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Blood Bank - JD > Hemolytic Disease of the Fetus and Newborn > Flashcards

Hemolytic Disease of the Fetus and Newborn Flashcards

1
Q

Prenatal testing includes:

A

pregnancy and transfusion history, ABO/Rh (with weak D) type, and antibody screen

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2
Q

Prenatal monitoring is done if the mother has what test results?

A

a positive antibody screen and the antibodies are clinically significant

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3
Q

How is prenatal monitoring done?

A

monitoring antibody titers and fetal distress

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4
Q

What test is performed to detect fetal cells in the mother?

A

Kleihauer-Betke Acid Elution

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5
Q

At what pH is the acid buffer in the Kleihauer-Betke test?

A

3.3

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6
Q

Which cells are not soluble in the acid buffer used for the Kleihauer-Betke test?

A

fetal cells

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7
Q

The selection of blood for an fetus/newborn exchange transfusion must include which 4 requirements?

A

Irradiated, CMV negative, No more than 5-7 days old, negative for Hgb S

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8
Q

What blood type is most commonly used in exchange transfusions?

A

Type O

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9
Q

If the mother and infant are both type O, what type can the donor be?

A

Type O

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10
Q

If the Mother is type A or B and the infant is Type O, what Type must the donor be?

A

Type O

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11
Q

For exchange transfusions, the donor blood must be compatible with who?

A

both the mother and the fetus/infant

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12
Q

If the mother is Type O and the Infant is Type A, what type must the donor be?

A

O

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13
Q

If the Mother is type B and the infant is Type A, what type must the donor be?

A

Type O

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14
Q

If the Mother is type A and the infant is type A, what type must the donor be?

A

A or O

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15
Q

If the mother is Type AB and the infant is Type A what type must the donor blood be?

A

A or O

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16
Q

If the mother is type O and the infant is type B, the donor blood needs to be Type…

A

O

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17
Q

If the mother is type A and the infant is type B, the donor unit needs to be type…

A

O

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18
Q

If the mother is Type B or AB and the infant is type B, what type must the donor blood be?

A

B or O

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19
Q

If the mother is type A and the infant is type AB, what type must the donor blood be?

A

Type A or O

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20
Q

If the mother is type B and the infant is type AB, what type must the donor blood be?

A

B or O

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21
Q

If the mother is type AB and the infant type is AB, what type of blood can be donated?

A

AB, A, B, or O

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22
Q

What is Hemolytic Disease of the Fetus and Newborn?

A

The destruction of fetus/newborn RBCs from maternal antibodies crossing the placenta

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23
Q

What are two other names for HDFN?

A

Erythroblastosis fetalis OR Hydrops fetalis

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24
Q

Other than anti-D, what are the other 5 most common and significant antibodies that can cause HDFN?

A

anti-K, -E, -c, -C, and -Fy(a)

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25
Q

Why is ABO HDFN considered “protective” against other forms of HDFN?

A

The RBCs are being destroyed by ABO antibodies before the mom can be sensitized to the other antigens of the fetal cells.

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26
Q

What is RhIg?

A

a form of passive anti-D that binds and destroys fetal RBCs circulating in the mom before the mom can be sensitized and form her own anti-D

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27
Q

What would cause a positive DAT on a cordocentesis sample and why is that the only answer?

A

Maternal antibodies cause the positive DAT because fetus and neonates don’t have formed antibodies to cause the DAT to be positive.

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28
Q

If a DAT is positive, what procedure is done next?

A

elution

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29
Q

Fetal DNA testing can be done as early as how many weeks gestation?

A

10 to 12 weeks

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30
Q

The relative concentration of all antibodies capable of crossing the placenta and causing HDFN is determined by…

A

antibody titration

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31
Q

Antibody titration method must include which testing phase and reagent?

A

indirect antiglobulin phase with monospecific anti-IgG

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32
Q

TRUE or FALSE: Enhancement media can be used when tittering antibodies.

33
Q

TRUE OR FALSE: The same genotype of cells should be used for ALL titers.

34
Q

TRUE OR FALSE: Once the first titer is completed, the sample can be discarded.

A

FALSE. When a subsequent titer is performed, the previous sample must be run as well to monitor the titer.

35
Q

Antibody titer results are recorded as which 2 possible ways?

A

reciprocal of the titration endpoint OR as a titer score

36
Q

TRUE OR FALSE: The titration must be performed exactly the same way each time the patient’s serum is tested.

37
Q

At what value is a titer considered critical?

38
Q

A titer reproducibly and repeatedly at 32 or above indicates what test to be done?

A

Color Doppler Middle Cerebral Artery Peak Systolic Velocity studies after 16 weeks gestation.

39
Q

What does the Color Doppler MCA-PSV test for and determine?

A

Tests for Hgb to determine the presence of fetal anemia

40
Q

TURE OR FALSE: Titer alone can predict severity

41
Q

Which antibody is well known for staying at low titers, but can cause severe HDFN?

42
Q

How does the Color Doppler MCA-PSV reliably predict fetal anemia.

A

When hemolysis occurs in the fetus, hgb decreases (and RBCs), which will increase the velocity in which the fetal blood passes through the middle cerebral artery (MCA). An increase in velocity suggests fetal anemia.

43
Q

Why is the Color Doppler MCA-PSV the best method to use when intervention is needed?

A

It is noninvasive.

44
Q

What is measured in amniotic fluid to determine fetal anemia?

45
Q

How is the concentration of bilirubin measures in amniotic fluid?

A

By the change in absorbance at 450 nm. As the change gets bigger, the worsening of the fetal hemolytic disease.

46
Q

Why must cord blood be washed very well before it can be tested?

A

Warton’s Jelly, which can cause false positives.

47
Q

What is the normal Hgb levels of an infant?

A

14-18 g/dL

48
Q

If fetus/infant Hgb levels drop below 10 g/dL, what needs to be done?

A

(intrauterine) transfusion.

49
Q

Spherocytes can be found in which type of HDFN?

50
Q

ABO HDFN or Rh (or other antibody) HDFN?

Weak positive or negative DAT?

51
Q

ABO HDFN or Rh (or other antibody) HDFN?

Increased number of spherocytes.

52
Q

ABO HDFN or Rh (or other antibody) HDFN?

Normal osmostic fragility

A

Rh (or other) HDFN

53
Q

ABO HDFN or Rh (or other antibody) HDFN?

Increased osmotic fragility

54
Q

ABO HDFN or Rh (or other antibody) HDFN?

Increased sedimentation rate

55
Q

ABO HDFN or Rh (or other antibody) HDFN?

Negative spontaneous aggregation

A

Rh (or other) HDFN

56
Q

ABO HDFN or Rh (or other antibody) HDFN?

positive spontaneous aggregation

57
Q

ABO HDFN or Rh (or other antibody) HDFN?

Jaundice within 24 hours and greatly increased bilirubin

A

Rh ( or other) HDFN

58
Q

ABO HDFN or Rh (or other antibody) HDFN?

Delayed jaundice and slightly increased bilirubin

59
Q

What is the Kleihauer-Betke calculation to determine the volume of fetomaternal hemorrhage?

A

(#fetal cells x Maternal blood volume) / # maternal cells = Volume of fetomaternal hemorrhage

60
Q

If a mother is Rh negative, when is RhIg administered in a normal pregnancy?

A

28 weeks gestation

61
Q

TRUE OR FALSE: RhIg is administered to an Rh negative mother after an abortion during the first trimester.

62
Q

TRUE OR FALSE: RhIg is not given to an Rh negative mother after an amniocentesis.

A

FALSE. RhIg is administered to an Rh negative mother after an amniocentesis at 16-18 weeks gestation AND again at 28 weeks

63
Q

If an Rh negative mother delivers an Rh positive baby, within how many hours must RhIg be administered?

A

Within 72 hours of delivery

64
Q

1 vial of RhIg is good for how many mLs of red blood cells and whole blood of fetal origin?

A

15 mL red blood cells

30 mL whole blood

65
Q

What therapy is used on an infant with hyperbilirubinemia?

A

phototherapy

66
Q

What wavelengths are used for phototherapy?

A

460-490 nm

67
Q

How does phototherapy work?

A

Breaks down the unconjugated bilirubin into isomers, which are less lipophilic and less toxic to the brain.

68
Q

How does intravenous immune globulin (IVIG) reduce fetal hemolysis?

A

The IVIG competes with maternal antibodies for the Fc receptors on the macrophages in the infant’s spleen, reducing the amount of hemolysis.

69
Q

Because exchange transfusions must lack hemolytic anti-A, anti-B, and anti-A,B, what is done to accomplish this?

A

wash the cells

70
Q

What is the main goal for performing exchange transfusions?

A

To decrease the level of bilirubin to prevent kernicterus.

71
Q

What are 4 goals (including the main goal) for exchange transfusions?

A
  1. Decrease the level of bilirubin to prevent kernicterus
  2. Remove baby’s sensitized RBCs
  3. Provide compatible RBCs with adequate oxygen-carrying capacity
  4. decrease the level of incompatible antibody in the baby.
72
Q

List 3 reasons why fresh blood is required for intrauterine exchange transfusions.

A
  1. maximize RBC viability to decrease pigment and potassium ion from nonviable cells
  2. Maximize 2,3-DPG levels for optimum oxygen-carrying capacity of Hgb
  3. Minimize potassium ion levels in plasma to avoid cardiac irregularities
73
Q

What are the advantages to using irradiated blood for a transfusion? Disadvantages?

A

Advantage: little to no risk of graft-vs-host disease and can be used on different components
Disadvantage: requires time to prepare and is expensive

74
Q

Which blood components have the advantage of containing all coagulation factors, including platelets?

A

FFP and Platelet-Rich plasma

75
Q

Which blood component has the adnavtage of improved oxygen-carrying capacity?

A

deglycerolized RBCs

76
Q

Which blood component is readily available?

A

packed RBCs

77
Q

Which blood component has the disadvantage of containing hemolytic and metabolic byproducts?

A

packed RBCs

78
Q

Which blood component has no plasma, therefore, no hemolytic or metabolic byproducts?

A

washed packed RBCs

79
Q

RhIg is used to protect…

A

subsequent fetuses that the mother may carry in the future.

Blood Bank - JD (16 decks)

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