What should be done if cord cells remain positive after washing and controlling for DAT?

In cases where cord blood cells remain positive after washing and performing a direct antiglobulin test (DAT), it's crucial to understand the implications of a persistently positive result. The correct course of action is to perform an elution on the cord cells.

An elution is performed to isolate antibodies that may be attached to the newborn’s red blood cells. This is particularly important because it can help determine the specific antibody causing the positive DAT, which is critical in cases of hemolytic disease of the newborn or other hemolytic conditions. The process entails breaking the bond between the antibodies and the red blood cells to analyze the antibodies for different types (e.g., ABO, Rh) that may be present.

Obtaining a heelstick sample is not the appropriate next step in this situation, as it does not address the need to investigate the reason behind a persistently positive DAT in cord blood. Recording the DAT result without further investigation does not provide information necessary for diagnosis or treatment. Similarly, obtaining another cord sample does not contribute additional value when the existing sample needs further investigation through elution. Therefore, the focus should be on performing the elution to gain insights into the underlying cause of the positive DAT.