​My wife and I are both "O" blood type, but the baby has ABO hemolytic disease, is it...

*The professional part involved in this article is only for medical professionals to read for reference.
It's time to test the doctor's communication skills.
A father is holding a baby who is less than 24 hours old to see a doctor.

When the coating is opened, dense bleeding spots can be seen on the baby's face, the whole body is red, the eyebrows turn yellow when crying, the skin is obviously yellow when the fingers are pressed on the skin, and a huge scalp hematoma can be touched on the head.

Collecting medical history, full-term vaginal delivery, delivery time of the fetal head is slightly longer, there is compression of the birth canal.

After giving birth, the milk was given smoothly and he had two bowel movements.
The mother's blood type was O type, Rh was positive, and the father's blood type was O type, Rh is unknown.

 Skin yellowing visible to the naked eye occurs less than 24 hours after birth, and it is necessary to actively search for the cause and early intervention.

Generally consider neonatal ABO or Rh blood type incompatibility hemolytic disease.

However, the parents of the child’s medical history collection are both O type, and the mother’s Rh is positive, and there is no basis for ABO or Rh blood type incompatibility.
Combined with the baby’s birth canal squeeze, the examination shows pressure purpura and scalp hematoma.
Doctors are more concerned about extravascular hemolysis caused by scalp hematoma or internal hemorrhage in other parts, and excessive bilirubin production caused by increased red blood cells and excessive destruction of red blood cells.

Therefore, the doctor prescribed blood routine, liver function, head CT, and abdominal color Doppler ultrasound examinations in the outpatient clinic.

Of course, for the first time a newborn baby has blood, we will routinely bring the child's blood type, although in theory, the baby should be O type.

 The first result is the blood routine and blood type.
The blood type column of the O-type baby is impressively written as type B.
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This happens sometimes in the neonatology department, and the following scenarios quickly appear in the minds of such doctors.
: 1.
Laboratory error 2.
Specimen check error 3.
Report Zhang Guan Li Dai 4.
Dad remembered the blood type incorrectly 5.
The first three items that the child is not the father are the hospital’s problems.
If it is not handled properly, it will cause disputes and patient distrust.
Fourth The most common item is the best to deal with, and the fifth item is the least common and the most difficult to deal with.

In response to this special situation, the department even made a detailed process.

 First, hold Dad.

The outpatient doctor left the test report and said: "You go back first and wait for other results to come out before deciding how to deal with the baby's situation.
"
Second, check the specimen.

Neonatologists, blood collection nurses, nurses who send specimens, and doctors in the laboratory department follow the process, scan the code to review the specimens, specimen handover records, and re-test with another test method to confirm: there is no problem with the specimen, and the baby's blood type is indeed type B .

Immediately afterwards, review the mother's blood type.

Contact the obstetrics department, check the mother's blood type report, the previous blood type test records, and confirm that the mother was also type O for the first time.
The outpatient and inpatient examinations were both type O.

Determine the mother and child, except for medical examination errors, the next step is to determine the father's blood type.

Of course, you can’t tell him that your baby’s blood type is inconsistent with him.
Instead, it’s a euphemistic request: To determine the cause of your baby’s jaundice, ask your father to test another blood type.
Please cooperate with the treatment.

Under normal circumstances, Dad will cooperate.

And often at this link, the matter ends, because many fathers have misremembered their blood types.
After the father and son's blood types match, the newborn hemolytic disease test is checked for further processing.

However, this father remembered correctly, his blood type report was indeed O type.

 In the next step, contact your mother first: your child’s blood type is B, and your child’s father’s blood type is O.
This phenomenon does not exist in conventional theory.
Do you have anything to say? Do you want to tell your father this result, because your child is very likely to have ABO hemolytic disease of the newborn.
During the treatment, you need to explain the condition to your father and sign it.

Simply put, we need our mother to tell us whether we need to temporarily conceal the baby's blood type for her.

Generally, we will get three answers: 1.
Your test is wrong, I want to complain! 2.
I am 100% sure that the child belongs to my husband.

3.
Don't tell my husband first, contact me later.
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This mother gave us the second answer, which is very sure, that is, I can tell my father's blood type.

The child’s hemolytic disease report came back: blood type B, direct anti-human globulin, release of anti-B antibody, release of anti-A and anti-B antibody, three items are positive, the diagnosis is clear.

 He was admitted to the neonatology department for hospitalization, and the communication and signature were all fathers.
He only asked: Is this possible? Answer: Generally, parents are of type O, and babies are of type O, but there may be genetic mutations such as gene mutations, and further inspections are required.

 During the hospitalization, the father asked the doctor to help collect a drop of blood for the child for a paternity test.
The mother also agreed.
Because of the seriousness of the incident, the doctor refused to help with the blood collection.

 After the hemolytic disease was cured, the couple took the child to do a paternity test.
A few days later, my father told me on WeChat: The child is not his.
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there is no rare genetic mutation.

In clinical work, it is found that the blood types of children and their parents do not conform to the genetic law occasionally.
Because biological inheritance is a very complicated process, doctors are also full of skills in how to deal with and communicate with the newborn’s diseases.

Let's take a look at the ABO blood type legacy chart first.

Table 1 ABO blood type genetic rule table So simply by blood type, can you directly deny patriarchy? Can't! For the time being, we need to determine whether the man has a parent-child relationship with the child as the controversial father or the accused father (AF).
Excluding the parent-child relationship can be summarized as the following two situations: 1.
The child has genes that neither the mother nor the AF have.
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2.
Children without AF must pass a gene to their offspring.

 There are many genetic markers to be determined, and red blood cell blood type is only one of them, including white blood cell blood type, red blood cell enzyme type, serotype, etc.
, and there are many measurement methods.

The number of genetic markers tested increases, and the possibility of encountering genetic mutations also increases.
Genetic mutations mainly include: gene mutations, silent genes, alternative alleles, gene deletions, blood group mutations, gene exchanges, weak antigens, chimeras, mosaic antigens , Physiological and pathological variations, etc.
Although the probability of encountering genetic variations is very low, in order to avoid potential genetic variations, the exclusion of paternity should be based on at least two genetic markers.

 As neonatologists, we need to pay attention to the following points: 1.
The baby has jaundice soon after birth.
You cannot directly exclude or confirm the diagnosis based on the blood type provided by the parents.
You must determine a blood type for the baby.

2.
If there is a discrepancy between the blood types of the baby and the parents, check the blood types of the father, mother, and baby first to avoid iatrogenic errors and test errors.

3.
Weak recheck blood type is correct, pay attention to communication skills and communication sequence.

It is generally recommended to notify the mother first, and listen to the mother's opinion to decide whether to notify the father and who will notify the father.

4.
The clinical department can not only determine and exclude parent-child relationship by blood type, nor provide services for collecting blood, hair, and nail specimens.
If family members have needs in this regard, it is recommended that parents bring their babies to a qualified institution for testing .