7 - Obs - Red Blood Cell Isoimmunisation 2

Question 1

Manifestation of Rhesus Disease
As ? levels rise in ? woman, Abs cross placenta, causing ?. Mild causes neonatal ?. May be sufficient ? to cause neonatal ?(HDNB). More ?
disease leads to in ? anaemia, as this worsens, HF, ? and oedema (?) and fetal death. Rh disease worsens w ? pregs as maternal Ab prod ?.

Answer 1

Abs
sensitised
haemolysis
jaundice
haemolysis
anaemia
severe
utero
ascites
hydrops
successive
increases

Question 2

MGMT of isoimmunisation-

1. ID of women at risk of fetal ?/?.
2. Assess if/how severely the fetus is ?.
3. Blood ? in ? or delivery of affected fetus.

Answer 2

haemolysis/anaemia
anaemic
transfusion
utero

Question 3

Identification
? women screened for Abs at ? and ?wks. Maternal blood sampling for ? cells can test for Rh status where father is ?, ? can help but risks. If anti-D levels <10 IU/ml, signif fetal problem v ?, check levels every ?-?wks. If anti-D above 10, further ?.

Answer 3

unsensitized
booking
28
fetal
heterozygote
amniocentesis
unlikely
2-4
Ix

Question 4

Assessing Severity of Fetal Anaemia
Pregs at risk of fetal ? assess w ???. ? USS of ? ? in ?(PVS) of fetal middle ? aa has high sens before 36wks. Used every ?w in at risk pregs. V severe anaemia (under ? g/dl) detectable as ? of excessive fetal ?. If anaemia suspected, fetal ? ? done under USS using ? in umbilical vv at cord insertion at ? or in ? vein. Risk of fetal loss is 1%, after ?wks done w facilities for immed ? if compx.

Answer 4

anaemia
USS
Doppler
peak velocity in systole
cerebral
2
<5
hydrops
fluid
blood sampling
needle
placenta
intrahepatic
28
delivery

Question 5

Treatment of Fetal Anaemia: In Utero ?

Fetal Blood sampling done with Rh?ve, high ?, CMV –ve blood ready, can be ? down needle into ? vv if ? confirmed. Process of ? and ? repeated at incr intervals until ?wks, then ?
done. Blood more ? given to neonate, both top-up (for ?) and exchange (for ? due to haemolysis) transfusions may be req.
All neonates born to Rh?ve women have ? ? checked, FBC, blood film and bilirubin – may detect ? isoimmunisation.

Answer 5

Transfusion

-
haematocrit
injected
umbilical
anaemia
quantification
transfusion
36
delivery
easily
anaemia
hyperbilirubinaemia
-
blood group
mild