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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
IUT blood ideally.... days old
3-5
26
4 basic requirements for any blood given to baby
* irradiated * leukoreduced * CMV = * sickledex =
27
Liley graph
bilirubin determination based on amniocentesis
28
2 major complications of HDFN's postnatal course
Anemia leading to heart failure Unconjugated bilirubinemia due to immature fetal liver
29
kernicterus
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
30
IgG half life
25 days
31
gives guidelines for when to transfuse based on weight and bilirubin level
technical manual
32
non-HDFN causes of bilirubinemia
Infection G6PD deficiency Prematurity Thalassemia Other disorders of heme synthesis Hereditary spherocytosis Breastfeeding
33
phototherapy can decrease bilirubin by...
1.5-2 mg/12-24 hours
34
additional requirements for fetal blood transfusions (4)
* **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
5 indications for booster transfusion
* 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
4 functions of exchange transfusion
* 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
describe products given in exchange transfusion
* Combine FFP with RBCs * Hematocrit of pRBC/FFP unit adjusted to 40-50% (or whatever Dr requests)
38
required testing for exchange transfusions
* ABO/Rh on mom and baby’s blood, as donor must be compatible with both * ABS on mom and baby * Electronic XM
39
during IUT, donor blood is injected into...
umbilical vein or abdominal cavity of fetus (enters through lymphatic channels)
40
indications for IUT repeated...
hemoglobin <10 g/dL hydrops noted repeated every 1-4 weeks until delivery
41
If initial ABS is negative, additional -------- is unnecessary during 4 month neonatal period
XM
42
If initial ABS for a neonatal transfusion is +, units may either be...
* 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
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...
tested for anti-A/anti-B (AHG phase screen with A1 and B cells)
44
anti-D affects ----- pregnancies
1/1200
45
RhIg preparation
derivative prepared by purifying human anti-D and treating it to inactivate lipid-enveloped viruses
46
standard RhIg vial covers...
15 mL D+ RBCs or 30 mL whole blood
47
2 possible RhIg mechanisms of action
* 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
When is RhIg given?
28 weeks after gestational procedures, trauma, miscarriage, abortion, ectopic pregnancy — (within 72 hours of these events)
49
passive anti-D detected ---- weeks after delivery
up to 11
50
---- of pregnancies are ABO incompatible
1/5
51
ABO HDFN s/s
* Hyerbilirubinemia * Jaundice 12-14 hours after birth (placenta no longer handles excess bilirubin), but normal at birth * PBS — microspherocytes
52
2 problems with anti-K
Inhibits erythropoiesis in baby Causes extravascular hemolysis in baby
53
anti-K HDFN can occur at ---- weeks or earlier
18-20
54
maternal plasma used to genotype fetus used in UK, not US
Cell-free DNA genotyping
55
Ab to HPA, specifically HPA-1a (98% cases)
Fetal/neonatal alloimmune thrombocytopenia (FNAIT)
56
FNAIT infant tx
Ag= platelets from mom or donor random transfusions IVIg
57
Routine prenatal workup (3)
* TS on all women at initial prenatal visit * ABS must detect CS Abs (AABB) * Repeat ABS on Rh= women at 28 weeks
58
IgM that may require further monitoring
Anti-M is an IgM that can have IgG components, so some physicians may request that it be monitored
59
prenatal titration performed if...
ABS+ due to IgG
60
titer baseline
first trimester titer frozen and kept; run in parallel with further titers
61
serial titers begin at... repeated ------- to monitor potential HDFN
16-18 weeks monthly
62
A titer of 32 or higher is followed up with...
amniocentesis, Doppler Flow studies, or cordocentesis
63
Mercy's cord blood collection policy
collect on all Rh=, O+, and sensitized moms
64
alteration to DAT on cord blood
IgG only C3 not present
65
rosette test/fetal screen
qualitative test to see if a FMH has occurred also performed on all RhIg candidate moms
66
explain rosette test procedure
* 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
rosette/fetal screen contraindications
* **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
fetal bleed quantified with...
Kleihauer-Betke test
69
KB test is based on...
resistance of Hemoglobin F to lysis (fetal cells) in an acidic environment adult RBCs lyse when exposed to acid; appear as “ghost” cells
70
KB false +
mother has sickle cell trait (increased HbF)
71
----- KB cells counted
2000
72
equation to find RhIg dose
1 + (fetal cells)(5000 mL maternal blood vol)/(maternal cells)(30) = vials RhIg
73
other methods to quantify a FMH
flow cytometry ELISA
74
effect of too little RhIg
cause immune enhancement in response to fetal D antigen
75
RhIh eval given when...
prenatal RhIG, miscarriage, abortion or fetal demise no baby sample is available
76
2 sample required for postpartum RhIg eval and results indicating RhIg required
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
Can assume the anti-D found in ABS is passive in nature when...
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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