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Immunohematology - 4444 > Hemolytic disease of the fetus and newborn > Flashcards

Hemolytic disease of the fetus and newborn Flashcards

1
Q

HDFN is also known as

A

Erythroblastosis fetalis

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2
Q

HDFN

A

Fetal or newborn red blood cells (RBCs) are
destroyed by maternal immunoglobulin G (IgG)

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3
Q

Hemolytic disease ofthe fetus and newborn

Maternal antibodies

A

– Cross the placenta
– Sensitize fetal RBCs
– Shorten RBC survival

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4
Q

The genetic reason for hemolytic disease of the fetal newborn

A

Rh negative woman and Rh positive man conceive a child

and then effects 2nd pregnancy

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5
Q

HDFN may occur when fetal cellls escape into

A

the maternal circulation as a result of a
fetomaternal hemorrhage

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6
Q

etiology of fetal RBC antigens

A

that
the mother does not have
stimulate the mother to
produce antibodies

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7
Q

Etiology

Antibodies bind

A

Antibodies bind to fetal
antigens and cause RBC
destruction in the fetal
liver and spleen

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8
Q

Etiology

Before birth

Indirect bilirubin is conjugated by

A

Indirect bilirubin is
conjugated by the
maternal liver

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9
Q

Etiology

Before birth

As RBC destruction continues

A

fetal
erythropoiesis increases

  • Erythroblasts are released
    (erythroblastosis fetalis)
  • Edema occurs in the
    peritoneal and pleural
    cavities (hydrops fetalis)
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10
Q

Etiology

what may result

A

Cardiac failure may result

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11
Q

After birth

Newborn cannot _______

Unconjugated bilirubin binds to albumin and then to ____________

Permanent brain damage ( __________) may result if ___________ binds to tissues of the central nervous system

A

AFTER BIRTH
* Newborn cannot
conjugate bilirubin
* Unconjugated bilirubin
binds to albumin and
then to tissues (jaundice)
* Permanent brain damage
(kernicterus) may result if
bilirubin binds to tissues
of the central nervous
system

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12
Q

Overview of HDFN

what is the RBC antibody type
Fetus must possess an __________ that the mother lacks
___________ is inherited from the father

A

IgG

  • RBC antibody must be IgG
  • Only IgG crosses the placenta
  • Fetus must possess an antigen
    that the mother lacks
  • The gene is inherited from the father
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13
Q

HDFN

Antigen must be

A

Well developed at birth

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14
Q

Types of HDFN

A

Rh (D antigen)
ABO
Other antibodies

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15
Q

Rh HDFN

is the most

A

Severe

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16
Q

Rh HDFN

when are women sensitized

A

D-negative women are sensitized during
the first pregnancy with a D-positive baby

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17
Q

Rh HDFN

Subsequent __________ are affected

A

Pregnancies

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18
Q

Rh HDFN

what is positive

A

DAT

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19
Q

Rh HDFN

symptoms that may occur

A

Jaundice and or anemia may occur

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20
Q

Rh HDFN

Rh immune globulin

A

Is given to prevent Rh HDFN

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21
Q

ABO HDFN

Most common type of

A

HDFN

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22
Q

ABO HDFN

mother has group _____

_______ may be effected

Mothers IgG ________ attaches to babys red cell antigens

A
  • Mother has group O blood; baby has group A or B
    blood
  • First pregnancy may be affected
  • Mother’s IgG anti-A,B attaches to baby’s red cell
    antigens
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23
Q

ABO HDFN

Production of mild symptoms is possible due to

A
  • A or B substances in tissue that may neutralize
    antibodies
  • Fetal/infant RBCs may be poorly developed
  • Fetal/infant RBC sites may be reduced
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24
Q

ABO HDFN

__________ may occur

A

Jaundice

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25
Phototherapy can be used to treat
Jaundice
26
Other types of HDFN
-Any IgG can cause HDFN -Anti-c and anti-K antibodies are common causes -Other Kell antibodies and antibodies to Kidd, Duffy, S, and -U antigens are less common -Agglutination with paternal cells and maternal serum is a clue to a low-frequency antigen
27
ANY _______ can cause HDFN
IgG
28
__________ and _________ antibodies are common causes
Anti-c and anti-K
29
what are less common causes of HDFN
Kell, Kidd, Duffy, S, and U
30
what is a clue to a low frequency antigen
Agglutination with paternal cells and. maternal serum
31
Prenatal testing serves two purposes
– Identifies D-negative women who are candidates for RhIG – Identifies women with antibodies capable of causing HDFN
32
Antibody titration helps determine
helps determine whether certain procedures should be performed
33
Antibody titration Baseline titer is determined in the first _________ and repeated at ___________
Baseline titer is determined in the first trimester and repeated at 4- to 6-week intervals (sample is frozen for future testing)
34
Antibody titration A titer that rises by
2 dilutions (compared to baseline) is significant
35
A titer of ___ or ____ s usually critical for anti-D and other Rh antibodies
16-32 is usually critical for anti-D and other Rh antibodies
36
The highest concentration of dilution compared with these two numbers 1:2 or 1:128
1:128
37
Ultrasound Color doppler ultrasonography can detect
Fetal anemia
38
Ultrasound Color Doppler ultrasonography can detect fetal anemia leads to
Increased cardiac output and low blood viscosity
39
Ultrasound Severity of anemia is determined by evaluating the peak ___________
systolic velocity in the middle cerebral artery
40
Amniocentesis is scanned by
spectrophotometrically for 350 to 700 nm
41
Amniocentesis A change in optical density above
baseline (450 nm) is a measure of bilirubin
42
Aminocentesis The OD is plotted on a
Liley graph (using gestational age) – Upper zone (zone 3): severe HDFN – Middle zone (zone 2): moderate disease – Lower zone (zone 1): mild disease
43
Aminocentesis Three alternatives exist based on results
– Pregnancy continues to term – Intrauterine transfusion is performed – Early labor is induced * Fetal lung maturity must be determined (lecithin-sphingomyelin [L:S] ratio should be greater than 2:1)
44
Cordocentesis Fetal blood sample is taken for
* Hemoglobin and hematocrit testing * Bilirubin testing * RBC genotyping
45
Cordocentesis _________ is low
1% to 2%
46
Cordocentesis Cordocentesis can be used for
intravascular transfusions in cases of severe HDFN
47
Fetal genotyping
* Fetal DNA can be typed using maternal plasma during the second trimester * Predicting the fetal genotype could avoid amniocentesis or cordocentesis if the fetus lacks the antigen
48
Postpartum testing D testing
– All infants born to D-negative mothers are tested, including for weak D antigen
49
Postpartum testing False negative results Preform what
* D-antigen sites are blocked by antibody (blocking phenomenon) * Perform elution (will demonstrate anti-D antibody)
50
False positive results
* Weak D test is performed on RBCs coated with antibodies * Rh control will be positive at antihuman globulin (AHG) phase
51
Cord blood or neonate testing ABO testing
* Only the forward grouping is performed * ABO antibodies are not yet produced * Cord blood is washed to remove Wharton’s jelly
52
DAT
* Elution may be necessary if the test is positive and if the mother’s antibody has not been identified or the maternal serum sample is unavailable * If the eluate is negative, an antibody to low-frequency antigen is suspected * If the eluate is positive with A or B cells and negative with screening cells, ABO HDFN is indicated
53
Prevention RhIG prevents
alloimmunization in D-negative mothers
54
RhIG only prevents
formation of anti-D antibody
55
Antepartum administration Intitial dose (300ug) is given at
28 weeks’ gestation
56
Postpartum administration
* Nonimmunized women receive one full dose of RhIG within 72 hours of delivery * More than one dose may be necessary if the mother has fetomaternal hemorrhage of more than 30 mL
57
Rosette Test
58
59
Screening for fetomaternal hemorrhage RhIG candidates are screened for
Fetomaternal hemorrhage
60
Screening for Fetomaternal Hemorrhage Most common screening method is the rosette test
* Uses postpartum maternal specimen * Maternal RBCs are incubated with anti-D antibody * D-positive indicator cells are added * Rosettes are observed under the microscope * Less than 1 rosette per 3 low-power fields: one dose of RhIG * More than 1 rosette per 3 low-power fields: bleed must be quantitated
61
Quantifying Fetomaternal Hemorrhage To calculate the additional doses of RhIG, what is used
flow cytometry or the Kleihauer-Betke test is performed
62
Quantifying Fetomaternal Hemorrhage Kleihauer-Betke test is based on the following facts
– Fetal hemoglobin is resistant to acid (retains dye) – Adult hemoglobin is not resistant to acid (ghost-like)
63
Kleihauer-Betke Acid Elution Hemoglobin ____ is resistant to acid elution Expose thin smear of blood to acid buffer,
F Expose thin smear of blood to acid buffer adult hemoglobin eluted out.
64
Kleihauer-Betke Acid Elution
- Smears are stained with hematoxylin and erythrosin B. * Adult rbcs appear as ghost cells, stroma only, while fetal cells appear bright pink and refractile. * Count number of fetal cells in 2000 adult cells. * Precision of test poor even in experienced hands. *  Flow Cytometry!
65
RhIG dosing calculation
66
Treatment Intrauterine transfusions ABO/Rh and DAT results should be interpreted with
caution in newborns who have had intrauterine transfusions
67
Treatment Intrauterine transfusions _________ may phenotype as group O, D negative blood because group O, D-negative unit is given
Cord blood
68
Intrauterine Transfusions DAT may be
Falsely negative or weakly positive
69
Intrauterine Transfusion Corrects
anemia and prevents heart failure
70
Intrauterine transfusion Blood for intrauterine transfusion Lacks what RBCs collected within
Group O Rh neg RBCs Lack antigens which antibo- dy(ies) are directed within 7 days
71
Blood for intrauterine transfusions __________ to prevent graft- versus host disease
Irradiated
72
blood to Intrauterine transfusions Negative for
Cytomegalo- virus and/or leukocyte reduced
73
Blood for intrauterine transfusion Negative for Hgb ____
Negative for Hgb S
74
Exchange transfusion Replacement of
1-2 whole blood volume
75
Exchange transfusion Corrects anemia without expanding the _________ Removes newborns RBC and replaces with _________ Reduces what
* Corrects anemia without expanding the blood volume * Removes newborn’s RBCs and replaces them with antigen-negative cells * Reduces bilirubin (prevents kernicterus) * Reduces maternal antibody
76
Exchange Transfusion _________ is determined in a infant
ABO and D
77
Exchange Transfusion Maternal or Infant serum or plasma is.used for Antigen negative units are given if what is determined in the infant
* ABO and D typing is determined in the infant * Maternal or infant serum or plasma is used for antibody screening * Antigen-negative units are given if antibody is present
78
Exchange Transfusion Procedure
* Cannulate umbilical vein. * “Pull” baby blood. * Wait * “Push” donor blood. * Wait * Repeat
79
Phototherapy Initial treatment for
hyperbilirubinemia
80
Phototherapy Mild cases of
HDFN, such as ABO HDFN
81
Phototherapy Uses fluorescent
blue light (420 to 475 nm)
82
Phototherapy light converts bilirubin to
Light converts bilirubin to isomers that are excreted in the bile
83
Phototherapy If patient is unresponsive
exchange transfusion may be necessary
84

Immunohematology - 4444 (17 decks)

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