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

HDN Maternal Perspective Flashcards

1
Q

HDN definition

A

Maternal alloantibodies specific for inherited paternal RBC antigens, resulting in fetal/newborn RBC destruction

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2
Q

When do fetal RBCs sensitize mom?

A
  • trauma
  • delivery
  • medical interventions
  • aborted pregnancies
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3
Q

Test to run if HDN suspected

A

DAT
detects if Ab already attached to baby RBC

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4
Q

What alloantibody does Type O mom make against Type A or Type B baby? Can it cause HDN?

A

anti-A,B IgG
Can cause HDN

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5
Q

Test to run if DAT positive for HDN suspicion

A

Elution Ab ID

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6
Q

Traits of HDN Ab

A
  • can cross placenta (IgG)
  • not absorbed by normal tissues
  • causes hemolysis (IgG1 and IgG3 more efficient)
  • positive on fetal cells
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7
Q

Follow-up test if positive Ab ID

A

Ab titer

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8
Q

Describe Ab titer results if HDN is happening

A

Ab titer gets stronger in the presence of sensitizing baby Ag

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9
Q

List order of maternal testing

A
  1. ABO Type and screen
  2. Ab ID
  3. Ab titer if positive Ab ID
  4. FMH qualitative screen
  5. KLB or flow cytometry quantitative test
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10
Q

What information is gathered when diagnosing HDN?

A
  • transfusion and pregnancy history
  • type and screen
  • confirm rh neg status for rhogam
  • Ab ID if needed
  • Ab titration baseline
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11
Q

Critical titer for anti-D

A

16-32 in AHG phase

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12
Q

Critical titer for anti-K

A

8

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13
Q

Significant change defined by a difference of what dilution?

A

2-fold dilutions

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14
Q

As long as the titer is less than ____, titers may be performed every 4-6 weeks

A

8

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15
Q

As little as _____ of fetal cells can sensitize mom

A

1 ml

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16
Q

95% cases diagnosed before 1968 were because of ____

A

D antigen

17
Q

Serological detection of Weak D

A
  • IS And AHG phase
  • polyclonal anti-D
  • verify with saline control
  • if mutation inside RBC membrane, then don’t need Rhogam (Weak D) bc mom won’t make anti-D
18
Q

Describe Rhogam protection

A

One dose protects mom against D-pos exposure of 30 ml bleeds for up to 12 weeks

19
Q

Molecular Weak D testing

A

SNP panel for Weak D, run on MALIDI-Tof or other automated genotype analyzer

20
Q

When to do molecular weak D testing

A
  • woman childbearing age is weak D
  • woman of childbearing age is Rh pos but has anti-D serologically demonstrated
21
Q

Weak D tests mostly done for who?

A

Babies and donors
not moms

22
Q

What is Rhogam?

A

High-titered IgG anti-D that immunizes D-neg mom against D Ag

23
Q

Criteria for receiving Rhogam

A
  • Rh-neg mom
  • Mom no history of anti-D
24
Q

Describe antepartum Rhogam dosing

A
  • Initial dose at 28 wk gestation
  • Dose follows invasive procedures amniocentesis or cordocentesis
  • Dose can also follow pregnancy manipulations (abortion)
25
Q

Describe postpartum Rhogam

A

Give within 72 hr of delivery of Rh-pos infant

26
Q

Fetal maternal bleed (FMH) screen test principle

A
  • Weak anti-D reagent incubates with pt cells, wash away unbound Ab, incubate with indicator cells to form countable rosettes
  • dependent on fetus being Rh pos and mother Rh neg
27
Q

FMH test results

A
  • qualitative test to determine dose of RhIG
  • Neg result means < 15 ml bleed, give standard dose
  • Pos result means > 15ml bleed, perform quantitative test to find dose
28
Q

Kleihauer-Betke test principle

A

Fetal hemoglobin resistant to acid treatment and will stain darker than maternal cells

29
Q

Kleihauer-Betke calculation for number of RhIG doses

A
  • % bleed = #fetal cells/#mom cells
  • doses = %bleed * (5000/30) + 1
  • # mom cells = 1000
30
Q

Kleihauer-Betke purpose

A

Determine extent of fetal bleed

31
Q

T/F
Fetus must be Rh pos to have bleed detected in Kleihauer Betke test

A

False
Can be Rh neg

32
Q

Fetal neonatal alloimmune thrombocytopenia

A
  • IgG plt antibodies cross placenta
  • 80% caused by anti-HPA-a1
  • IVIG therapy treatment
  • Mom’s anti-plt antibodies attack baby’s platelets
33
Q

Immune thrombocytopenic purpura (ITP)

A
  • Autoimmune disorder in mom, can also affect fetus
  • body attacks own platelets
  • 15% neonates need plt transfusion at birth
  • treat w Prednisone
34
Q

Most common cause of HDN

A

ABO

Blood Bank 2: Summer 2024 (8 decks)

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