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Liz's Blood Bank Module 2 > HDFN > Flashcards

HDFN Flashcards

1
Q

List the 3 classes of HDFN

A
  • ABO HDFN
  • Rh HDFN
  • “Other” HDFN
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2
Q

Msot common class of HDFN

A

ABO HDFN

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3
Q

Most severe class of HDFN

A

Rh HDFN

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4
Q

Mechanism of maternal immunization and placental transfer of Ab(s) in HDFN

A

When baby is born, the placenta breaks and there’s a disruptio of placental circulation and an exchange of maternal and baby blood. The mother makes Abs to the foreign cells

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5
Q

Most common ABO group of a mother who delivers a newborn affected w/ ABO HDFN

A

Group O

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6
Q

List 3 reasons that a first born child is more likely to be affected w/ ABO HDFN than Rh HDFN

A
  • ABH Ags found widely distributed throughout body
  • ABH Ags aren’t fully developed in fetal life
  • IgG titer of ABO Abs is usually much lower than anti-D b/c most ABO Abs are IgM; less cross placental and less damage to cells
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7
Q

3 reasons for the severity of Rh HDFN

A
  • Rh is only found on RBCs
  • Rh Ags are fully developed at birth
  • IgG titer is higher b/c it crosses the placenta
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8
Q

Reasons for the severity of “Other” HDFN

A

?

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9
Q

Reasons for the severity of ABO HDFN

A

?

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10
Q

3 reasons why ABO HDFN is usually a relatively mild disease

A

?

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11
Q

How can fetomaternal ABO incompatibility prevent immunization of the mother against Rh or other blood group Ag

A

In ABO-incompatible pregnancies, the baby’s RBCs are IMMEDIATELY sensitized by the mother’s ABO abs and are quickly removed from her circulation by her liver

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12
Q

HDFN

- Mechanism of RBC destruction by maternal Ab

A

Abs are produced as a result of txn or pregnancy. The exposure is usually at the time of the delivery

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13
Q

HDFN

- Response of fetus to RBC destruction

A

Anemia

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14
Q

HDFN

- Management of bilirubin in utero

A

Baby’s cells become coated in utero, cells removed by baby’s RES, Hgb breaks down, indirect bili produced, bili removed by moms liver before birth

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15
Q

HDFN

- Management of bilirubin after delivery

A

After birth, baby’s immature liver canot conjugate bilirubin, so it accumulates in the baby’s system → kernicterus

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16
Q

HDFN

- Greatest danger to the fetus in utero

A

?

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17
Q

HDFN

- Greatest danger to the newborn after delivery

A

?

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18
Q

List 3 indications for performing intrauterine txns (IUTs)

A
  • Amniotic fluid graphs in high zone II or in zone III
  • PUBS indicates hgb level < 10 g/dL
  • Fetal hydrops is noted on ultrasound exam
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19
Q

What type fo blood should be selected for IUT?

A
  • O neg,
  • Washed cells with >80% HCT
  • Compatible with mom’s serum
  • Ag Neg to mom’s Ab
  • “Fresh”
  • Irradiated, leukoreduced
  • CMV, hgbS Neg
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20
Q

At birth, baby’s blood type may look like ____ ____ b/c 90% of circulation is transfused cells. ____ at birth may be mixed field positive, or possible negative

A

O negative; DAT

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21
Q

Criteria for cord blood work-up

A
  • Group O
  • Rh negative
  • IAT +
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22
Q

Cord blood work up

- Weak DAT +

A

ABO HDFN

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23
Q

Cord blood work up

- Strong DAT +

A

Rh HDFN

24
Q

Elution is performed on cord blood to identify ____ coating cell

A

Ab

25
Q

HDFN is characterized by what?

A

Ags absent on maternal RBCs, but present on paternal RBCs

26
Q

The Ab involved in HDFN can be transported across the placenta b/c it belongs to which Ig class?

A

IgG

27
Q

Discuss the pathogenesis of HDFN

A
  • Mother lacks Ag; father has Ag
  • Fetus has Ag
  • Mom makes Ab after fetomaternal bleed
  • Ab crosses placenta in subsequent pregnancies
  • Ab coats fetal RBCs
28
Q

Total bilirubin in the fetal circulation and amniotic fluid may be elevated in HDFN but why is the fetus NOT affected?

A

Bilirubin gets filtered out by mom’s liver

29
Q

Which statement is true for ABO HDFN?

  • a) It’s generally milder than Rh HDFN
  • b) It does not occur in a first pregnancy
  • c) The mother is usually blood group O
  • d) Phototherapy is often the only treatment required
A

It doesn’t occur in a first pregnancy

30
Q

If a neonate requires an exchange txn for HDFN, why is the maternal specimen is the specimen of choice to use for the compatibility test? 2nd choice? 3rd choice?

A
  • 1st: Mom’s serum has highest concentration of offending Ab and therefore, the best sample to test w/
  • 2nd: Eluate made from baby’s cells
  • 3rd: Baby’s serum
31
Q

Principle of Liley graph

A

Plots change in optical density vs. gestational age. Amniotic fluid is measured at 450nm to detect amounts of bilirubin present. Result is plotted and point falls into 1 of 3 zones

32
Q

Define zones I, II, and III on the Liley graph

A
  • Zones I → mild or no disease
  • Zones II → moderate; continue to monitor throughout pregnancy
  • Zones III → severe disease, hemolysis; IUT or early delivery
33
Q

List 3 tests that can detect a fetomaternal hemorrhage

A
  • Weak D
  • Rosette test
  • Kleihauer-Betke stain
34
Q

Weak D sensitivity

A

Least sensitive; requires at least 30mL bleed in order to be detected. Result is weak mixed field

35
Q

Fetomaternal hemorrhage kit sensitivity

A

Sensitive to 2mL bleed of fetal cells into mother; appear as rosettes of D+ cells when viewed microscopically

36
Q

Kleihauer-Betke stain sensitivity

A

Most sensitive, used to quantify the amount of fetomaternal hemorrhage. Fetal cells appear bright pink, mother’s appear as ghost cells

37
Q

List the 4 objectives of an exchange txn for a newborn

A
  • To ↓ level of bilirubin and prevent kernicterus
  • Remove baby’s sensitized RBCs
  • Provide compatible RBCs w/ adequate O2-carrying capacity
  • ↓ level of incompatible Ab in baby
38
Q

Principle of Rosette kit test

A

Rh+ fetal cells coated w/ anti-D form rosettes w/ Rh+ indicator cells. Distinguished from Rh negative RBCs (qualitative)

39
Q

Principle of Kleihauer-Betke test

A

Maternal blood smear treated w/ acid and stained w/ counterstain. Fetal cells resistant to acid remain pink, maternal cells appear as ghosts. After quantitating # of fetal cells present, yield is in % fetal cells

40
Q

Purpose of ABO/Rh prenatal test

A

See if mom is group O (predict possibility of ABO/HDFN) and to see if mom is Rh negative, in which she will need antenatal RHIG at 28 weeks

41
Q

Purpose of IAT prenatal test

A

Screens for unexpected IgG Abs, those capable fo causing HDFN

42
Q

Purpose of titer prenatal test

A

Monitors Ab production in mom. If ↑, corresponds w/ baby affected by HDFN. Indicates need for additional testing, beginning w/ amniocentesis

43
Q

Purpose of amniocentesis prenatal test

A

Sample of amniotic fluid is tested fro amount of bilirubin present, plotted on Liley graph

44
Q

Purpose of Percutaneous Umbilical Blood Sampling (aka cordocentesis)

A

Takes actual sample of baby’s blood that can be tested for hgb, hct, ABO/Rh, DAT, Ag typing

45
Q

Purpose of paternal testing

A

Determine zygosity of father fro offending Ag, thus aiding in predicting occurence of HDFN in baby

46
Q

Rh Immunge Globulin (RHIG)

- Objective/purpose for administration

A

Prevent the formation of anti-D in an Rh negative individual who has been exposed to Rh positive RBCs (here, fetal cells) by passive immunization w/ anti-D

47
Q

Rh Immunge Globulin (RHIG)

- Criteria for candidacy

A
  • Mother must be Rh negative
  • Infant must be Rh positive (including weak D)
  • Mother must not be already immunized to the D Ag (no anti-D)
  • Infants cannot have anti-D coating their cells (DAT+ due to anti-D)
48
Q

Rh Immunge Globulin (RHIG)

- Indications for use

A

?

49
Q

Rh Immunge Globulin (RHIG)

- Active ingredient

A

Sterile IgG anti-D

50
Q

Rh Immunge Globulin (RHIG)

- Standard dose

A

300ug neutralizes 30mL WB or 15mL packed cell bleed

51
Q

Rh Immunge Globulin (RHIG)

- Time frame

A

Ideally, w/in 72 hours from delivery; better to give late than not at all

52
Q

Rh Immunge Globulin (RHIG)

- Route of administration

A

Intramuscularly

53
Q

Calculate fetal bleed and # of vials RHIG needed

A

(# fetal cells/total # of cells) x 100 = % fetal cells
% fetal cells x 50 = volume of FMH (WB)
(FMH/30) = # vials + 1

54
Q

Effects of antenatal RHIG may have on a patient’s IAT results at the time of the delivery

A

Antenatal dose of RHIG can still be detected in the mother’s circulation at time of delivery (1/2 life of anti-D is 22 days). After confirming recipt of RHIG at 28 week mark, this anti-D can be ignored. Mother will still need another dose of RHIG postpartum. Occasionally, the anti-D from RHIG will coat the baby’s cells giving a DAT+

55
Q

Rosette

  • Positive appearance
  • Negative appearance
A
  • Pos: ≥5 rosettes/5 fields (at least 7.5mL fetal bleed into mom)
  • Neg: 0-4 rosettes/5 fields (indicates bleed b/w 2.5-7.5mL)
  • Neg: 0 rosettes/5 fields (< 2.5 mL fetal bleed into mom)

Liz's Blood Bank Module 2 (8 decks)

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