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Blood Bank 2: Summer 2024 > HDN Baby Perspective > Flashcards

HDN Baby Perspective Flashcards

1
Q

Fetus

A
  • Unborn
  • Relies on mom for kidney and liver function, waste removal, and oxygenation
  • has placenta and cord
  • difficult to collect transfusion specimen
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2
Q

Newborn

A
  • infant from birth-4mth of age
  • Ab still developing
  • no maternal waste management to aid in bodily functions
  • specimens available by heel stick or. cord (at birth)
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3
Q

List order of infant blood testing

A
  1. Fwd ABO type
  2. DAT
  3. Elution
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4
Q

DAT testing in infants

A

IgG only, no complement

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5
Q

ABO HDN

A
  • most common
  • least severe
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6
Q

Rh HDN

A
  • least common
  • most severe
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7
Q

Other types of HDN

A
  • K and c common
  • k, Jka, Fya, Fyb, S, s, U
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8
Q

Hydrops fetalis

A
  • Abnormal fluid buildup in 2+ compartments of baby organs
  • sensitized RBCs undergo extravascular hemolysis (Rh incompatibility with mom)
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9
Q

Hydrops fetalis pathophysiology liver/spleen

A
  • increased erythropoiesis-> erythroblastosis
  • hepatosplenomegaly
  • portal hypertension
  • decreased albumin synthesis
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10
Q

Hydrops fetalis pathophysiology of plasma/heart

A
  • decreased oncotic pressure
  • high output cardiovascular failure
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11
Q

Hydrops fetalis pathophysiology of fetal tissues

A

edema, ascites, effusions

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12
Q

What are 3 ways to determine severity of hydrops fetalis in utero?

A
  1. ultrasonography
  2. amniocentesis
  3. cordocentesis
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13
Q

ultrasonography purpose

A
  • measure amount of amniotic fluid
  • determine size and location of placenta
  • assess fetal edema, liver, and spleen size
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14
Q

amniocentesis purpose

A
  • evaluate degree and significance of hemolysis
  • determine change in OD450 of bilirubin
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15
Q

cordocentesis purpose

A
  • venipuncture of umbilical vein
  • determine H/H and bilirubin levels
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16
Q

Kernicterus

A
  • excess maternal Ab still circulating in newborn
  • RBC destruction continues
  • Newborn liver limited ability to process indirect bilirubin
  • rises dramatically to toxic levels->brain buildup
  • bilirubin > 18 mg/dL
17
Q

Why does jaundice appear in kernicterus?

A
  • Bilirubin builds up in basal ganglia and cerebellum, which damages CNS
  • within a few hr/day after birth
18
Q

List ways of treating postpartum jaundice

A
  1. phototherapy for mild jaundice
  2. IVIG controls hemolysis action of Ab
  3. exchange transfusion for mod-severe jaundice, at risk of kernicterus (removes 90% Ab and 50% bilirubin)
19
Q

How to select blood for neonate/fetus transfusion

A
  • Group O or ABO compatible and Rh neg (O neg best)
  • RBCs < 7 days old and suspended n Ab FFP
  • CMV neg and leukoreduced
  • Irradiated
  • Hgb S-neg
  • Ag neg for maternal Ab
20
Q

Explain crossmatch for neonate/fetus transfusion

A

Crossmatch compatible with mom’s plasma or eluate made from baby’s sensitized RBCs

21
Q

Baby’s cannot tolerate how much blood loss?

A
  • > 10% blood loss
  • maintain Hgb >14g/dL
22
Q

Why are blood warmers required for neonate transfusion?

A

Hypothermia risk

23
Q

Neonate/fetus transfusion risks

A
  • graft v host disease due to immature immune system
  • toxicity of K+, Ca+, H+ (liver can’t metabolize citrate, low GFR)
24
Q

Describe exchange transfusion unit

A
  • most often used for bilirubin removal, can be used to remove drugs or toxins
  • double volume, 2 sep components that are 85 ml/kg
  • FFP only used to suspend LRBC component to ideal Hct 45-60%
  • fresh irradiation product is preferred to avoid potassium increase
25
Q

Indicates for platelet or plasma transfusion for infants in NICU

A
  • plt count < 50,000
  • impaired plt production, increased destruction, abnormal distribution
26
Q

Component type for platelet/plasma transfusion of neonate

A
  • ABO specific
  • 5-10 ml/kg body weight
27
Q

ECMO

A
  • prolonged treatment removes CO2 and replenishes O2
  • used for cardiac surgery recovery or meconium aspiration syndrome
  • product type is 1-2 units for priming and 1 FFP
28
Q

Polycythemia

A
  • Hct > 65% too viscous for appropos gas exchange
  • product type is whole blood removed and replaced with crystalloid or normal saline

Blood Bank 2: Summer 2024 (8 decks)

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