HDN/HTR/QA

Question 1

What is hemolytic disease of newborn (HDN)?

Answer 1

Destruction of fetal or neonate RBC’s by antibodies produced by the mother
Caused by IgG antibodies

Question 2

What blood bank tests are typically completed on all pregnant women?

Answer 2

Type and screen, Du (weak D) testing

Question 3

What process is occurring in the fetus to compensate for the maternal antibody destruction of RBCs?

Answer 3

Kernicterus increases. Hematopoietic tissue, fetal bond marrow, spleen, and liver increase RBC production as anemia increases due to mother’s antibody.

Question 4

What may be done to evaluate the severity of HDN during pregnancy?

Answer 4

Amniocentesis or cardocentesis.

Question 5

What blood bank tests should be done on all cord bloods, when HDN is suspected?

Answer 5

ABO grouping, Rh typing, DAT

elution - antibody ID if necessary

Question 6

What further tests may be helpful if the baby is sensitized?

Answer 6

Bilirubin

Question 7

What criteria must blood meet in order to be suitable for an exchange transfusion for a fetus or newborn?

Answer 7

Group O RBCs, gamma irradiated to decrease GVHD, antigen for mother’s antibody, CMV neg, blood < 7 days old.

Question 8

What specimen do you use for crossmatching in a fetal transfusion?

Answer 8

Mother’s serum

Question 9

Why should cord cells be washed 4 times before testing for ABO, Rh, and DAT?

Answer 9

To remove Wharton’s jelly, which will cause false positive agglutination

Question 10

What screening test can be done to detect fetal blood in the mother’s post delivery specimen?

Answer 10

Rosette technique

Question 11

What is the theory behind the rosette screen for fetal RBCs?

Answer 11

A sample of the mother’s blood is mixed with anti-D. The anti-D attaches to the fetal D pos cells, which makes it invisible. O pos cells are added that attache to the anti-D on the fetal cells, making a circle around them (a Rosette). A pos test indicates a large fetal bleed into the mother’s circulation

Question 12

What quantitative test can be completed to determine how many fetal cells are in the mother’s serum?

Answer 12

Confirmation test such as Kleihauer-Betke for quantitation

Question 13

What is the shelf life and storage temp for RhIg?

Answer 13

2 years at 1-6 degrees

Question 14

What else can be done to quantitate fetal bleed into the mother’s circulation besides the Kleihauer-Betke test?

Answer 14

Flow cytometry

Question 15

Which immunoglobulin class can cross the placenta and enter a fetus’ circulation?

Answer 15

IgG 1-4

Question 16

When are multiple doses of Rh immune globulin indicated?

Answer 16

Confirmatory test - Bleihauer-Betke pos

Question 17

Why are antibodies titered? When is this important?

Answer 17

Antibodies are titered in the mother to give a relative # of antibodies that are crossing the placenta and also to see if the titer is increasing

Question 18

Why must the RBCs be standardized for each antibody titer?

Answer 18

The RBCs used for each titration should be from the same donor, approximately same storage time & same concentration. The 1st serum specimen should be frozen and done in parallel with each subsequent titer

Question 19

A babe is found to have a pos DAT. How would you interpret?

Answer 19

Elution - antibody ID

Question 20

What would you do if the mother was a pos for weak D and had a negative FMH screen?

Answer 20

No work up

Question 21

What would you do if the mother has a negative weak D and pos FMH screen?

Answer 21

Quantitate by Kleihauer-Betke or similar technique

Question 22

What is the incidence of forming anti-D for an Rh negative mother giving birth to an Rh positive baby?

Answer 22

9%

Question 23

In HDN, the greatest risk to the newborn after 24 hours is ?

Answer 23

Hyperbilirubinemia

Question 24

The most frequently seen cause of HDN is:

Answer 24

anti-A, anti-B, anti-A,B

Question 25

One of the most severe cause of HDN is:

Answer 25

anti-D

Question 26

Why isn't anti-Le(a) associated with HDN?

Answer 26

Most anti-Le(a) are IgM so they don't cross the placenta and if they are a rare IgG, the Lewis antigens are not well developed on fetal or newborn RBCs

Question 27

List the blood group systems that are rarely involved with hemolytic disease of the newborn or fetus

Answer 27

Lewis, P, MN

Question 28

If a fetus or newborn has a positive DAT, what are the next steps to be don before a transfusion?

Answer 28

Elution, antibody ID, blood selection that is CMV neg, irradiated and without the corresponding antigen involved, crossmatch

Question 29

How many vials of RhIg should be administered if the mother had a positive Rosette test and no fetal cells were seen on Kleihauer-Betke slide?

Answer 29

One

Question 30

What is the principle of the Kleinhauer-Betke test for fetal maternal bleed?

Answer 30

Maternal blood smear is treated with acid & then stained with a counterstain. Fetal cells (containing Hgb F) will remain pink because they are resistant to the acid. Mother's cells will appear ghost-like. the % of fetal cells is calculated after 2000 cells are counted. From this, the volume of fetal cells in the mother's circulation is counted

Question 31

Which RBC antigens are not expressed on RBCs at birth?

Answer 31

Lewis, P, Lutheran

Question 32

What class of antibody and temperature of reaction is the cause of the most sever intravascular transfusion reactions?

Answer 32

IgM broad thermal range, ABO

Question 33

What signs and symptoms are occurring in the patient who is having a febrile transfusion reaction?

Answer 33

One degree C rise of temp over baseline temp during/within 24 hours after transfusion One degree C rise of temp over baseline during/within 8 hours after transfusion Probable causes: antibodies to human leukocyte antigens and cytokines in the unit of blood if not leukoreduced shortly after collection

Question 34

What can be done to prevent further problems with febrile nonhemolytic transfusion reactions?

Answer 34

Better filtering out WBCs Could use washed RBCs or deglycerized to remove all WBCs including fragments and cytokines produced during storage if not pre-storage leukoreduced

Question 35

What signs and symptoms are occurring in the patient who is having an allergic transfusion reactions?

Answer 35

Erythema, pruritis, hives. Fevers may or may not be present

Question 36

What can be done to prevent further problems with allergic transfusion reactions?

Answer 36

Removal of plasma with blood components (washed RBCs and platelets) and premedication with antihistamine

Question 37

What signs and symptoms are occurring in the patient with immediate intravascular hemolytic transfusion reaction?

Answer 37

Immediate, pt frequently has fever, chills, oliguria. some experience anuria, coagulapathy and 1 out of 10 ie o hypotension

Question 38

What signs and symptoms are occurring in the patient with delayed extravascular hemolytic transfusion reaction?

Answer 38

Fever, chills, jaundice, unexpected anemia, and decreased haptoglobin

Question 39

What is transfusion-associated circulatory overload (TACO)? What is the likely cause?

Answer 39

Symptoms are seen when the patient's cardiovascular system's inability to handle too much volume occurs. Congesting heart failure signs and symptoms occur. Circulatory overload

Question 40

What would the complication for a patient that has received frequent RBC transfusions over a life time?

Answer 40

Iron overload

Question 41

What needs to be done to a unit of RBCs before issue them to a severely immunocompromised recipient?

Answer 41

Irradiated

Question 42

What would possibly cause a physically induced transfusion reaction?

Answer 42

RBC hemolysis from heat damage RBC hemolysis from freezing/washing process Pushing donor unit too fast through transfusion needle - causing hemolysis

Question 43

What is the most likely cause of transfusion related acute lung injury?

Answer 43

Donor antibodies to MHC antigens

Question 44

What is the primary cause of post-transfusion purpura and a severe drop in the platelet count of the recipient?

Answer 44

Platelet antibodies HPA (Ia) in recipient

Question 45

If a patient has a massive transfusion, what electrolyte may fall because of citrate toxicity?

Answer 45

Calcium

Question 46

If a patient has antibodies to IgA, what type of transfusion reaction may occur?

Answer 46

Anaphylactic

Question 47

If a person has anti-IgA and needs RBC products, what can be done to make a safe transfusion?

Answer 47

Wash the RBCs