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Week 11 > HDN > Flashcards

HDN Flashcards

1
Q

Cause of HDN

A

Development of anti_D in D negative woman following exposure to D positive red cells. Antibody crosses placenta and coats D positive cells

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2
Q

Other significant antibodies

A

D, c, K

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3
Q

Hydrops

A

Primarily hepatic in origin: hepatosplenomegaly, portal HTN, hypoalbuminaemia, anasarca

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4
Q

Kernicterus

A

Deposition of bilirubin in basal ganglia

  • neurosensory deafness
  • spastic chroathetosis
  • mental retardation
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5
Q

Incidence of alloimmunisation

A

10.2 per 10000 live births

Less than 10% requiring transfusion

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6
Q

IUT due to antibodies

A

85% anti D
10% anti- Kell
3.5% anti-c

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7
Q

Causes of Feto-maternal haemorrhage

A 
Delivery (including c/s)
Abortion
APH
ECV
Closed abdominal injury
Ectopic pregnancy
IUFD
SB
Amino
CVS
FBS
Embryo reduction
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8
Q

If antibody screen positive at booking then need to do the following:

A 
Antibody identification
Antibody quantitative
Testing protocol
Paternal screening
Fetal genotype gets
Post-delivery ABO/D group/Hb/DAT/bilirubin
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9
Q

Testing protocol (frequency of testing)

A

Anti-D, c, K : 4 weekly to o28/40 then 2 weekly to gestation

Others: booking and 28 weeks

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10
Q

Assessing severity of HDFN

A

Antibody titres (1:32)
Quantitative of antibodies - if Anti D more than 15- high risk hydrops
MCA PSV
Fetal USS
Invasive monitoring with umbilical blood sampling
Fetal blood typing

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11
Q

Indicators of high fetal risk of HDN —>refer to FMU

A

Hx of non-ABO HDFN requiring transfusion, irrespective of antibody
Anti-D >10iu/ml
Anti-K: untransfused women, partner K+
Rising anti-c (>20IU)

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12
Q

Role of MCA and PSV

A

Reciprocal relationship between fetal Hb & velocity of cerebral flow
In fetal anaemia - blood velocity is increased
Must do at a 0 degree angle
Useful between 16-35 weeks
If >1.5MoM then prediction of anaemia 100% with 12% false positive

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13
Q

Other USS signs of fetal anaemia

A

Placental thickness, UV diameter, liver length, spleen perimeter: useful to assess fetal maturity, does not identify early fetal disease —>changes visible only once hydrops has occurred, weak correlation with fetal hcg/HB

Doppler- detects early fetal anamia

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14
Q

DAT - direct antiglobulin test must be done in any IAT reactive antibody present in pregnancy — results

A

If DAT +ve: heck Hb and Bili to dx HDN

If DAT negative, no risk of HDN

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15
Q

Management of alloimmunisation during pregnancy

A

Intrauterine red cell transfusions
IVigG
Premature delivery

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16
Q

How IUT works

A

IUT supresses erythropoietin causing hypoproliferative anaemia in the neonatal period- may need top ups

Can expect normal developmental outcomes

17
Q

When to deliver

A

After 35/40 if severe
If titre stays less than critical and first pregnancy - 39 weeks
If critical to tire or if IUTs- 37 - 38 weeks

18
Q

Management of neonate

A

Samples after delivery
Exchange transfusions
Phototherapy
Top-up transfusions

19
Q

When to give Anti-D by trimester

A 
1st trimester (250 IU)
CVS
Miscarriage
TOP
Ectopic
2nd and #rd (625IU)
Obs haemorrage
Amnio, cordocentesis
ECV
Abdo trauma

Prophylaxis: 28 and 34 (625IU)

20
Q

Why does Kell kill

A

Dual mechanism of fetal anaemia

  • hemolysis form IgG antibodies crossing the placenta
  • fetal bone marrow erythropoietin suppression leading to an aplastic anaemia
21
Q

Approach if antibody screen positive

A

Determine antibody type
Do titre
Past Obs his
Determine paternal zygosity - if homozygous, child will be affected, if heterozygous 50% chance —> do NIPS

22
Q

If subsequent pregnancy with high risk of fetal anaemia then screening should be

A

MCA PSVs from 16-18 weeks

23
Q

Anti D dosing

A

Before 12/40 250IU
After 12/40 and PP 625IU
If further event after 2 weeks at any gestation- give further dose
If less than 2 weeks bu more than 20 weeks gestation - for another dose
Ongoing intermittent bleeding after 12 weeks - give anti-D at 2 weekly intervals

Week 11 (4 decks)

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