Hemolytic Disease of Fetus and Newborn Flashcards
Destruction of red blood cells of the fetus and neonate by antibodies
produced by the mother
HEMOLYTIC DISEASE OF FETUS AND NEWBORN
(HDFN)
The only natural occurring antibodies will be under the?
ABO Blood group system
Rh HDFN only happens during first or second pregnancy?
Second
HDFN is also known as?
Erythroblastosis fetalis
Causes of HDFN which will only be formed if we
have been exposed to D antigen?
Rh BGS – anti-D
Mainly Rh antibodies are (?) what kind of Ab
IgG in nature
what kin of immunoglobulin able to cross the placenta?
IgG
Causes of HDFN which has naturally occurring antibodies so it doesn’t need pre-exposure or sensitization
ABO BGS – anti-A, anti-B
BO BGS HDFN happens in first or second?
First pregnancy
What ABO Ab is IgG in nature and can cross placenta?
Anti-AB
What is rare BGS cause HDFN?
– Duffy BGS, MNS BGS
Example: Rh+ (baby) and Rh- (mother)
Fetomaternal incompatibility
- 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.
Fetomaternal hemorrhage
The main goal of the complement system is (?)
Lysis
in Rh HDN, the first baby is (?) and the second baby (?)
Safe, affected
Every time that there is an antigen and
antibody reaction, (?) happens.
complement
6 pathogenesis of Rh HDN?
- Fetomaternal incompatibility
- Fetomaternal hemorrhage
- Maternal antibodies are formed against
paternally derived antigens - During subsequent pregnancy, placental
passage of maternal IgG antibodies - Maternal antibody attached to fetal RBC
- Fetal RBC hemolysis
The entry of fetal blood into the maternal circulation before or during delivery.
Fetomaternal hemorrhage
(?) are naturally occurring and
the main antibody involved when it comes to
hemolytic disease of the newborn for the
ABO is: (?)
ABO Ab, Anti-AB
ABO HDN is when the mother is in the
blood group (?)
Blood group O (anti-A, anti-B, antiAB(IgG in nature)
ABO HDN is when the baby is?
Blood type (A, B, AB)
What is more severe HDN? Rh or ABO
Rh
Common manifestation of ABO HDN is
the?
Yellow discoloration of the baby.
The rate of RBC destruction depends on
antibody titer and specificity and on the
number of antigenic sites of the fetal
RBCs.
HEMOLYSIS
- 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.
ERYTHROBLASTOSIS FETALIS, Anemia
Caused by decreased hepatic
production of plasma proteins.
HEPATOSPLENOMEGALY
HEPATOSPLENOMEGALY resulting in?
-portal hypertension, hepatocellular damage.
Occurs when the bone marrow fails to
produce enough RBC resulting in Erythropoiesis
will occur OUTSIDE the bone marrow.
HEPATOSPLENOMEGALY
What do you call enlargement of the Spleen and Liver?
HEPATOSPLENOMEGALY
Decreased RBC which result to enlarged frontal bone because
it produces RBC
Cooley’s anemia
Refers to the production of blood cells outside of the bone marrow? it also cause?
extramedullary hematopoiesis, HEPATOSPLENOMEGALY
Disease that is severe anemia and hypoproteinemia
lead to the development of (?)
HYDROP FETALIS
- high-output cardiac failure with generalized edema,
- effusions,
- ascites.
In severe cases, hydrops fetalis can
develop by how many weeks?
18-20 weeks’ gestation
HYDROP FETALIS cause to baby?
Yellowish color of baby
Organ conjugate bilirubin?
Liver
Hemoglobin toxic waste product
indirect bilirubin or unconjugated bilirubin
When RBC destruction
occurs, hemoglobin is
released and is cleaved
into its?
Heme and globin portions
Indirect bilirubin is contained in the?
Heme portion
Indirect bilirubin needs to be (?)
or converted into (?) for it to be eliminated outside the body.
Conjugated, direct Bilirubin
Is responsible for the color of
urine and feces.
Conjugated bilirubin
Process in CB in urine?
Conjugated bilirubin→Urobilinogen→Urobilin (yellow color of the urine)
Process in CB in Feces?
Conjugated bilirubin→Stercobilinogen→Stercobilin (Brown color of feces)
Unconjugated, or indirect,
bilirubin can reach levels toxic
to the infant’s brain, what quantity?
(more than 18-20 mg/dL)
is bilirubin-induced neurological damage, which is most commonly seen in infants.
KERNICTERUS
WHAT ARE THE FACTORS AFFECTING SEVERITY OF HDFN?
- ANTIGENIC EXPOSURE
- HOST FACTORS
- IMMUNOGLOBULIN CLASS
- ANTIBODY SPECIFICITY
It can cause trauma to mix the
blood of the baby and mother
Diagnostic procedures
Transplacental hemorrhage of fetal
RBCS, how many percent?
7%
Increased risk of fetomaternal hemorrhage
Amniocentesis, chorionic villus
sampling, trauma to the abdomen
Ability of individuals to produce
antibodies in response to antigenic
exposure varies, depending on complex
genetic factors.
HOST FACTORS
Active transport of IgG, begins in the (?)
and continues (?)
second trimester,continues until birth.
More efficient in RBC hemolysis than IgG2 and IgG4.
IgG1 and IgG3
IgG molecules transported via the (?)
of the antibodies
FC portion
is the most antigenic (can stimulate
anti-D)
D
Most immunogenic when it comes to
HDN?
Rh
Of all the non-Rh system antibodies, what is considered the most
clinically significant in its ability to cause HDFN.
Anti-Kell
- Present on immature erythroid cells in the bone marrow.
- Severe anemia occurs not only by the destruction of circulating
RBCs but also by precursors.
Kell antigens
what are the immature forms of RBC?
(reticulocyte,
pronormoblasts,
polychromatophilic normoblast)
Ab identifies in prenatal specimens as causes of HDFN that is COMMON?
Anti-D
Anti-D+C
Anti-D+E
Anti-C
Anti-E
Anti-c
Anti-e
Anti-kell
Ab identifies in prenatal specimens as causes of HDFN that is RARE?
Anti-FY^a
Anti-s
Anti-M
Anti-N
Anti-S
Anti-jk^a
Ab identifies in prenatal specimens as causes of HDFN that is NEVER because thay are IgM in nature?
Anti-Le^a
Anti-Le^b
Anti-I
Anti-IH
Anti-P1
Anti-duffy a
Anti-Fya
also known as kid blood group
system
Anti-JKa
- ABO and Rh typing
- Antibody screen and specificity
SEROLOGIC TESTING
What are the 3 clinical testing?
AMNIOCYTE TESTING
ANTIBODY TITERS
AMNIOCENTESIS AND CORDOCENTESIS
- Identify presence of genes coding for
the antigens which may cause
HDN - Rh D, Rh CE, RHAG may be the
possible causes of HDN
AMNIOCYTE TESTING
AMNIOCYTE TESTING is If the mother is (how many weeks of AOG?)
10-12 weeks (age of gestation)
It is 18-20 weeks AOG: assess fetal
status
AMNIOCENTESIS AND CORDOCENTESIS
- Gauge severity of HDFN
- More increase the antibody
titer, the more pronounce the
hemolytic disease of the
newborn
ANTIBODY TITERS
It is a procedure in which the
amniotic fluid is removed from the uterus
for testing or treatment
Amniocentesis
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
Amniotic fluid
(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.
Cordocentesis
Transfusion of the mother to baby inside
the womb
INTRAUTERINE TRANSFUSION
INTRAUTERINE TRANSFUSION indications
- 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
- Important in assessing
fetal cardiovascular
distress and fetal
anemia or fetal
hypoxia. - Indicates anemia
MCA-PSV (Middle cerebral
arterial peak systolic velocity)
noted on ultrasound examination
Fetal hydrops
If the absorbance is in
Zone I, this indicates
that there is a (?)
mild or low fetal disease.
But if it is in Zone II & III indicates?
moderate disease, severe disease
- Access fetal umbilical
vein - Inject donor RBC’s
directly into the vein.
Cordocentesis
GOAL of Cordocentesis: Maintain the
fetal hemoglobin above (?)
10 g/dL
Cordocentesis Repeated every (?) until delivery
2-4 weeks
Interrupt transport of maternal antibody
to the fetus.
EARLY DELIVERY
is common especially in babies
delivered through normal
spontaneous vaginal delivery
(SVD).
Fetomaternal hemorrhage
Deliver the baby through
cesarean section.
EARLY DELIVERY
increase in
the bilirubin levels in the blood.
Hyperbilirubinemia
Ultraviolet light exposure to treat
hyperbilirubinemia
PHOTOTHERAPY
This wavelength is used to
change the unconjugated
bilirubin into isomers which are
less lipophilic and less toxic to
the brain.
460-490 nm
what are the SEROLOGIC TESTING: Newborn Infant
a. ABO grouping
b. Rh typing
c. Direct antiglobulin test
d. Indirect Antiglobulin Test
e. Elution
Forward typing only!
ABO grouping
Infant’s RBCs can be heavily antibody
bound with maternal anti-D. Causing a false-negative Rh type also
known as?
blocked Rh.
Rh typing reagent?
SALINE anti-D
What you will do in blocked Rh?
elution
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.
Direct antiglobulin test
Most important serologic test for the
diagnosis of HDFN.
Direct antiglobulin test
For WEAK D
- Test for in vitro sensitization
o We will make antigen-antibody
production
Indirect Antiglobulin Test
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+.
Elution
NEWBORN TRANSFUSION 2 types?
a. Aliquot transfusion
b. Exchange transfusion
NEWBORN TRANSFUSION that correct anemia
Aliquot transfusion
Aliquot means small amounts only, at
least ?
10-20 ml of blood
- 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
Exchange transfusion
Requirements for Newborn Transfusion?
- Group O red cells
- CMV negative
- Rh (-)
- Gamma irradiated
- Fresh
- Hematocrit level >70%
prevent by irradiation or
washing
CMV negative
it also prevents
graft vs host disease (tendency of the
grafted blood to attack the host tissue)
Gamma irradiated
Fresh blood means less that?
less 7 days old
Used to prevent immunization to D
antigen by the use of high-titered RhIG
RhIG (Rh immune globulin)
Before delivery- risk of sensitization is
(?) in susceptible women
1.5 to 1.9%
greatest risk of immunization in RhIG
Delivery
When the RhIG is given
- Before delivery (antenatal)
- During delivery
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.
RhIG (Rh immune globulin)
THE FOLLOWING WOMEN ARE NOT CANDIDATES
FOR RhIG:
- D NEGATIVE WOMEN WHO HAVE D NEGATIVE
BABIES. - D POSITIVE WOMEN.
- D NEGATIVE WOMEN KNOWN TO BE
IMMUNIZED TO D.
RhIG must be given to D negative women under
the following circumstances in which the baby’s
D is unknown
- After amniocentesis
After miscarriage
After abortion
After ectopic pregnancy
Vaginal bleeding at any time during
pregnancy.
Cordocentesis
Chorionic villus sampling
INDICATIONS of RhIG
- POSTPARTUM
- ANTENATAL
IN POSTPARTUM, Rh (-) unsensitized mothers should
receive RhIG soon after delivery of an Rh
(+) infant within
72 hours after delivery.
In ANTENATAL, RhIG is given early during the?
3rd trimester or at 28 weeks.
In UK, 1 vial contains
100 ug (post partum
prophylaxis)
In US, 1 vial contains (?) of anti-D
sufficient to protect against (?) of
packed red blood cells or (?) of
whole blood.
300 ug, 15mL, 30 mL
In UK, Microdose is 1 vial contains?
50ug
Given for women who had
undergone abortion,
amniocentesis, ectopic rupture
at 12 weeks of gestation.
1 vial contains 100 ug
The total fetal blood volume is
estimated to be less than (?) at (?) weeks
less than 5mL at 12 week
- Quantify fetomaternal hemorrhage.
- Maternal blood smear is treated with
acid or alkali then stained with a
counterstain.
KLEIHAUER-BETKE TEST
Maternal cells
ghosts
Fetal cells
pink
(resistant to acid)
Fetal cells
not resistant to acid or an alkali
Maternal blood
