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Gaby’s Green Top Guidelines > 2014 65 Red Cell Antibodies > Flashcards

2014 65 Red Cell Antibodies Flashcards

1
Q

When should blood group & antibody status be checked for all women?

A

Booking & 28/40

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2
Q

When & how should fetal genotyping be performed for red cell antigens?

A
  1. Non-invasive prenatal testing
  2. For C, c, D, E, e & K antigens
  3. When maternal antibodies present
  4. For other antigens, consider CVS or amnio if fetal anaemia a concern or if being performed for another reason
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3
Q

In the context of red cell antibodies, when should referral to a fetal medicine specialist be made?

A
  1. Rising antibody levels/titres
  2. Levels/titres above a certain threshold
  3. US features suggestive of fetal anaemia
  4. Hx of unexplained severe neonatal jaundice
  5. Hx of neonatal anaemia requiring transfusion or exchange transfusion
  6. Hx of previous significant HDFN
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4
Q

What thresholds for anti-D a) should prompt FMU referral, b) can cause severe HDFN?

A

a) >4
b) >15

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5
Q

What level of anti-c a) should be referred to FMU, b) can cause severe HDFN?

A

a) >7.5
b) >20

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6
Q

What level of anti-K a) should be referred to FMU, b) can cause severe HDFN?

A

All levels

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7
Q

What levels of anti-E should be referred to FMU?

A

All levels if anti-c also present

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8
Q

How often should red cell antibody levels be tested in pregnancy?

A
  1. Anti-c, anti-D & anti-K: every 4 weeks up to 28/40
    Then every 2 weeks up to delivery
  2. Other antibodies: at 28/40
    Refer earlier if previous HDFN
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9
Q

How should pregnancies at risk of fetal anaemia be monitored?

A
  1. If fetus carries corresponding antigen for maternal antibody, and titre rises above specified level:
  2. Weekly USS, esp for MCA PSV
  3. FMU consideration of invasive treatment if MCA PSV > 1.5 MoM (multiples of the median) or other signs of fetal anaemia
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10
Q

What type of donor blood should be used for intrauterine transfusion?

A
  1. Group O (low titre haemolysin) or fetal ABO compatible
  2. Negative for antigen corresponding to maternal red cell antibodies
  3. Only in specialist FMU
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11
Q

How often should pregnant women with red cell antibodies & high risk of needing transfusion, eg placenta praevia or sickle cell, be cross-matched?

A

At least weekly

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12
Q

If maternal transfusion is required, what type of blood should be selected?

A
  1. Same ABO group
  2. Same RhD type
  3. K negative
    4.CMV negative
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13
Q

Wat are the requirements to blood for intrauterine transfusion?

A
  1. Same as for neonatal exchange, except
  2. Plasma removed for increased haematocrit 0.7-0.85
  3. Always irradiated
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14
Q

What are the requirements of blood for neonatal exchange?

A
  1. ABO compatible with neonate & mother
  2. Rh D -ve, or identical to neonate
  3. K -ve
  4. Negative for antigens corresponding to maternal antibodies
  5. Less than 5 days old
  6. CMV -ve
  7. Irradiated unless delay unacceptable
  8. Plasma reduced, not in SAGM additive
  9. Hematocrit 0.5-0.6
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15
Q

What are the requirements of blood for neonatal top-up transfusion?

A
  1. As for exchange, except:
  2. Does not need to be irradiated, unless previous IUT
  3. Can be stored in SAGM
  4. Can be up to 35 days old
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16
Q

What cord blood investigations should be performed if mother has red cell antibodies?

A
  1. Direct antiglobulin test
  2. Hb
  3. Bilirubin
17
Q

How should the neonate be managed in maternal red cell antibodies?

A
  1. Regular assessment of neurobehavioural state
  2. Watch for jaundice or anaemia
  3. Regular bilirubin & Hb
  4. Avoid early discharge
  5. Feed regularly to reduce dehydration & severity of jaundice
  6. Photo therapy &/or exchange transfusion for jaundice
18
Q

What proportion of pregnancies have a) red cell antibodies detected, b) excluding anti-D & of clinical significance?

A

a) 1.2%
b) 0.4%

19
Q

How do red cell antibodies come to be?

A
  1. Alloimmunisation
  2. From previous pregnancy, transfusion or transplantation
20
Q

What is the pathophysiology of HDFN?

A
  1. Transplacental passage of maternal IgG
  2. Immune haemolysis of fetal/neonatal red cells
  3. Anaemia, jaundice
  4. Hydrops, preterm birth, perinatal death
21
Q

What is the perinatal survival rate with red cell antibodies, a) overall, b) hydropic, c) non-hydropic?

A

a) 84%
b) 74%
c) 94%

22
Q

At what stage of pregnancy can NIPT genotyping be done for red cell antibodies?

A

16/40
Except K, which is 20/40

23
Q

What are the signs of fetal anaemia?

A
  1. Raised MCA peak systolic velocity, > 1.5 x MoM
  2. Polyhydramios
  3. Skin oedema
  4. Cardiomegaly
24
Q

What is the difference between direct & indirect antiglobulin testing?

A

Direct: antibodies attached to surface of RBCs
To diagnose blood-related conditions eh autoimmune haemolytic anaemia
Indirect: antibodies floating in blood
To determine reaction to blood transfusion or sensitising event

25
Q

Why is blood for exchange transfusions irradiated?

A
  1. To prevent replication of donor T leucocytes
  2. To prevent transfusion-related graft vs host disease
26
Q

Why is SAGM additive not suitable for intrauterine transfusion or neonatal exchange transfusion?

A

Glucose can result in rebound hypoglycaemia
Mannitol can have diuretic & intracerebral pressure effects

27
Q

When should delivery be timed for women with red cell antibodies that could cause fetal anaemia?

A

37-38/40
Earlier if titres rising or to time with IUT

28
Q

What are the causes of neonatal a) perinatal & b) late anaemia?

A

a) passively acquired maternal antibodies
b) transient suppression of erythropoiesis, particularly after transfusion
Low numbers of erythrocytes despite low packed cell volume & normal erythropoietin

29
Q

Why is sensorineural hearing loss increased in infants with haemolytic disease of the newborn?

A

Toxic effect of bilirubin on developing cranial nerve VIII

Gaby’s Green Top Guidelines (51 decks)

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