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CCHS SBB > HDFN > Flashcards

HDFN Flashcards

1
Q

term used to describe the condition in which maternal antibody is reacting with antigens on the baby’s rbcs

A

hemolytic disease of the fetus and newborn

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2
Q

pathophysiology of HDFN

A

maternal antibody crosses placental barrier to fetal circulation, attaches to corresponding antigens on baby’s RBCs, and antibody-coated cells are destroyed by macrophages in fetal spleen

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3
Q

HDFN maternal antibodies are what antibody class

A

IgG

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4
Q

placental transfer factor found on what antibody class?

A

IgG

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5
Q

pathophysiology behind name erythroblastosis fetalis

A

fetal marrow responds to moderate or severe disease by increasing red cell production (ERYTHROPOIESIS) and releases red cells into circulation before they mature resulting in nucleated red cells (ERYTHROBLASTS)

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6
Q

IgG subclasses more efficient at causing hemolysis

A

IgG1 and IgG3

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7
Q

which IgG subclass is associated with more severe HDFN?

A

IgG1

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8
Q

most common cause of ABO HDFN

A

anti-A,B from O mother

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9
Q

offending antibody in Rho HDFN

A

anti-Rho(D) or its combinations, anti-rh’(CD) and anti-rh’‘(DE)

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10
Q

most common reason for positive DAT in cord blood testing

A

ABO antibodies

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11
Q

jaundice in ABO HDFN

A

not present at birth, appears 6-24 hours after birth, resolved by bili lights

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12
Q

expected findings in ABO HDFN

A 
mild jaundice 24 hours after birth
spherocytosis
polychromasia
nRBCs
ABO incompatibility between mother and child
maternal Ab screen negative
cord DAT weakly positive or negative
presence of IgG anti-A, anti-B, or anti-A,B in cord plasma and eluate
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13
Q

can ABO HDFN occur in first pregnancy?

A

yes

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14
Q

can Rho HDFN occur in first pregnancy?

A

not expected

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15
Q

amount of D positive fetal blood needed to immunize D negative mother

A

0.1 mL

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16
Q

___ HDFN protects the fetus against ___ HDFN

A

ABO - Rh
ABO incompatible fetal cells will be rapidly removed from maternal circulation by anti-A or anti-B before anti-D can be produced

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17
Q

most common “other” HDFN

A

anti-K
anti-c
anti-E

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18
Q

what makes anti-K HDFN the most clinically significant “other” HDFN?

A

suppresses fetal erythropoiesis, which exacerbates fetal anemia

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19
Q

effects of HDFN in utero

A

anemia
increased hematopoiesis
hepatosplenomegaly
hydrops fetalis

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20
Q

what causes hepatosplenomegaly in HDFN?

A

liver and spleen enlarge due to increased RBC production, spleen removes baby’s antibody coated cells

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21
Q

what form of bilirubin is increased in HDFN?

A

indirect

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22
Q

how is indirect bilirubin cleared in utero in HDFN?

A

passes back into maternal circulation, conjugated by mother’s liver, excreted

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23
Q

hydrops fetalis

A

generalized edema
effusions
portal hypertension
cardiac failure

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24
Q

what causes kernicterus in HDFN?

A

unconjugated bilirubin builds up in infant because liver cannot process into direct bili and clear product (maternal liver no longer clearing after birth)
excess bili is toxic to brain tissues, leads to irreversibly damage to CNS and mental retardation

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25
Q

effects of HDFN after birth

A

continued risk of hydrops fetalis/anemia
jaundice 6 hrs after delivery
kernicterus

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26
Q

why are premature infants more likely to be affected by kernicterus than full-term infants?

A

immaturity of blood-brain barrier

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27
Q

specific transferase that breaks down indirect bili to direct bili

A

uridine diphosphoglucuronyl transferase

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28
Q

half-life of IgG antibody

A

25 days

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29
Q

physiologic causes of neonatal jaundice other than HDFN

A

hyperbilirubinemia of premature infants
hereditary spherocytosis
congenital hemolytic anemia

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30
Q

metabolic causes of neonatal jaundice

A

maternal diabetes
galactosemia
G6PD deficiency
pyruvate kinase deficiency

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31
Q

infection causes of neonatal jaundice

A

congenital syphilis
hepatitis
rubella
CMV

32
Q

drug cause of neonatal jaundice

A

overdose of vitamin K

33
Q

prenatal testing to diagnose HDFN

A 
identify at-risk women
serologic testing on mom
antigen type dad
ultrasounds to monitor
amniocentesis
cordocentesis
34
Q

semi-quantitative means of measuring the amount of antibody

A

antibody titration

35
Q

prozone phenomenon in first titer tube due to?

A

excess antibody to antigen ratio

36
Q

clinically significant antibody titer

A

initial 32

change of 2 tubes or more

37
Q

PUBS

A

percutaneous umbilical sampling of baby’s blood

38
Q

PUBS usually done when:

A

mother has history of HDN in her kids
Ab titer is 32 or higher
significant change in titer

39
Q

PUBS can be performed as early as ___ weeks gestation

A

16

40
Q

fluid drawn from amniotic sac about 26 weeks of pregnancy

A

amniocentesis

41
Q

amniocentesis results plotted on _____

A

Liley Graph

42
Q

analysis of amniotic fluid:

A 
color
turbidity
contamination with blood
pH
dilution
L/S ratio
43
Q

antigen typing of father: homozygous

A

fetus is at risk of HDFN

44
Q

antigen typing of father: heterozygous

A

fetus may be at risk of HDFN. genotype of fetus can be determined by PCR

45
Q

what does fetal blood flow in brain show in HDFN?

A

increased flow = anemia in fetus. faster blood flows is greater degree of anemia

46
Q

why may red cells from babies with Rho-HDN appear Rn negative at immediate spin?

A

D antigen site covered with mother’s anti-D

47
Q

weak D test result if baby has positive DAT

A

invalid

48
Q

most important diagnostic test for HDN

A

Direct Coombs

49
Q

lab testing on cord blood samples

A

Abo and Rh (Weak D on IS negative to Rh negative mom)

50
Q

what is done if cord blood DAT is positive?

A

elution and ID of antibody

bilirubin testing

51
Q

why is cord blood testing done on babies from type O mothers?

A

assess risk of ABO HDN due to anti-A,B

52
Q

why is cord blood testing done on babies from Rh negative moms?

A

to determine need for RhIg

53
Q

other testing ordered on some cord blood samples

A

RPR

agar gal on black and asian babies

54
Q

prenatal management and treatment of ABO HDN

A

not routinely done

55
Q

postnatal treatment of ABO HDN

A

phototherapy

exchange transfusion in severe cases

56
Q

why is ABO HDN not routinely treated with prenatal management?

A

anti-A, anti-B titers don’t correlate to disease severity

risks of fetal monitoring and fetal trx are greater than risk of ABO HDFN

57
Q

ABO HDN occurrence in first born

A

40-50%

58
Q

Rh HDN occurrence in first born

A

5%

59
Q

DAT in Rh HDN

A

positive

60
Q

DAT in ABO HDN

A

positive or negative

61
Q

which HDN are spherocytes present?

A

ABO

62
Q

which HDN frequently requires exchange transfusion?

A

Rh

63
Q

treatment of severe HDFN

A

intrauterine transfusion
early induction of labor
exchange transfusion after birth
human serum albumin

64
Q

purpose of human serum albumin transfusion for HDFN

A

binds unconjugated bilirubin, preventing deposition in fat-rich brain cells

65
Q

risk of human serum albumin transfusion for HDFN

A

can aggravate congestive heart failure

66
Q

2 routes of transfusion for intrauterine transfusion

A

intraperitoneal

intravascular

67
Q

intrauterine transfusion route where needle is inserted across maternal abdominal wall and uterine wall into fetal peritoneal cavity and catheter is threaded into peritoneal cavity of the fetus

A

intraperitoneal route

68
Q

intrauterine transfusion route where fetal circulation is accessed through placental cord

A

intravascular route

69
Q

IUT route that requires several days for absorption into vascular space

A

intraperitoneal

70
Q

where are RBCs absorbed in fetus in intraperitoneal route?

A

subdiaphragmatic lymphatics

71
Q

risks of IUT

A 
perforation of internal structures
bleeding from cord puncture site
infection
fetal bradycardia
premature labor
premature leakage of amniotic fluid
72
Q

why does jaundice not occur before delivery?

A

bilirubin produced by breakdown of cells in fetal spleen passes via placenta to maternal circulation and excreted by liver

73
Q

purpose of exchange transfusion

A

remove sensitized cells from baby’s circulation
introduce antibody-free cells with oxygen carrying capacity
reduction of plasma bilirubin to prevent kernicterus
reduction of circulating maternal antibody
restore normal cardiac function

74
Q

blood requirements for intrauterine or exchange transfusion

A 
irradiated
CMV reduced risk
hemoglobin S negative
lack corresponding antigen
less than 7 days old preferred
75
Q

what may be used for red cells in exchange transfusion if it is difficult to find antigen negative blood due to high antigen frequency or multiple antibodies?

A

mother’s washed red cells

CCHS SBB (40 decks)

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