MLT BB HDFN, RhIg, Antiglobulin

Question 1

What is HDFN

Answer 1

Hemolytic Disease of the Fetus and Newborn; destruction of the rbc’s of a fetus/newborn by antibodies produced by the mother.

Question 2

HDFN. Serological tests of the mother:

Answer 2

ABORh, TNS, paternal geno/pheno-type

Question 3

HDFN. Serological test of fetus/newborn

Answer 3

ABORh, DAT, elution

Question 4

What is RHIG and how does it work?

Answer 4

RHIG; a concentrated, purified anti-D prepared from human serum of immunized donors, that is given to Rh= moms with Rh+ babies.

It acts to prevent the mother from becoming immunized to Rh+ fetal cells, thu preventing anti-D formation by mom.

Question 5

How is blood chosen for an exchange transfusion

Answer 5

Group O blood cells that are antigen negative to mother’s antibodies. CMV negative as well. Rh= for unknown blood types or are Rh=.

Question 6

How can a newborn benefit from an exchange transfusion:

Answer 6

Can remove high levels of unconjugated bilirubin;removal of part of the circulating maternal antibodies, removal of sensitized rbc’s, replacement of incomplete rbc’s with compatibile ones; helps to interrupt bilirubin production caused my hemolysis

Question 7

What is the purpose of the fetal screen? If pos?

Answer 7

To detect fetomaternal hemorrhage; if positive quantitation of hemorrhage must be done using Kleihaur-Betke test

Question 8

What is coombs sera(AHG)?

Answer 8

Anti-human globulin; an antibody prepared in rabbits thats directed against human immunogloblin or complement or both.

Question 9

What is the principle of the reaction with AHG?

Answer 9

Antibody molecules and complement components are globulins; human globulin stimulates animal to produce antibody. AHG reacts with human globulin molecules, either bount to rbc or free in serum, causing agglutination

AHG combines with the Fc portion of the sensitizing antibody molecules. The 2 Fab sites of the AHG molecule form a bridge between adjacent portional to bound globulin amount. Must wash to remove unbound globulins.

Question 10

Mother:
A neg
Du neg
IAT meg

Baby:
B neg
Du pos
DAT neg

Is RHIG indicated?

Answer 10

Yes, its needed. Mother is RH neg, baby is Rh +, IAT and DAT neg. Mother should be given RHIG.

Question 11

Mother:
O neg
Du meg
IAT pos
ANTI-D 1+
FMS neg

Baby:
O pos
DAT neg

Is RHIG indicated?

Answer 11

No. Anti-D was ID’d in mother, so it is a passive presumptive anti-D from antepartum RHIG.

Question 12

HDFN Intervention

Answer 12

Plasmapheresis of mother as a temporary solution until fetus is more mature

Intrauterine trnasfusion after 20 weeks if severe fetal distress

Early induction

Question 13

ABORH
DAT
CBCD
Bilirubin

Answer 13

Test on cord blood sample, for HDFN

Question 14

Postivie DAT on neonate can be cause by?

Answer 14

Wharton’s jelly

Immune antibody from antigen negative mom attached to cells of Antigen pos baby

nonspecific protein

Question 15

ABORH
TNS
XM

Answer 15

testing before exchange transfusion

Question 16

Exchange Transfusion criteria

Answer 16

Red cells compatible with both mother and baby and negative for antigen causing problem

O negative (or compat to both) rbc’s must be CMV=, Hbs=, preferably 5-7 days old

Packed rrbc plus FFP to yield whole blood with approx 45-60% Hct

Question 17

Advantages of Exchange Transfusion

Answer 17

removal of unconjugated bilirubin

removal of part of the circulating maternal antibody

replacement of incompatible rbc with compatible rbc

removal of sensitized rbc