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Mercy CLS 4: Blood Bank > 9. HDFN > Flashcards

9. HDFN Flashcards

1
Q

Cord blood testing flowchart

Mother’s ABO results

A

O —cord tested
A, B, AB —cord only tested if problems expected or if infant in NICU

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2
Q

Cord blood testing flowchart

Mother’s Rh results

A

Neg —cord tested
Pos —cord only tested if problems expected or if infant in NICU

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3
Q

Cord blood testing flowchart

Mother’s ABS results

A

Pos —cord tested
Neg —cord only tested if problems expected or if infant in NICU

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4
Q

Cord blood testing flowchart

Baby’s ABO results

A

“Junky”, weak reactions, or sticky appearance —wash 4x and repeat

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5
Q

Cord blood testing flowchart

Baby’s Rh results

A

Pos with Rh= mom —RhIg eval on mom
Pos with Rh+ mom, or Neg —no RhIg eval

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6
Q

Cord blood testing flowchart

Baby’s DAT results

A

Pos —possible HDFN — IAT
Neg —no further testing

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7
Q

Cord blood testing flowchart

Group A baby after DAT+

A

Pos A cell —mild HDFN, no further testing
Neg A cell —no further testing

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8
Q

Cord blood testing flowchart

Group B baby after DAT+

A

Pos B cell —mild HDFN, no further testing
Neg B cell —no further testing

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9
Q

Cord blood testing flowchart

Baby DAT+
ABS+
due to anti-D
mother has hx of RhIg

A

no HDFN
no further testing

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10
Q

Cord blood testing flowchart

Baby DAT+
ABS+
not due to anti-D

A

HDFN possible
eluate to ID

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11
Q

Cord blood testing flowchart

Baby DAT+
ABS=

A

no further testing

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12
Q

5 conditions required for HDFN to occur

A
  • Fetus inherits an antigen the mother lacks
  • Antigen is developed in utero
  • Mother is immunized to the antigen
  • Antibody can cross the placenta
  • Destruction of fetal RBCs occurs
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13
Q

unable to cause HDFN (5)

A

Lewis
P1
Ii
MN (if IgM)
Lua

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14
Q

how can P1 be related to HDFN?

A

Parvovirus B15 in mother can lead to fetal anemia; accesses RBCs through P1 antigen

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15
Q

list of HDFN antibodies in order of most to least common

A

anti-D
anti-A,B
anti-c and anti-E
anti-K

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16
Q

— and — are more efficient hemolysins than — and —

A

IgG1 and IgG3
IgG2 and IgG4

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17
Q

— is transported across the placenta earlier and in larger amounts than —

A

IgG1
IgG3

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18
Q

erythroblastosis fetalis

A

hepatosplenomegaly caused by extramedullary hematopoiesis in spleen and liver to compensate for anemia

other functions of spleen and liver are decreased

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19
Q

hydrops fetalis

A

albumin production drops due to decrease in liver function

as oncotic pressure falls, fluid equilibrates across vascular/interstitial space

leads to edema, ascites, pleural effusion

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20
Q

seen on prenatal blood smear

A

increased reticulocytes, NRBCs

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21
Q

ultrasound used to assess…

A

hydramios, scalp/limp edema, fetal ascites, pleural/pericardial effusions, placenta size, HSM

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22
Q

echo/doppler used to assess…

A

blood flow across umbilical cord

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23
Q

provides direct measure of fetal blood parameters

A

PUBS/cordocentesis

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24
Q

risks of invasive methods of fetal monitoring

A

miscarriage, PROM, preterm labor, more exposure of mom to fetal RBCs

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25
Q

IUT blood ideally…. days old

A

3-5

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26
Q

4 basic requirements for any blood given to baby

A
  • irradiated
  • leukoreduced
  • CMV =
  • sickledex =
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27
Q

Liley graph

A

bilirubin determination based on amniocentesis

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28
Q

2 major complications of HDFN’s postnatal course

A

Anemia leading to heart failure
Unconjugated bilirubinemia due to immature fetal liver

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29
Q

kernicterus

A

fetus’ porous blood-brain barrier allows bilirubin to enter the basal ganglia of the brain

causes neural defects, seizures, abnormal reflexes and eye movements, or death

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30
Q

IgG half life

A

25 days

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31
Q

gives guidelines for when to transfuse based on weight and bilirubin level

A

technical manual

32
Q

non-HDFN causes of bilirubinemia

A

Infection
G6PD deficiency
Prematurity
Thalassemia
Other disorders of heme synthesis
Hereditary spherocytosis
Breastfeeding

33
Q

phototherapy can decrease bilirubin by…

A

1.5-2 mg/12-24 hours

34
Q

additional requirements for fetal blood transfusions (4)

A
  • Fresh, generally less than 7 days old
  • Washed or deglycerolized to remove plasma, anticoagulant, electrolytes
  • High hematocrit to minimize volume overload
  • Crossmatch-compatible with maternal specimen
35
Q

5 indications for booster transfusion

A
  • Infant’s hematopoietic system not functioning normally
  • Respiratory distress associated with early delivery
  • Replaces iatrogenic losses
  • Stabilization before an exchange transfusion
  • Delayed anemia at 3-5 weeks due to HDFN
36
Q

4 functions of exchange transfusion

A
  • Provide fresh, undamaged Ag= cells to improve O2 delivery, alleviating anemia and hypoxia
  • Lower bilirubin to prevent kernicterus
  • Remove Ab-coated, damaged cells from circulation
  • Remove maternal Ab in plasma that could react with newly formed RBCs
37
Q

describe products given in exchange transfusion

A
  • Combine FFP with RBCs
  • Hematocrit of pRBC/FFP unit adjusted to 40-50% (or whatever Dr requests)
38
Q

required testing for exchange transfusions

A
  • ABO/Rh on mom and baby’s blood, as donor must be compatible with both
  • ABS on mom and baby
  • Electronic XM
39
Q

during IUT, donor blood is injected into…

A

umbilical vein or abdominal cavity of fetus (enters through lymphatic channels)

40
Q

indications for IUT
repeated…

A

hemoglobin <10 g/dL
hydrops noted
repeated every 1-4 weeks until delivery

41
Q

If initial ABS is negative, additional ——– is unnecessary during 4 month neonatal period

A

XM

42
Q

If initial ABS for a neonatal transfusion is +, units may either be…

A
  • negative for the corresponding antigen (i.e. no crossmatch)
  • compatible by AHG crossmatch until the antibody is no longer demonstrable in the neonate plasma/serum
43
Q

If a non-O neonate is to receive non-O RBCs that are incompatible with the maternal ABO, the neonate’s plasma/serum must be…

A

tested for anti-A/anti-B
(AHG phase screen with A1 and B cells)

44
Q

anti-D affects —– pregnancies

A

1/1200

45
Q

RhIg preparation

A

derivative prepared by purifying human anti-D and treating it to inactivate lipid-enveloped viruses

46
Q

standard RhIg vial covers…

A

15 mL D+ RBCs or 30 mL whole blood

47
Q

2 possible RhIg mechanisms of action

A
  • Flood of Ab acts as a feedback system, telling the immune system that no more anti-D is required
  • RhIg “covers”/hides baby’s Ag so mom’s immune system doesn’t find and respond to it
48
Q

When is RhIg given?

A

28 weeks
after gestational procedures, trauma, miscarriage, abortion, ectopic pregnancy — (within 72 hours of these events)

49
Q

passive anti-D detected —- weeks after delivery

A

up to 11

50
Q

—- of pregnancies are ABO incompatible

A

1/5

51
Q

ABO HDFN s/s

A
  • Hyerbilirubinemia
  • Jaundice 12-14 hours after birth (placenta no longer handles excess bilirubin), but normal at birth
  • PBS — microspherocytes
52
Q

2 problems with anti-K

A

Inhibits erythropoiesis in baby
Causes extravascular hemolysis in baby

53
Q

anti-K HDFN can occur at —- weeks or earlier

A

18-20

54
Q

maternal plasma used to genotype fetus
used in UK, not US

A

Cell-free DNA genotyping

55
Q

Ab to HPA, specifically HPA-1a (98% cases)

A

Fetal/neonatal alloimmune thrombocytopenia (FNAIT)

56
Q

FNAIT infant tx

A

Ag= platelets from mom or donor
random transfusions
IVIg

57
Q

Routine prenatal workup (3)

A
  • TS on all women at initial prenatal visit
  • ABS must detect CS Abs (AABB)
  • Repeat ABS on Rh= women at 28 weeks
58
Q

IgM that may require further monitoring

A

Anti-M is an IgM that can have IgG components, so some physicians may request that it be monitored

59
Q

prenatal titration performed if…

A

ABS+ due to IgG

60
Q

titer baseline

A

first trimester titer
frozen and kept; run in parallel with further titers

61
Q

serial titers begin at…
repeated ——- to monitor potential HDFN

A

16-18 weeks
monthly

62
Q

A titer of 32 or higher is followed up with…

A

amniocentesis, Doppler Flow studies, or cordocentesis

63
Q

Mercy’s cord blood collection policy

A

collect on all Rh=, O+, and sensitized moms

64
Q

alteration to DAT on cord blood

A

IgG only
C3 not present

65
Q

rosette test/fetal screen

A

qualitative test to see if a FMH has occurred

also performed on all RhIg candidate moms

66
Q

explain rosette test procedure

A
  • Maternal RBC suspension is incubated with an anti-D reagent
  • The cells are washed to remove unbound antibody
  • Indicator cells (ficin-treated Rh+ cells) are added to the tubes
  • If Rh+ fetal cells are present, the indicator cells form clumps around them, appearing as “rosettes” in a sea of free red blood cells (the maternal Rh= RBCs)
  • If no Rh+ fetal cells are present, no rosettes will be seen
67
Q

rosette/fetal screen contraindications

A
  • Before 20 weeks gestation, because the volume of FMH will always be treated with one vial of RhIG due to the lower blood volume of fetus
  • Routine prenatal visit at 28 weeks gestation (when no abdominal trauma has occurred)
  • Baby is weak D +, or mother is Rh+ or weak D+
68
Q

fetal bleed quantified with…

A

Kleihauer-Betke test

69
Q

KB test is based on…

A

resistance of Hemoglobin F to lysis (fetal cells) in an acidic environment

adult RBCs lyse when exposed to acid; appear as “ghost” cells

70
Q

KB false +

A

mother has sickle cell trait (increased HbF)

71
Q

—– KB cells counted

A

2000

72
Q

equation to find RhIg dose

A

1 + (fetal cells)(5000 mL maternal blood vol)/(maternal cells)(30) = vials RhIg

73
Q

other methods to quantify a FMH

A

flow cytometry
ELISA

74
Q

effect of too little RhIg

A

cause immune enhancement in response to fetal D antigen

75
Q

RhIh eval given when…

A

prenatal RhIG, miscarriage, abortion or fetal demise

no baby sample is available

76
Q

2 sample required for postpartum RhIg eval and results indicating RhIg required

A

cord blood evaluation & postpartum maternal TS

Cord blood results must be Rh+, weak D+, or baby’s type unknown

Maternal TS includes ABO, Rh (weak D not required), ABS (if no allo-anti-D present, RhIG given)

77
Q

Can assume the anti-D found in ABS is passive in nature when…

A

there is history of RhIG administration during last 12 weeks and titer is 4 or less

Mercy CLS 4: Blood Bank (13 decks)

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