HDFN & HA

Question 1

What are the dangers of hemolytic anemias especially as pertains to neonatal/ fetuses.

Answer 1

• destruction of RBC increase free Hgb = increases unconjugated bilirubin
• Anemia limits oxygen carrying capacity

Question 2

what is a fetomaternal hemorrhage?

Answer 2

Fetal cells enter maternal circulation due to;
- placental rupture
- trauma
- delivery
- amniocentesis
- abortions
- miscarriage

Question 3

How much fetal cells is needed to sensitize mom to produce anti-D?

Answer 3

As little as 1 mL

Question 4

Which immunoglobulins are the most efficient at producing intravascular hemolysis?

Answer 4

• IgG 1
• IgG 3

Question 5

What happens if hemolysis in neonatal go untreated?

Answer 5

kernicterus at > 300 umol/L
- seizures
- brain damage
- deafness
- Death

Question 6

What is hydrops fetalis?

Answer 6

When Baby produces more immature cells (don’t respond like mature cells) in response to HDN and the organs cannot handle the anemia, enlargement of the liver and spleen

Question 7

What is the most severe form of HDFN?

Answer 7

Rh (Anti-D)

Question 8

What is the most common form of HDFN ?

Answer 8

ABO incompatibility

Question 9

What is included in prenatal assessments?

Answer 9

• ABO/Rh
• Rhogam
• Antibody screening
• Identify any offending antibodies
• Possible titrations

Question 10

What is zone 1 on the Liley graph?

Answer 10

Mild hemolysis - unaffected newborn

Question 11

What is zone 2 on the Liley graph?

Answer 11

Moderate hemolysis - HDFN repeat testing

Question 12

What is zone 3 on the Liley graph?

Answer 12

Severe hemolysis, HDFN risk fetal death

Question 13

When is the optical density the highest during a gestational period?

Answer 13

3rd trimester, decreases steadily until birth.

Question 14

What does it indicate if the Optical density doesn’t change, or remains increased through the gestational period?

Answer 14

fetal hemolytic disease

Question 15

What can be done to correct fetal hemolytic disease?

Answer 15

Intrauterine transfusions to remove bilirubin, sensitized RBC and antibodies.

Question 16

What is the block-D phenomenon?

Answer 16

Maternals anti-D is bound to all of the infants D antigen sites making the infant seem Rh negative.

Question 17

What are post delivery tests that a ran regularly on newborns?

Answer 17

• Weak D is Baby and mom are Rh -
• ABO testing

Question 18

What is the purpose of doing exchange transfusions on neonates?

Answer 18

• increase Hgb
• increase RBC
• Decrease Bilirubin, maternal AB’s in circulation and sensitized RBC

Question 19

What is the screening for fetomaternal hemorrhage?

Answer 19

• Rosette test (Qualitative)
• Kleihauer-Betke Test (Quantitative)

Question 20

In the rosette test if 1 rosette is seen out of 3 low power fields how many units of RhIG should be given?

Answer 20

1 dose

Question 21

How many cells are counted in the KB test?

Answer 21

2000 cells

Question 22

In the rosette test if 5 rosette is seen in multiple low power fields how many units of RhIG should be given?

Answer 22

Should be determined by using the KB test.

Question 23

What is Wharton’s jelly?

Answer 23

• Gelatinous intracellular substance of the umbilical cord.

Question 24

In intravascular hemolysis what RBC morphology would you more commonly see?

Answer 24

Schistocytes

Question 25

In extravascualr hemolysis what RBC morphology would you more commonly see?

Answer 25

Spherocytes

Question 26

Which IgG subclass cannot mount an immune response?

Answer 26

IgG 4

Question 27

When the classical pathway is activated which immunoglobulin mounts a reaction more effectively?

Answer 27

IgM

Question 28

What are the criteria required for IgG to mount an immune response in the classical pathway?

Answer 28

- Subclass involved - Location and number of IgG sites on the RBC - Avidity

Question 29

What are the lab findings for intravascular hemolysis?

Answer 29

- hemoglobinemia - hemoglobinuria - decreased Haptoglobin - increased unconjugated bilirubin - DAT (+) - increased LDH

Question 30

What are the lab findings for extravascular hemolysis?

Answer 30

- Spherocytosis - decreased haptoglobin - increased unconjugated bilirubin - increased LDH - DAT (+)

Question 31

What are the three classifications of immune hemolytic anemia?

Answer 31

- Alloimmune - Autoimmune - Drug induced

Question 32

What are the two main types of autoimmune hemolytic anemias?

Answer 32

- Warm AIHA - Cold AIHA

Question 33

What are the three classes of Cold AIHA?

Answer 33

- Primary cold agglutinin disease - cold paroxysmal syndrome - Paroxysmal cold hemoglobinuria/ nocturnal

Question 34

What is the Donath Landsteiner test?

Answer 34

Test which determines if a patient has a cold antibody can be done - indirect - direct

Question 35

Which drug commonly causes positive DAT?

Answer 35

Aldomet

Question 36

What are the 4 mechanism by which drugs can cause or mimic hemolytic anemia?

Answer 36

1. Autoimmune mechanism 2. Drug absorption mechanism 3. Immune complex mechanism 4. Membrane modification mechanism

Question 37

Who am I? (Drug related mechanisms that cause HA), mimic WAIHA, cause extravascular hemolysis and produce strong DAT + that can last years after discontinuing the conflicting drug.

Answer 37

Autoimmune mechanism

Question 38

Who am I? (Drug related mechanisms that cause HA), commonly caused by large doses of penicillin and cephalosporin. DAT + and extravascular hemolysis.

Answer 38

Drug absorption mechanism

Question 39

Who am I? (Drug related mechanisms that cause HA), least common of the mechanisms, quinidine is commonly responsible for this, formation of an antibody-drug immune complex. Complement DAT +, intravascular hemolysis.

Answer 39

Immune complex mechanism

Question 40

Who am I? (Drug related mechanisms that cause HA), commonly cause by cephalosporins, cause a + DAT, and is the result of plasma proteins absorbing onto the RBC.

Answer 40

Membrane modification mechanism.