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Immunohematology > Hemolytic Diseae of Newborn > Flashcards

Hemolytic Diseae of Newborn Flashcards

1
Q

Fetal and Neonatal Erythropoiesis

A

Fetal Sites of Hematopoiesis
- Yolk sac, Liver, Bone Marrow
- Hgb F

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2
Q

Newborn RBC

A

45-70 day life
53-90% Hgb F (high O2 affinity)

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3
Q

Newborn RBC at 40 weeks

A

Cord Blood Hgb = 19 +/- 2.2 g/dl

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4
Q

Infant Size

A

Smaller transfusion volume

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5
Q

Hypovolemia

A

Not enough volume, not right blood pressure
Leads to decreased O2 in tissues and acidosis
Transfuse “whole blood” - transfuse pRBC O cells using AB plasma

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6
Q

Cold Stress

A

0% fat
MUST use blood warmers

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7
Q

Newborn Immunologic Status

A

Maternal Antibodies
- Baby has mom IgG, transfuse with antigen negative blood
Graft vs Host - give irradiated pRBCs

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8
Q

Metabolism Concerns

A

K+ Levels and 2,3 DPG Levels
Need Fresh Blood

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9
Q

CMV

A

MUST give true CMV negative blood

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10
Q

Decreased RBC Survival

A

Increased RBC production
Nucleated RBCs

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11
Q

Erythroblastosis fetalis

A

Hct - 15% or less

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12
Q

Size of Liver and Spleen

A

Increased

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13
Q

Anemia

A

Hydrops fetalis
Severe anemia
Cardiac Failure and Death
Likely Requires Intrauterine Transfusion

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14
Q

Three Main Categories of HDN

A

ABO HDN
Rh HDN
HDN due to other antibodies

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15
Q

ABO HDN

A

Maternal IgG ABO Antibody (Type O mothers IgG)
Less Severe

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16
Q

Rh HDN

A

Maternal IgG Anti-D
Most Severe

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17
Q

HDN Due to other antibodies

A

Maternal IgG Antibody

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18
Q

Maternal Immunization for ABO HDN

A

Naturally occuring antibodies
A or B infants with Group O Mother
- Tyoe AB mother do NOT cause HDN

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19
Q

Maternal Immunization Rh Immune Globulin (Rhogam)

A

IgG Anti-D
Administered at 28 weeks
Administered Post Partum
Mimics ABO Incompatibility Effect (may cause pos DAT on baby)

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20
Q

Prenatal Testing on Mother

A

ABO/Rh - includes weak D testing
Antibody Screen
- Antibody Identification
- Antibody Titer (if High Risk)
- 1:32 titer or higher associated with severe HDN

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21
Q

Other Prenatal Testing

A

Father’s Antigen Status

22
Q

28 week Prenatal Testing

A

For Rh Negative Mothers
- ABO/Rh
- Antibody Screen
- Rh Ig

23
Q

Monitor of HDN Severity

A

Amniocentesis
- Rh neg mothers with high-titer anti D or previously affected pregnancies
- LEvel of bile pigment in amniotic fluid - Optical Density 450nm

24
Q

PUB Sample Testing (Percutaneous Umbilical Blood)

A

Very risky procedure
Umbilical Vein
ABO/Rh
DAT
Cord Hgb
Bilirubin
CBC
Antigen Typing

25
Q

Fetal Lung Maturity

A

Consideration of Early Delivery
Ratio of Lecithin to Sphingomylin (L/S Ratio)
If fetus <29 weeks or severe HDN indicated

26
Q

L/S Ratio >2.0:1

A

Mature

27
Q

L/S Ratio 1.5:1

A

40% respiratory distress
Physician and mom call if should deliver early

28
Q

L/S Ratio <1.5:1

A

70% respiratory distress
Choose to do intrauterine transfusion

29
Q

Intrauterine Transfusion

A

Risky Procedure
RBCs infused through fetal abdominal wall or umbilical vein
Repeated with small volumes until delivery

30
Q

Intrauterine Transfusion Products

A

Fresh RBCs (<7 days old); Hct = 80%
Washed RBCs
CMV Negative or Leukodepleted
Irradiated
Group O, Rh Negative reconstituted with AB plasma
- MUST be negative for antigen corresponding to mom Ab

31
Q

Post Delivery Testing

A

ABO/Rh
DAT

32
Q

ABO/Rh Post Delivery

A

No reverse Group
Weak D Testing

33
Q

DAT Post Delivery

A

anti IgG AHG
Positive - elute Ab and identify
ID Ab in maternal or cord serum

34
Q

Exchange Transfusion Helps

A

Remove antibody-coated RBCs
Controls anemia
Removes Bilirubin
- Prevents Kernicterus

35
Q

Blood Products for Exchange Transfusion

A

Group O RBCs
Must be compatible with maternal antibody
Rh compatible with mother and infant

36
Q

Complications of Exchange Transfusion

A

Cardiac (if go to fast)
Vascular-Mechanical (destroy too many cells)
Infections
Hematologic-Coagulation
Immunologic (GVHD)
Hypothermia

37
Q

Post Delivery Testing Mother

A

ABO/Rh (weak D)
IAT
FMH Screen (possibly)
Kleihauer-Betke Stain

38
Q

FMH Screen

A

Performed on D negative mom
Must be anti-D negative

39
Q

Kleihauer-Betke Stain

A

Determine amount of fetal blood mom was exposed to
Hgb F resistant to acid denaturation

40
Q

RhIg Calculation

A

(% fetal cells x 50)/30

41
Q

First dose of RhIg

A

28 weeks
Rh Negative mother
No Immune Anti D

42
Q

RhIg After Delivery

A

Within 72 hours
Rh Negative Mother
No Immune Anti D
Rh Positive Baby

43
Q

Group O Mother
Group O, A, B Baby

A

pRBCs Group O

44
Q

Group A Mother
Group O or B Baby

A

pRBCs Group O

45
Q

Group A Mother
Group A or AB Baby

A

pRBCs Group A or O

46
Q

Group B Mother
Group O or A

A

pRBCs Group O

47
Q

Group B Mother
Group B or AB Baby

A

pRBCs B or O

48
Q

Group AB Mother
Group A Baby

A

pRBCs Group A or O

49
Q

Group AB Mother
Group B Baby

A

pRBCs Group B or O

50
Q

Group AB Mother
Group AB Baby

A

pRBCs Group AB, A, B, or O

Immunohematology (17 decks)

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