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Immunohematology [Blood Banking] > HDFN > Flashcards

HDFN Flashcards

1
Q

Hemolytic disease of the fetus and newborn (HDFN) is the destruction of the red blood cells (RBCs) of a fetus and neonate by antibodies produced by the _.

A

mother

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2
Q

initial diagnosis of maternal RBC alloimmunization

A

serologic

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3
Q

_ is caused by the destruction of the fetal RBCs by antibodies produced by the mother.

A

HDFN

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4
Q

Only antibodies of the immunoglobulin _ class are actively transported across the placenta via Fc receptors;

A

G (IgG)

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5
Q

_ has become the most common cause of HDFN

A

ABO incompatibility

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6
Q

antibody that can cross the placenta

A

IgG

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7
Q

ABO antibodies are present in the _ of all individuals whose RBCs lack the corresponding _

A

plasma; antigen

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8
Q

antibodies that result from environmental stimulus in early life

A

isohemagglutinins

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9
Q

clinically significant ABO HDFN occurs most frequently in group _ mothers who have a group_ infant in the white populations and group _ infants in the black population and appears to be more likely when these antibody titers are high

A

O; A; B

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10
Q

Group A infant RBCs [serologically more similar to =

A

A2 adult cells

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11
Q

ABO HDFN & RhD HDFN causative antibody

A

IgG

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12
Q

RhD HDFN first pregnancy can be affected

A

rare

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13
Q

ABO HDFN can be predicted by titer

A

no

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14
Q

RhD HDFN bilirubin level at birth

ABO HDFN bilirubin level at birth

A

elevated;

normal range

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15
Q

RhD HDFN Intrauterine transfusion needed

A

sometimes

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16
Q

HDFN with anemia at birth

A

RhD HDFN

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17
Q

HDFN with phototherapy beneficial

A

ABO HDFN and RhD HDFN

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18
Q

HDFN with rare exchange transfusion needed

A

ABO HDFN

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19
Q

HDFN with uncommon exchange transfusion needed

A

RhD HDFN

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20
Q

The serious consequences seen with other causes of HDFN, such as stillbirth, _ , are extremely rare in ABO induced HDFN.

A

hydrops fetalis, and kernicterus

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21
Q

FMH

A

Fetomaternal Hemorrhage

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22
Q

leading cause of maternal alloimmunization

A

Previous pregnancy with FMH

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23
Q

In Rh-negative individuals who are transfused with 200 mL of RhD-positive RBCs, approximately _ respond and form anti-D.

A

85%

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24
Q

The active transport of IgG begins in the _ trimester and continues until birth.

A

second

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25
Q

The IgG molecules are transported via the _ portion of the antibodies

A

Fc

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26
Q

_ are more efficient in RBC intravascular hemolysis

A

IgG1 and IgG3

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27
Q

common antigens in the Rh system

A

(C, E, and c)

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28
Q

most antigenic

A

RhD

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29
Q

Common Antibodies Identified in Prenatal Specimens That Can
Cause of HDFN

A

D, D+C, D+E, C, E, c, e, K

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30
Q

Rare Antibodies Identified in Prenatal Specimens That Can
Cause of HDFN

A

Fya, s, M, N, S, JKa

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31
Q

Never Antibodies Identified in Prenatal Specimens That Can
Cause of HDFN

A

Lea, Leb, I, IH, P1

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32
Q

caused severe HDFN that required intervention and treatment

A

Anti-E and anti-c

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33
Q

Of the non–Rh system antibodies, _ is considered the most clinically significant in its ability to cause HDFN.

A

anti-Kell

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34
Q

Kell blood group antigens are present on immature erythroid cells in the fetal _.

A

bone marrow; (destruction of RBC and precursor)

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35
Q

occurs when maternal IgG attaches to specific antigens of the fetal RBCs.

A

Hemolysis

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36
Q

Destruction of fetal RBCs and the resulting anemia stimulate the fetal bone marrow to produce RBCs at an accelerated rate, even to the point that immature RBCs (erythroblasts) are released into the circulation

A

erythroblastosis fetalis

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37
Q

erythropoiesis outside the bone marrow is increased in the hematopoietic tissues of the fetal _

A

spleen and liver

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38
Q

hepatosplenomegaly results in

A

portal hypertension and hepatocellular damage

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39
Q

three different phases of anemia

A
  1. early-onset anemia
  2. late hemolytic anemia
  3. late hyporegenerative anemia
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40
Q

anemia mechanism: antibody- mediated hemolysis

A

early-onset anemia

41
Q

anemia mechanism: continued hemolysis, the expanding intravascular compartment, and natural decline of hemoglobin levels

A

late hemolytic anema

42
Q

anemia mechanism: marrow suppression as a result of transfusions and IUT, antibody destruction of RBC precursors, and deficiency of erythropoietin

A

late hypogenerative anemia

43
Q

onset of early anemia

A

Within / 7 days of birth

44
Q

onset of late hemolytic anemia & late hypogenerative anemia

A

> 2 weeks of age

45
Q

conjugated and rendered water soluble bilirubin

A

direct bilirubin

46
Q

indirect bilirubin travels thru bloodstream to _ to be direct b.

A

liver

47
Q

RBC destruction releases hemoglobin, which is metabolized to _

A

bilirubin

48
Q

pathway of indirect to direct bilirubin

A

iB - bloodstream - liver - dB - gastrointestinal tract

49
Q

t/f. fetal liver can metabolize indirect bilirubin

A

false

50
Q

toxic level of indirect bilirubin

A

> 18-20 mg/dL

51
Q

toxic bilirubin can cause

A

permanent damage to the brain / kernicterus

52
Q

detection of ABO HDFN is best done

A

after birth

53
Q

the material surrounding the blood vessels

A

Wharton’s jelly

54
Q

t/f. cord blood should be anticoagulated for storage

A

true

55
Q

most important diagnostic test for ABO HDFN

A

DAT on the cord or neonatal RBCs

56
Q

Collecting _ blood samples on all delivered infants is highly recommended.

A

cord

57
Q

HDFN Caused by RBC Alloimmunization

The recommended practice is to perform the _ and _ detection test at the first prenatal visit, preferably during the first trimester.

A

type; antibody

58
Q

antibody-enhancing medium that can increase sensitivity of the assays

A

polyethylene glycol (PEG) or low ionic strength solution (LISS)

59
Q

Test that must be able to detect clinically significant IgG alloantibodies that are reactive at 37°C and in the anti- globulin phase

A

antibody detection method, or indirect antihuman globulin test (IAT)

60
Q

rather common in pregnant women but have not been reported to cause HDFN

A

Lewis system antibodies

61
Q

can cause mild to moderate HDFN, although rarely.

A

anti-M and anti-N

62
Q

The J-chain of IgM anti- bodies can be destroyed by _ reagent when establishing the immunoglobulin class

A

sulfhydryl (dithiothreitol; 2-mercaptoethanol)

63
Q

Most of pregnant women have received RhIG, either after an event with increased risk of fetomaternal hemorrhage or at _ weeks’ gestation (antenatal)

A

28

64
Q

A titer higher than _ almost always indicates active immunization;

A

4

65
Q

The relative concentration of all antibodies capable of cross- ing the placenta and causing HDFN is determined by _

A

antibody titration

66
Q

recommended method in antibody titration

A

saline antiglobulin tube test

67
Q

saline antiglobulin tube test: _ -minute incubation at _ and the use of _ reagent, although other methods have also been proposed

A

60; 37degC; anti-IgG

68
Q

critical titer in recommended method

A

16

69
Q

If the initial titer is 16 or higher, a second titer should be done at about _weeks’ gestation

A

18 to 20

70
Q

> 32 titer is indicator for:

<32 should be repeated after 4-week intervals, beginning at 16 to 20 weeks’ gestation and then _ during the _ trimester.

A

Doppler imaging to asses MCA-PSC

every 2 to 4 weeks; third

71
Q

predicted copy number of the gene

A

zygosity

72
Q

Risk stratification of the fetus can be directly carried out by obtaining fetal cells through _ as early as _ weeks’ gestation.

A

amniocentesis or chorionic villous sampling (CVS) ; 10 to 12

73
Q

Fetal DNA Testing

To avoid an invasive procedure, fetal DNA can be isolated from _ from a peripheral blood sample to determine RHD and KEL genotype.

A

maternal plasma

74
Q

advanced fetal risk strat- ification for mothers with RBC alloimmunization

A

cell-free DNA (cfDNA) method

75
Q

At about 16 to 20 weeks’ gestation, the clinical diagnosis of fetal anemia can be made using an ultrasound technique called _

A

fetal middle cerebral artery peak systolic velocity (MCA-PSV)

76
Q

invasive monitoring of fetus

A

Cordocentesis and Amniocentesis

77
Q

sensitive enough to predict significant fetal anemia in which intervention may be needed

A

> 15 multiples of mean (MoM)

78
Q

If the fetus has not reached an acceptable gestational age for delivery, and the hematocrit level is less than 30%, _ is usually indicated.

A

intrauterine transfusion

79
Q

MCA-PSV replaced _ to monitor amniotic fluid bilirubin levels

A

amniocentesis

80
Q

Intervention in the form of intrauterine transfusion becomes necessary when one or more of the following conditions exists:
• MCA-PSV indicates _ (>1.5 MoM).
• _ is noted on ultrasound examination.
• Cordocentesis blood sample has hemoglobin level _
• _ ∆OD 450 nm results are high and/or increasing.

A

anemia;
fetal hydrops;
> 10g/dL;
Amniotic fluid

81
Q

accessing the fetal umbilical vein

A

cordocentesis

82
Q

performed by accessing the fetal umbilical vein (cordocentesis) and injecting donor Transfusion Practices RBCs directly into the vein

A

Intrauterine transfusion

83
Q

goal of intrauterine transfusion

A

maintain fetal hemoglobin > 10 g/dL

84
Q

drawn at the time of birth is used to confirm HDFN and prepare for possible transfusion.

A

cord blood sample

85
Q

most important serologic test for diagnosing HDFN

A

DAT with anti-IgG reagent

86
Q

_ is the use of whole blood or equivalent to replace the neonate’s circulating blood and simultaneously remove maternal anti- bodies and bilirubin.

A

Exchange transfusion

87
Q

For patients with known HDFN, close observation of _ and _ is warranted

A

bilirubin levels and hemoglobin

88
Q

Phototherapy at _ nm is used to metabolize the unconjugated bilirubin to isomers that are less lipophilic, less toxic to the brain, and able to be excreted through urine.

A

460 to 490

89
Q

For infants with _ or history of intrauterine transfusion, phototherapy is generally sufficient to adequately conjugate the bilirubin and lessen the need for transfusion.

A

mild to moderate hemolysis

90
Q

used to treat hyper- bilirubinemia of the newborn caused by HDFN

A

Intravenous immune globulin (IVIG)

91
Q

The IVIG competes with the_ antibodies for the Fc receptors on the _ in the infant’s _, reducing the amount of hemolysis.

A

mother’s; macrophages; spleen

92
Q

RhIG should be given to RhD-negative mothers, the first dose is provided at _ weeks’ gestation,

A

28

93
Q

RhIG immunization second dose is given after _ of an RhD-_ infant within _ hours.

A

delivery; positive; 78

94
Q

regular-dose vial of RhIG in the United States contains sufficient anti-D to protect against 15 mL of _ or 30 mL of _

A

packed RBCs; whole blood

95
Q

regular dose of RhIG in
WHO:
UK:

A

WHO 300 μg
UK 100 μg

96
Q

Volume of fetomaternal hemorrhage

A

Number of fetal cells × Maternal blood volume / Number of maternal cells

97
Q

the calculated volume of fetomaternal hemorrhage is then divided by _ to determine the number of required vials of RhIG; then add _ vial

A

30; 1

98
Q

used to quantitate the number of fetal RhD-positive cells in the mother’s circulation as a result of a fetomaternal hemorrhage

A

Kleihauer-Betke test or flow cytometry

Immunohematology [Blood Banking] (2 decks)

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