HDFN Flashcards
Most common HDFN
ABO HDFN
Most severe HDFN
Rh HDFN
HDFN
a.k.a Erythroblastosis fetalis
Immune destruction of fetal red cells due to maternal antibodies from previous pregnancy
Pathphysio - Hydrops fetalis
In utero
Pathophysiology - Hydrops Fetalis
1. Anemia
2. Increased red cell production
2. 1. Erythroblasts in circulation
2. 2. Decreased protein
3. ** Increased erythropoiesis** (liver & spleen)
4. Hepatosplenomegaly
4. 1. Hypertension & Hepatocellular damage
5. High output cardiac failure w/ edema, ascites, effusion.
Pathophysio - Neonatal HDFN
at birth
Pathophysio - Neonatal HDFN
- Increased B1 (no conjugation)
- Jaundice
- Kernicterus (18-20 mg/dL B1)
- Permanent brain damage
18-20 mg/dl
B1
can cause Kernicterus and permanent brain damage
Condition for HDFN to occur:
* Mother:
* Fetus:
Condition for HDFN to occur:
* Mother: Rh negative
* Fetus: Rh positive
Others: Mother must have IgG antibodies from previous pregnancy
Common HDFN antibodies
Anti-D (95%)
Anti-K
ABO antibodies
< 1 mL
volume of fetal RBCs can immunize the mother
ABO HDFN
- First child:
- Predictable:
- Preventable:
- Spherocytes:
ABO HDFN
- First child: Affected
- Predictable: No
- Preventable: Yes
- Spherocytes: Yes
Rh HDFN
- First child:
- Predictable:
- Preventable:
- Spherocytes:
Rh HDFN
- First child: Not affected
- Predictable: Yes (Titer)
- Preventable: Yes
- Spherocytes: Rare
Cord Blood
Sample to condirm HDFN
10-12 weeks
2nd trimester
Fetal DNA Testing
identify coding genes for the antigens which cause HDFN
Saline Antiglobulin Tube Test
methos in antibody titer determination of HDFN
predict severity of HDFN
>16 Ab Titer
Critical Titer
proceed with proper management
2nd titer should be done at **18-20 weeks
> 32 Ab titer
Indicates to color doppler imaging
Antibody Titer
* >16
* >32
Antibody Titer
* >16 - Critical Titer
* >32 - indicates Color doppler imaging
O.D. 450
Collection: Amniocentesis & Cordocentesis
Bilirubin Testing
estimates the extent of fetal hemolysis
Middle Cerebral Artery-Peak Systolic Velocity (MCA-PSV) Ultrasonography
Predict anemia
based on the reduced viscosity at low hematocrit resulting to faster velocity
18-20 weeks
Amniocentesis for O.D. 450
HDFN Management
Intrauterine Transfusion
Transfusion of fetus in utero
Transfusion of PRBCs to the fetus (in utero) to **correct anemia **
Indication - Intratuterine Transfusion
Indication - Intratuterine Transfusion (one or more condition)
* Hemoglobin <10 mg/dL
* MCA-PSV indicates anemia
* Fetal hydrops on ultrasound
* High zone **(Zone II/Zone III) **in O.D. 450
Purpose - Intrauterine transfusion
Maintain >10 mg/dL of fetal hemoglobin
Exchange Transfusion
Transfusion of newborn infant
Removal maternal antibody and antigen negative RBCs to correct anemia and hyperbiliribunemia
0.5mg/dL/hr rise in bilirubin or 10 mg/dL in first 24 hrs
Indication for exchange transfusion
Requirements - Neonatal Transfusion
* Type:
* Unit:
* Negative:
* Treatment:
Requirements - Neonatal Transfusion
* Type: Group O negative
* Unit: <7 days
* Negative: CMV, Hb S
* Treatment: Irradiated (prevent GVHD)
<7 days
Unit life span for exchange transfusion
460-490 nm
Phototherapy
Remove bilirubin and prevent kernicterus in newborn
Exchange transfusion
Antenatal administration - RhIg
28 weeks or early 3rd trimester
Postnatal RhIg administration
72 hrs of delivery
Shelf-life RhIg
2 years
Full dose Rh0gam
* Anti-D:
* Protection:
Full dose Rh0gam
* Anti-D: 300ug
* Protection: WB - 30 ml; pRBC - 15 ml
Mini/Micro dose Rh0gam
* Anti-D:
* Protection:
Mini/Micro dose Rh0gam
* Anti-D: 50 ug of anti-D
* Protection: WB - 5 ml; pRBC - 2.5 ml
Qualitative Fetal screen
Fetal screen Rosette method
Quantitative Test for Fetal blood
Flow Cytometry
Kleiahauer Betke acid eultion Test
