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Transfusion Exam > HDFN & HA > Flashcards

HDFN & HA Flashcards

1
Q

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

A
  • destruction of RBC increase free Hgb = increases unconjugated bilirubin
  • Anemia limits oxygen carrying capacity
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2
Q

what is a fetomaternal hemorrhage?

A

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

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3
Q

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

A

As little as 1 mL

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4
Q

Which immunoglobulins are the most efficient at producing intravascular hemolysis?

A
  • IgG 1
  • IgG 3
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5
Q

What happens if hemolysis in neonatal go untreated?

A

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

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6
Q

What is hydrops fetalis?

A

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

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7
Q

What is the most severe form of HDFN?

A

Rh (Anti-D)

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8
Q

What is the most common form of HDFN ?

A

ABO incompatibility

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9
Q

What is included in prenatal assessments?

A
  • ABO/Rh
  • Rhogam
  • Antibody screening
  • Identify any offending antibodies
  • Possible titrations
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10
Q

What is zone 1 on the Liley graph?

A

Mild hemolysis - unaffected newborn

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11
Q

What is zone 2 on the Liley graph?

A

Moderate hemolysis - HDFN repeat testing

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12
Q

What is zone 3 on the Liley graph?

A

Severe hemolysis, HDFN risk fetal death

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13
Q

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

A

3rd trimester, decreases steadily until birth.

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14
Q

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

A

fetal hemolytic disease

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15
Q

What can be done to correct fetal hemolytic disease?

A

Intrauterine transfusions to remove bilirubin, sensitized RBC and antibodies.

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16
Q

What is the block-D phenomenon?

A

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

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17
Q

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

A
  • Weak D is Baby and mom are Rh -
  • ABO testing
18
Q

What is the purpose of doing exchange transfusions on neonates?

A
  • increase Hgb
  • increase RBC
  • Decrease Bilirubin, maternal AB’s in circulation and sensitized RBC
19
Q

What is the screening for fetomaternal hemorrhage?

A
  • Rosette test (Qualitative)
  • Kleihauer-Betke Test (Quantitative)
20
Q

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

A

1 dose

21
Q

How many cells are counted in the KB test?

A

2000 cells

22
Q

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

A

Should be determined by using the KB test.

23
Q

What is Wharton’s jelly?

A
  • Gelatinous intracellular substance of the umbilical cord.
24
Q

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

A

Schistocytes

25
Q

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

A

Spherocytes

26
Q

Which IgG subclass cannot mount an immune response?

A

IgG 4

27
Q

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

A

IgM

28
Q

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

A
  • Subclass involved
  • Location and number of IgG sites on the RBC
  • Avidity
29
Q

What are the lab findings for intravascular hemolysis?

A
  • hemoglobinemia
  • hemoglobinuria
  • decreased Haptoglobin
  • increased unconjugated bilirubin
  • DAT (+)
  • increased LDH
30
Q

What are the lab findings for extravascular hemolysis?

A
  • Spherocytosis
  • decreased haptoglobin
  • increased unconjugated bilirubin
  • increased LDH
  • DAT (+)
31
Q

What are the three classifications of immune hemolytic anemia?

A
  • Alloimmune
  • Autoimmune
  • Drug induced
32
Q

What are the two main types of autoimmune hemolytic anemias?

A
  • Warm AIHA
  • Cold AIHA
33
Q

What are the three classes of Cold AIHA?

A
  • Primary cold agglutinin disease
  • cold paroxysmal syndrome
  • Paroxysmal cold hemoglobinuria/ nocturnal
34
Q

What is the Donath Landsteiner test?

A

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

35
Q

Which drug commonly causes positive DAT?

A

Aldomet

36
Q

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

A
  1. Autoimmune mechanism
  2. Drug absorption mechanism
  3. Immune complex mechanism
  4. Membrane modification mechanism
37
Q

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.

A

Autoimmune mechanism

38
Q

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

A

Drug absorption mechanism

39
Q

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.

A

Immune complex mechanism

40
Q

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.

A

Membrane modification mechanism.

41
Q
A

Transfusion Exam (5 decks)

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