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HDFN Flashcards

1
Q

the destruction of the red blood cells (RBCs) of a fetus and neonate by antibodies produced by the mother

A

HDFN

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2
Q

95% of the cases of HDFN were caused by maternal antibodies directed against the

A

RhD

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3
Q

The mother can be stimulated to form RBC antibodies naturally (ABO), by

A

previous pregnancy, or transfusion
(RBC alloimmunization)

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4
Q

initial diagnosis of maternal RBC alloimmunization is

A

Serologic

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5
Q

reported a transfusion reaction from transfusing a husband’s blood to a postpartum woman

A

1939 Levine and Stetson

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6
Q

the mother had been immunized to the fa- ther’s antigen through

A

fetomaternal hemorrhage (FMH). The antigen was later identified as RhD.

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7
Q

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

A

HDFN

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8
Q

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

A

IgG

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9
Q

In the case of HDFN

A

the antibodies are directed against the blood group antigens on the fetal RBCs that were inherited from the father.

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10
Q

the most common cause of HDFN

A

HDFN Caused by ABO

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11
Q

are present in the plasma of all individuals whose RBCs lack the corre- sponding antigen

A

isohemagglutinins / ABO Abs

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12
Q

most likely to form high-titered IgG anti-ABO antibodies, ABO HDFN is nearly always limited to A or B infants of_______ with potent anti- A,B antibodies.

A

Group O mother

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13
Q

mild course of ABO HDFN

A

related to the poor development of ABO antigens on fetal RBCs

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14
Q

The serious conse- quences seen with other causes of HDFN, such as

A

-still birth
-hydrops fetalis
-kernicterus

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15
Q

ABO HDFN causes a bilirubin peak at

A

1 to 3 days

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16
Q

the leading cause of maternal alloimmunization.

A

Fetomaternal Hemorrhage

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17
Q

Interventions that can increase the risk of FMH.

A

amniocentesis
chorionic villus sampling
trauma to the abdomen

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18
Q

active transport of IgG begins in the

A

Second trimester

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19
Q

IgG molecules are transported via the

A

Fc portion

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20
Q

more efficient in RBC intravascular he- molysis than are IgG2 and IgG4

A

IgG 1 and IgG3

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21
Q

common antigens in the Rh system

A

C, E, c

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22
Q

is considered the most clinically significant in its ability to cause HDFN.

A

Anti-Kell

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23
Q

present on immature erythroid cells in the fetal bone marrow, so severe anemia occurs not only by destruction of circulating RBCs but also by destruc- tion of precursors

A

Kell antigens

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24
Q

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

A

Hemolysis

25
Q

Destruction of fetal RBCs and the resulting anemia stimulate the fetal bone marrow to produce RBCs at an accelerated rate

A

Erythroblastosis fetalis

26
Q

the development of high-output cardiac failure with generalized edema, effusions, and ascites, a condition known as

A

Hydrops fetalis

27
Q

Hydrops fetalis can develop

A

18 to 20 weeks

28
Q

three different phases of anemia caused by HDFN

A

early (within 7 days of birth)
- due to antibody- mediated hemolysis;

late hemolytic anemia (2 weeks or more after birth)
- due to continued hemolysis, the expanding intravascular compartment, and natural decline of hemoglobin levels;

late hyporegenerative anemia
- due to marrow suppression as a result of transfusions and IUT, antibody destruction of RBC precursors, and deficiency of erythropoietin

29
Q

Onset : Within 7 days of birth
Mechanism : Antibody-mediated hemolysis
Bilirubin : Elevated
Reticulocyte count : Normal or high

A

Early-onset anemia

30
Q

Onset : >/= 2weeks

Mechanism:
1. Antibody-mediated hemolysis
2. Natural decline of Hb levels
3. Expanding intravascular volume of growing infant

Bilirubin : usually elevated
Reticulocyte count: Normal to High

A

Late hemolytic anemia

31
Q

Onset : >/= 2 weeks
Mechanism:
1. Antibody destruction of RBC precursors and RBCs
2. Marrow suppression by IUT and transfusions
3. Erythropoietin deficiency
4. Expanding intravascular volume of growing infant

Bilirubin: Normal
Reticulocyte count: Low or Absent

A

Late hyporegenerative anemia

32
Q

bilirubin can reach levels toxic to the infant’s brain

A

more than 18 to 20 mg/dL

33
Q

newborn develops jaundice

A

12 - 18 hours

34
Q

most important diagnostic testing HDFN cause by ABO

A

DAT on the cord or neonatal RBCs

35
Q

recommended practice is to perform in HDFN Caused by RBC Alloimmunization

A

type and antibody detection test at the first prenatal visit, preferably during the first trimester.

36
Q

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)

37
Q

prenatal specimen must be typed for

A

ABO and RhD

38
Q

For tube testing, an antibody-enhancing medium can increase sensitivity of the assay.

A

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

39
Q

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

A

Antibody titration

40
Q

the recommended test for RhD-positive fathers when the mother has anti-D antibody

A

zygosity genotype testing

41
Q

the clinical diagnosis of fetal anemia can be made using an ultrasound technique called

*** The measurement is based on the reduced blood viscosity at lower hematocrits and resulting in faster velocity of the blood.

A

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

42
Q

done to determine fetal hematocrit.

A

Cordocentesis

43
Q

umbilical vein is visualized at the level of the cord insertion into the placenta

A

high-resolution ultrasound with color Doppler enhancement of blood flow

44
Q

monitor amniotic fluid bilirubin levels has been replaced with MCA-PSV

A

Amniocentesis

45
Q

amniotic fluid is tested by a spec- trophotometric scan optical density (∆OD) at

A

450 nm

46
Q

goal of intrauterine transfusion is to

A

maintain fetal hemoglobin above 10 g/dL

47
Q

the infant’s RBCs can be heavily antibody-bound with maternal anti-D, causing a false-negative Rh type, or what has been called

A

Blocked Rh

48
Q

most important serologic test for diagnosing HDFN is the

A

DAT with anti-IgG reagent

49
Q

collection from the donor are selected to reduce the risk of hyperkalemia

A

RBCs units less than 7 to 10 days

50
Q

After a two-volume exchange transfusion

A

90% of the red blood cells have been replaced

50% of the bilirubin has been removed

51
Q

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

Phototherapy at 460 to 490 nm

52
Q

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

A

Intravenous immune globulin (IVIG)

53
Q

The first dose of RhIG is provided at

A

28 weeks of gestation

54
Q

The second is provided at

A

After delivery

55
Q

it is recommended to give RhIG within

A

72 hours after delivery

56
Q

a maternal blood smear is treated with acid and then stained with counterstain.

A

Kleihauer-Betke test

57
Q

Fetal cells contain ______which is resistant to acid and will remain pink

A

Hgb F

58
Q

The most common genetic backgrounds that account for this serologic typing problem are called

A

weak D phenotypes

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