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Childs Health > Haemolytic disease of newborn > Flashcards

Haemolytic disease of newborn Flashcards

1
Q

What does haemolytic disease of the newborn do?

A

Cause haemolysis in neonate

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2
Q

What is haemolytic disease of the newborN?

A

Incompatability between rhesus antigens on surface of RBC of mother and foetus

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3
Q

What combination of antibodies in mother and baby can cause haemolytic disease of the newborn?

A

Mother - rhesus D negative
Foetus - Rhesus D positive

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4
Q

What happens in the first preganancy if a woman is RD- and foetus is RD+?

A

Foetus blood -> maternal circulation
Maternal immune system recognise rhesus antigens on foetus RBCs as foreign and produce antibodies -> SENSITISED
No probelms

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5
Q

When can haemolytic disease of the newborn occur in a first pregnancy?

A

When sensitisation happens early on eg antepartum haemorrhage

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6
Q

What causes haemolysis in subsequent pregnancies if baby is rhesus D+ and mother has anti-D antibodies?

A

anti-D antibodies -> placenta -> foetus, attach to rhesus antigens on RBC -> foetal immune system attacks RBC -> haemolysis

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7
Q

What does haemolysis in foetus cause?

A

Anaemia
High bilirubin

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8
Q

Risk factors for haemolytic disease of the newborn

A

Alloimmunisation during first pregnancy
Alloimmunisation during second or subsequent pregnancy
Failed prophylaxis

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9
Q

What increases risk of large foetal maternal haemorrhage at delivery?

A

Traumatic deliveries incl C section
Manual removal of placenta
Stillbirths and intrauterine deaths
Abdo trauma - 3rd trimester
Multiple pregnancies at delivery
Unexplained hydrops fetails

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9
Q

What increases risk of large foetal maternal haemorrhage at delivery?

A

Traumatic deliveries incl C section
Manual removal of placenta
Stillbirths and intrauterine deaths
Abdo trauma - 3rd trimester
Multiple pregnancies at delivery
Unexplained hydrops fetails

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10
Q

How is anti-D antibodies detected antenatally?

A

Indirect coombs test

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11
Q

Who has the indirect coombs test performed?

A

All rhesus negative women at first antenatal visit

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12
Q

Presentation of haemolytic disease of the newborn

A

Jaundice - yellow amniotic fluid, yellow ver
Pallor
Hepatosplenomegaly
Kernicterus
Hypoglycaemia
Hydops fatalis

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13
Q

What is kerniceterus?

A

Bilirubin encephalopathy

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14
Q

How does hydrops fetalis present antenatally?

A

Polyhydraminos - excessive amniotic fluid

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15
Q

How does hydrops fetalis present postnatally?

A

Subcutaneous oedema
Peridcardial effusion
Plueral effusion
Ascites
Hepatosplenomegaly
Placenta may be thickened

16
Q

Clinical signs of severe haemolytic disease

A

pallor
hepatosplenomegaly
oedema
petechiae
ascites

17
Q

Treatment for prenatal diagnosed haemolytic disease

A

Intrauterine transfusiom

18
Q

Investigations for haemolytic disease

A

Indirect coombs test
Antenatal US
Foetal blood smapling
FBC
Postnatal diagnosis

19
Q

What does antenatal US detect?

A

Signs of hydrops fetalis

20
Q

What does antenatal US detect?

A

Signs of hydrops fetalis

21
Q

What tests for foetal anaemia?

A

Foetal blood sample replaced by
Doppler US of MCA largely replaced foetal blood sampling as initial test

22
Q

What does an FBC show in haemolytic disease?

A

Anaemia
Reticulocyte count - up to 40% severe

23
Q

Bloods when extreme DIC?

A

Sphistocytes and burr cells may be observed
Neutropenia and thrombocytopenia

24
Q

What should be done immediately after birth in a rhesus negative mother?

A

Blood from umbilical cord checked for ABO and Rh blood group
Direct coombd test
Haemoglobin and baseline bilirubin

25
Q

What should be done immediately after birth in a rhesus negative mother?

A

Blood from umbilical cord checked for ABO and Rh blood group
Direct coombd test
Haemoglobin and baseline bilirubin

26
Q

What results after birth support haemolytic disease diagnosis?

A

Positive coombs test in presence of ABO or Rh incompatability

27
Q

Management of rhesus disease in utero

A
  • O negative transfusion at 18 weeks
  • Successful transfusion delivery 37-38 weeks
  • Unsuccessful transfusion delivery - 32 weeks
28
Q

When deliver baby after successful vs unseuccessful transfusion at 18 weeks?

A

37-38 weeks
Unsuccessful - 32 weeks

29
Q

Prognosis after delivery

A

50% - normal
25% - moderate disease
25% - severe disease

30
Q

What should be done for babies who have normal haemoglobin and bilirubin levels at birth with rhesus antiboides?

A

Monitored for late set anaemia at 6-8 weeks

31
Q

What to do with babies with moderate haemolytic disesae?

A

May require transfusion
May need phototheraoy to treat significatn hyperbilirubinaemia which may occur within 24 hours after birth

32
Q

Why do phototherapy in jaundiced babies?

A

Avoide kernicterus

33
Q

What should happen when severe haemolytic disease of newborn anticipated?

A

Attended by a paediatrician trained in neonatal resus and fresh O negative blood immediately available

34
Q

Management of severe haemolytic disease after birth

A

Immediate resus
Temo stabilisation
Exchange transfusion
Top up blood transfusions and phototheraoy may be needed
Early administration of IV haemogloblin

35
Q

What does early administration of IV immunoglobulins do for severe haemolytic disease?

A

Reduces haemolysis, peak bilirubin levels and need for exchange transfusion

Childs Health (82 decks)

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