for Bilirubin

Specimen Collection from the UTERINE ARTERY clearly indicate that it is CORD BLOOD Use the NEWBORN ID label Indicate the newborn provider

Use the Heparinized Lithium tube (green top).Collect 1 mL total of cord bloodFollow “Order of Draw” policy--blood must be transferred from the syringe into the green top lithium heparin tube first

C-06-12-60385 Published Date: 04-Oct-2019Page 3 of 6 Review Date: dd-Mon-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

CORD BLOOD SPECIMEN: COLLECTION

DOCUMENT TYPE: PROCEDURE Clearly indicate Date and Time of collection Send to Hematology

Invert blood tube a minimum of 8 timesSend to lab as soon as the newborn labels are available (to prevent clotting)

Prepare the Hematology/ Chemistry requisition for CBC

Specimen Collection from the UTERINE ARTERY clearly indicate that it is CORD BLOOD Use the NEWBORN ID label Indicate the newborn provider Clearly indicate Date and Time of collection Send to Chemistry

Use the EDTA (purple top) tubeCollect 1 mL total of cord bloodFollow “Order of Draw” policy -blood is transferred into the lavender top EDTA tube (CBC) following the green top to avoid contamination from the anticoagulant in the EDTA tube, which can affect the chemistry results.Invert blood tube a minimum of 8 times.Send to lab as soon as the newborn labels are available (to prevent clotting)

Documentation Newborn Clinical Path Newborn Record Labour and Delivery Summary (Rh negative specimens only) Hematology/ Chemistry Requisition (L 1050) http://www.elabhandbook.info/PHSA/Files/RequisitionForms

%2f1_20161214_073431_Hematology%20Chemistry%20Requisition%20-%20CW%2000051979%20(May%202008).pdf

Postnatal Maternal-Fetal Investigation Request (CW157)

Patient & Family Engagement/EducationExplain the procedure and the rationale to the patient and family.

ReferencesHYPERLINK "http://www.elabhandbook.info/PHSA/Default.aspx"C&W Electronic Laboratory

Reference Manual

Fung K, Eason E (2018). Prevention of Rh alloimmunization. SOGC Clinical Practice Guidelines No. 133. Journal of Obstetrics and Gynaecology Canada, Jan;40(1)

ePOPS Order of Draw http://policyandorders.cw.bc.ca/resource-gallery/Documents/Lab%20and%20Pathology%20Medicine/CWAC_PHL_4350JA1%20Order%20of%20Draw.pdf

Appendix Appendix A: How to Complete the Postnatal Maternal-Fetal Investigation Request form Appendix B: Specimen Collection and Labelling Requirements

Developed ByMaternal Newborn Program – Senior Practice Leader

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN24-Sept-2019 C-06-12-60385 Cord Blood Specimen: Collection Approved at: Perinatal Best Practice

Committee

DisclaimerThis document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA. 

C-06-12-60385 Published Date: 04-Oct-2019Page 4 of 6 Review Date: dd-Mon-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

CORD BLOOD SPECIMEN: COLLECTION

DOCUMENT TYPE: PROCEDUREAPPENDIX A How to Complete the Postnatal Maternal-Fetal Investigation Request form

C-06-12-60385 Published Date: 04-Oct-2019Page 5 of 6 Review Date: dd-Mon-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.

CORD BLOOD SPECIMEN: COLLECTION

DOCUMENT TYPE: PROCEDUREAppendix B: Specimen Collection and Labelling Requirements

C-06-12-60385 Published Date: 04-Oct-2019Page 6 of 6 Review Date: dd-Mon-2022

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.