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BB Lec > Hemolytic Disease of Fetus and Newborn > Flashcards

Hemolytic Disease of Fetus and Newborn Flashcards

1
Q

Destruction of red blood cells of the fetus and neonate by antibodies
produced by the mother

A

HEMOLYTIC DISEASE OF FETUS AND NEWBORN
(HDFN)

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2
Q

The only natural occurring antibodies will be under the?

A

ABO Blood group system

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3
Q

Rh HDFN only happens during first or second pregnancy?

A

Second

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4
Q

HDFN is also known as?

A

Erythroblastosis fetalis

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5
Q

Causes of HDFN which will only be formed if we
have been exposed to D antigen?

A

Rh BGS – anti-D

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6
Q

Mainly Rh antibodies are (?) what kind of Ab

A

IgG in nature

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7
Q

what kin of immunoglobulin able to cross the placenta?

A

IgG

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8
Q

Causes of HDFN which has naturally occurring antibodies so it doesn’t need pre-exposure or sensitization

A

ABO BGS – anti-A, anti-B

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9
Q

BO BGS HDFN happens in first or second?

A

First pregnancy

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10
Q

What ABO Ab is IgG in nature and can cross placenta?

A

Anti-AB

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11
Q

What is rare BGS cause HDFN?

A

– Duffy BGS, MNS BGS

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12
Q

Example: Rh+ (baby) and Rh- (mother)

A

Fetomaternal incompatibility

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12
Q
  • Most common if we have a normal spontaneous vaginal delivery (NSVD)
  • Mixing of their blood after birth.
  • Mother will be exposed in an Rh+ baby (D antigen). Mother will form antibodies like anti-D.
A

Fetomaternal hemorrhage

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13
Q

The main goal of the complement system is (?)

A

Lysis

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14
Q

in Rh HDN, the first baby is (?) and the second baby (?)

A

Safe, affected

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15
Q

Every time that there is an antigen and
antibody reaction, (?) happens.

A

complement

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16
Q

6 pathogenesis of Rh HDN?

A
  1. Fetomaternal incompatibility
  2. Fetomaternal hemorrhage
  3. Maternal antibodies are formed against
    paternally derived antigens
  4. During subsequent pregnancy, placental
    passage of maternal IgG antibodies
  5. Maternal antibody attached to fetal RBC
  6. Fetal RBC hemolysis
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17
Q

The entry of fetal blood into the maternal circulation before or during delivery.

A

Fetomaternal hemorrhage

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18
Q

(?) are naturally occurring and
the main antibody involved when it comes to
hemolytic disease of the newborn for the
ABO is: (?)

A

ABO Ab, Anti-AB

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19
Q

ABO HDN is when the mother is in the
blood group (?)

A

Blood group O (anti-A, anti-B, antiAB(IgG in nature)

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20
Q

ABO HDN is when the baby is?

A

Blood type (A, B, AB)

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21
Q

What is more severe HDN? Rh or ABO

A

Rh

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22
Q

Common manifestation of ABO HDN is
the?

A

Yellow discoloration of the baby.

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23
Q

The rate of RBC destruction depends on
antibody titer and specificity and on the
number of antigenic sites of the fetal
RBCs.

A

HEMOLYSIS

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24
Q
  • It happens when the hemolysis is
    continuous.
  • Destruction of fetal RBCs and the
    resulting (?) stimulate the fetal
    bone marrow to produce RBCs at an
    accelerated rate.
A

ERYTHROBLASTOSIS FETALIS, Anemia

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25
Q

Caused by decreased hepatic
production of plasma proteins.

A

HEPATOSPLENOMEGALY

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26
Q

HEPATOSPLENOMEGALY resulting in?

A

-portal hypertension, hepatocellular damage.

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27
Q

Occurs when the bone marrow fails to
produce enough RBC resulting in Erythropoiesis
will occur OUTSIDE the bone marrow.

A

HEPATOSPLENOMEGALY

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28
Q

What do you call enlargement of the Spleen and Liver?

A

HEPATOSPLENOMEGALY

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29
Q

Decreased RBC which result to enlarged frontal bone because
it produces RBC

A

Cooley’s anemia

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30
Q

Refers to the production of blood cells outside of the bone marrow? it also cause?

A

extramedullary hematopoiesis, HEPATOSPLENOMEGALY

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31
Q

Disease that is severe anemia and hypoproteinemia
lead to the development of (?)

A

HYDROP FETALIS

  • high-output cardiac failure with generalized edema,
  • effusions,
  • ascites.
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32
Q

In severe cases, hydrops fetalis can
develop by how many weeks?

A

18-20 weeks’ gestation

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33
Q

HYDROP FETALIS cause to baby?

A

Yellowish color of baby

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34
Q

Organ conjugate bilirubin?

A

Liver

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35
Q

Hemoglobin toxic waste product

A

indirect bilirubin or unconjugated bilirubin

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36
Q

When RBC destruction
occurs, hemoglobin is
released and is cleaved
into its?

A

Heme and globin portions

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37
Q

Indirect bilirubin is contained in the?

A

Heme portion

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38
Q

Indirect bilirubin needs to be (?)
or converted into (?) for it to be eliminated outside the body.

A

Conjugated, direct Bilirubin

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39
Q

Is responsible for the color of
urine and feces.

A

Conjugated bilirubin

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40
Q

Process in CB in urine?

A

Conjugated bilirubin→Urobilinogen→Urobilin (yellow color of the urine)

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41
Q

Process in CB in Feces?

A

Conjugated bilirubin→Stercobilinogen→Stercobilin (Brown color of feces)

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42
Q

Unconjugated, or indirect,
bilirubin can reach levels toxic
to the infant’s brain, what quantity?

A

(more than 18-20 mg/dL)

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43
Q

is bilirubin-induced neurological damage, which is most commonly seen in infants.

A

KERNICTERUS

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44
Q

WHAT ARE THE FACTORS AFFECTING SEVERITY OF HDFN?

A
  1. ANTIGENIC EXPOSURE
  2. HOST FACTORS
  3. IMMUNOGLOBULIN CLASS
  4. ANTIBODY SPECIFICITY
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45
Q

It can cause trauma to mix the
blood of the baby and mother

A

Diagnostic procedures

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45
Q

Transplacental hemorrhage of fetal
RBCS, how many percent?

A

7%

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46
Q

Increased risk of fetomaternal hemorrhage

A

Amniocentesis, chorionic villus
sampling, trauma to the abdomen

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47
Q

Ability of individuals to produce
antibodies in response to antigenic
exposure varies, depending on complex
genetic factors.

A

HOST FACTORS

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48
Q

Active transport of IgG, begins in the (?)
and continues (?)

A

second trimester,continues until birth.

49
Q

More efficient in RBC hemolysis than IgG2 and IgG4.

A

IgG1 and IgG3

49
Q

IgG molecules transported via the (?)
of the antibodies

A

FC portion

50
Q

is the most antigenic (can stimulate
anti-D)

A

D

51
Q

Most immunogenic when it comes to
HDN?

A

Rh

52
Q

Of all the non-Rh system antibodies, what is considered the most
clinically significant in its ability to cause HDFN.

A

Anti-Kell

53
Q
  • Present on immature erythroid cells in the bone marrow.
  • Severe anemia occurs not only by the destruction of circulating
    RBCs but also by precursors.
A

Kell antigens

54
Q

what are the immature forms of RBC?

A

(reticulocyte,
pronormoblasts,
polychromatophilic normoblast)

55
Q

Ab identifies in prenatal specimens as causes of HDFN that is COMMON?

A

Anti-D
Anti-D+C
Anti-D+E
Anti-C
Anti-E
Anti-c
Anti-e
Anti-kell

56
Q

Ab identifies in prenatal specimens as causes of HDFN that is RARE?

A

Anti-FY^a
Anti-s
Anti-M
Anti-N
Anti-S
Anti-jk^a

57
Q

Ab identifies in prenatal specimens as causes of HDFN that is NEVER because thay are IgM in nature?

A

Anti-Le^a
Anti-Le^b
Anti-I
Anti-IH
Anti-P1

58
Q

Anti-duffy a

A

Anti-Fya

59
Q

also known as kid blood group
system

A

Anti-JKa

60
Q
  • ABO and Rh typing
  • Antibody screen and specificity
A

SEROLOGIC TESTING

61
Q

What are the 3 clinical testing?

A

AMNIOCYTE TESTING
ANTIBODY TITERS
AMNIOCENTESIS AND CORDOCENTESIS

62
Q
  • Identify presence of genes coding for
    the antigens which may cause
    HDN
  • Rh D, Rh CE, RHAG may be the
    possible causes of HDN
A

AMNIOCYTE TESTING

63
Q

AMNIOCYTE TESTING is If the mother is (how many weeks of AOG?)

A

10-12 weeks (age of gestation)

64
Q

It is 18-20 weeks AOG: assess fetal
status

A

AMNIOCENTESIS AND CORDOCENTESIS

64
Q
  • Gauge severity of HDFN
  • More increase the antibody
    titer, the more pronounce the
    hemolytic disease of the
    newborn
A

ANTIBODY TITERS

65
Q

It is a procedure in which the
amniotic fluid is removed from the uterus
for testing or treatment

A

Amniocentesis

66
Q

Fluid that surrounds and
protects the baby from pregnancy. So this
fluid will contain fetal cells and various
proteins so we can test the amniotic fluid

A

Amniotic fluid

67
Q

(percutaneous umbilical
blood sampling) a diagnostic prenatal
test, an ultrasound transducer is used to
show the position of the fetus and
umbilical cord, after that a fetal blood
sample is withdrawn at the umbilical cord
for testing.

A

Cordocentesis

68
Q

Transfusion of the mother to baby inside
the womb

A

INTRAUTERINE TRANSFUSION

69
Q

INTRAUTERINE TRANSFUSION indications

A
  • MCA-PSV (Middle cerebral arterial peak systolic velocity)
  • Fetal hydrops
    Amniotic fluid at 450 nmresults are high
  • Cordocentesis blood sample
    has hemoglobin level less than
    10 g/dL (means possible that
    the baby has HDFN
70
Q
  • Important in assessing
    fetal cardiovascular
    distress and fetal
    anemia or fetal
    hypoxia.
  • Indicates anemia
A

MCA-PSV (Middle cerebral
arterial peak systolic velocity)

71
Q

noted on ultrasound examination

A

Fetal hydrops

72
Q

If the absorbance is in
Zone I, this indicates
that there is a (?)

A

mild or low fetal disease.

73
Q

But if it is in Zone II & III indicates?

A

moderate disease, severe disease

74
Q
  • Access fetal umbilical
    vein
  • Inject donor RBC’s
    directly into the vein.
A

Cordocentesis

75
Q

GOAL of Cordocentesis: Maintain the
fetal hemoglobin above (?)

A

10 g/dL

76
Q

Cordocentesis Repeated every (?) until delivery

A

2-4 weeks

77
Q

Interrupt transport of maternal antibody
to the fetus.

A

EARLY DELIVERY

78
Q

is common especially in babies
delivered through normal
spontaneous vaginal delivery
(SVD).

A

Fetomaternal hemorrhage

79
Q

Deliver the baby through
cesarean section.

A

EARLY DELIVERY

80
Q

increase in
the bilirubin levels in the blood.

A

Hyperbilirubinemia

80
Q

Ultraviolet light exposure to treat
hyperbilirubinemia

A

PHOTOTHERAPY

81
Q

This wavelength is used to
change the unconjugated
bilirubin into isomers which are
less lipophilic and less toxic to
the brain.

A

460-490 nm

82
Q

what are the SEROLOGIC TESTING: Newborn Infant

A

a. ABO grouping
b. Rh typing
c. Direct antiglobulin test
d. Indirect Antiglobulin Test
e. Elution

83
Q

Forward typing only!

A

ABO grouping

84
Q

Infant’s RBCs can be heavily antibody
bound with maternal anti-D. Causing a false-negative Rh type also
known as?

A

blocked Rh.

85
Q

Rh typing reagent?

A

SALINE anti-D

86
Q

What you will do in blocked Rh?

A

elution

87
Q

For testing of in vivo sensitization of
RBCs, inside the body there is an
antigen-antibody binding. Antibody is
attached in the RBCs.

(+) test indicates that antibodies are
coating the fetal red cells.

A

Direct antiglobulin test

88
Q

Most important serologic test for the
diagnosis of HDFN.

A

Direct antiglobulin test

89
Q

For WEAK D
- Test for in vitro sensitization
o We will make antigen-antibody
production

A

Indirect Antiglobulin Test

90
Q

He- lpful when cause of HDFN is in
question.

o RBCs and antibody will be
separated to test the red cells if
it is Rh- or Rh+.

o Because the maternal
antibodies masked the fetal red
cells, we cannot check if the
baby is Rh- or Rh+.

A

Elution

91
Q

NEWBORN TRANSFUSION 2 types?

A

a. Aliquot transfusion
b. Exchange transfusion

92
Q

NEWBORN TRANSFUSION that correct anemia

A

Aliquot transfusion

93
Q

Aliquot means small amounts only, at
least ?

A

10-20 ml of blood

94
Q
  • Remove high levels of unconjugated
    bilirubin and thus prevent kernicterus.
  • removal of circulating maternal antibody
  • removal of sensitized red cells
  • replacement of incompatible red cells
  • suppression of erythropoiesis
A

Exchange transfusion

95
Q

Requirements for Newborn Transfusion?

A
  • Group O red cells
  • CMV negative
  • Rh (-)
  • Gamma irradiated
  • Fresh
  • Hematocrit level >70%
96
Q

prevent by irradiation or
washing

A

CMV negative

97
Q

it also prevents
graft vs host disease (tendency of the
grafted blood to attack the host tissue)

A

Gamma irradiated

98
Q

Fresh blood means less that?

A

less 7 days old

99
Q

Used to prevent immunization to D
antigen by the use of high-titered RhIG

A

RhIG (Rh immune globulin)

100
Q

Before delivery- risk of sensitization is
(?) in susceptible women

A

1.5 to 1.9%

101
Q

greatest risk of immunization in RhIG

A

Delivery

102
Q

When the RhIG is given

A
  • Before delivery (antenatal)
  • During delivery
103
Q

It will prevent sensitization by binding
and inactivating the fetal Rh antigens
before the mother’s immune system can
respond by producing her own Rh
antibodies.

A

RhIG (Rh immune globulin)

104
Q

THE FOLLOWING WOMEN ARE NOT CANDIDATES
FOR RhIG:

A
  1. D NEGATIVE WOMEN WHO HAVE D NEGATIVE
    BABIES.
  2. D POSITIVE WOMEN.
  3. D NEGATIVE WOMEN KNOWN TO BE
    IMMUNIZED TO D.
105
Q

RhIG must be given to D negative women under
the following circumstances in which the baby’s
D is unknown

A
  • After amniocentesis
    After miscarriage
    After abortion
    After ectopic pregnancy
    Vaginal bleeding at any time during
    pregnancy.
    Cordocentesis
    Chorionic villus sampling
106
Q

INDICATIONS of RhIG

A
  1. POSTPARTUM
  2. ANTENATAL
107
Q

IN POSTPARTUM, Rh (-) unsensitized mothers should
receive RhIG soon after delivery of an Rh
(+) infant within

A

72 hours after delivery.

108
Q

In ANTENATAL, RhIG is given early during the?

A

3rd trimester or at 28 weeks.

109
Q

In UK, 1 vial contains

A

100 ug (post partum
prophylaxis)

110
Q

In US, 1 vial contains (?) of anti-D
sufficient to protect against (?) of
packed red blood cells or (?) of
whole blood.

A

300 ug, 15mL, 30 mL

111
Q

In UK, Microdose is 1 vial contains?

A

50ug

112
Q

Given for women who had
undergone abortion,
amniocentesis, ectopic rupture
at 12 weeks of gestation.

A

1 vial contains 100 ug

113
Q

The total fetal blood volume is
estimated to be less than (?) at (?) weeks

A

less than 5mL at 12 week

114
Q
  • Quantify fetomaternal hemorrhage.
  • Maternal blood smear is treated with
    acid or alkali then stained with a
    counterstain.
A

KLEIHAUER-BETKE TEST

115
Q

Maternal cells

A

ghosts

116
Q

Fetal cells

A

pink

117
Q

(resistant to acid)

A

Fetal cells

118
Q

not resistant to acid or an alkali

A

Maternal blood

BB Lec (4 decks)

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