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Hematology

Indirect Coombs test in pregnancy: antibodies against the child's blood group

According to the RIVM, during pregnancy blood from the child can enter the mother's blood, and if the child has a different blood group, the mother can make antibodies against the child's blood group. Antibodies are defence substances; according to MedlinePlus, the indirect Coombs test looks for antibodies against red blood cells that are free in the blood.

According to the RIVM, the mother's antibodies can reach the child's blood through the umbilical cord and break down the child's blood, after which the child develops anaemia, sometimes before birth and sometimes only after it. According to the RIVM, the mother has no trouble from them herself, so only a blood test shows the antibodies.

For the screen for these antibodies, Diagnostiek voor U uses ‘Negatief’ (negative) as its target value, without a unit.

Doctor's Assessment Included

The indirect Coombs test looks for antibodies against red blood cells that are free in the blood. According to the NVKC, it is another name for the irregular antibody test, and irregular antibodies are normally not present in the blood.

  • The indirect Coombs test result is a conclusion without a unit: Diagnostiek voor U uses ‘Negatief’ (negative) as its target value, Unilabs records ‘niet aantoonbaar’ (not detectable).
  • According to the NVKC, the indirect Coombs test is requested before a blood transfusion, before an operation that may need a transfusion, and in week 12 of pregnancy.
  • According to the NVKC, when irregular antibodies are found, specially matched blood is sometimes needed for a transfusion.

Reference Ranges

Expected result Negative

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

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Coombs Test (Indirect): what this test measures

The indirect Coombs test in pregnancy determines whether the mother's blood contains antibodies against blood groups she does not have herself; the RIVM names this, next to the ABO blood group, the Rhesus D and the Rhesus c blood group, as part of the blood test in pregnancy. At the NVKC, the same determination is known as the irregular antibody test.

Coombs Test (Indirect): why this value matters

Antibodies against the child's blood group, which the indirect Coombs test looks for in pregnancy, matter because, according to the NVKC, in the worst case they can break down the unborn child's red blood cells. According to the RIVM, once you have made antibodies against blood groups you do not lose them again, and they can flare up again in a next pregnancy.

Coombs Test (Indirect): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Coombs Test (Indirect): when is testing worthwhile?

According to the NVKC, in pregnancy the indirect Coombs test is part of the screening in week 12, and the test is sometimes repeated several times. According to the RIVM, women who are Rhesus D-negative or Rhesus c-negative have a slightly greater chance of making antibodies against blood groups; according to the RIVM, of all women 15 percent are Rhesus D-negative and 18 percent Rhesus c-negative.

Coombs Test (Indirect): symptoms of a high or low value

Low Levels

A negative indirect Coombs test in pregnancy matches the Diagnostiek voor U target value ‘Negatief’: according to the NVKC, irregular antibodies are normally not present in the blood.

High Levels

According to MedlinePlus, a positive indirect Coombs test may suggest erythroblastosis fetalis, a blood disease in newborns. According to the RIVM, when the laboratory finds antibodies against blood groups in pregnancy, further investigation is sometimes needed, sometimes also of the biological father's blood.

Coombs Test (Indirect): causes of a low or high value

What raises the value

  • Blood transfusion

    Irregular antibodies can be formed when ‘foreign’ blood enters the circulation, and that can only happen through a blood transfusion or during a pregnancy.

  • Pregnancy

    During a pregnancy, a little blood from the unborn child can enter the mother's bloodstream, against which she can form irregular antibodies.

Coombs Test (Indirect): lifestyle and this value

Discuss a positive indirect Coombs test in pregnancy with your midwife or gynaecologist, who according to the RIVM will tell you more about further investigation.

Coombs Test (Indirect): frequently asked questions

Do I notice antibodies against my child's blood group?

No, according to the RIVM a pregnant woman with antibodies against blood groups has no trouble from them herself; the antibodies can, however, sometimes cause problems during the pregnancy.

Coombs Test (Indirect): sources

  1. NVKC, Alles over testen: Irregulaire antistoffen, allesovertesten.nl, geraadpleegd 2026-10-17 (retrieved 2026) allesovertesten.nl

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