Neonatal/Intrauterine Transfusion Flashcards
RBCs for Intrauterine/Neonatal transfusion requirements.
- Fresh (<5 days old)*
- Irradiated
- Group O
- Negative for any active maternal antibody (eg, anti-D)
- CMV Neg.
*If fresh blood is not available, consider Washed
Intrauterine/Neonatal transfusion - Plasma/Platelets (plasma containing products):
-Compatibility
Must be compatible with neonate’s RBCs
What causes Neonatal Alloimmune Thrombocytopenia (NAIT)?
Maternal antiplatelet alloantibodies that cross the placenta and cause destruction of fetal platelets.
What is the most common maternal alloantibody directed against in NAIT?
HPA-1a
T/F: NAIT can affect the first pregnancy.
True
*The risk is higher is subsequent pregnancies and more severe
What is the greatest complication of NAIT?
Intracranial Hemorrhage (20% incidence; half occur in utero)
What is the treatment for NAIT?
High dose IVIg and/or Corticosteroids
If NAIT is confirmed in utero, when can intrauterine platelet transfusions begin?
18-20 weeks
To be significant HDFN, the maternal alloantibodies must be what type of antibody? (3)
IgG1, IgG2, IgG4
Without RhIg, what is the incidence of sensitization in an Rh- women bearing an Rh+ fetus?
15%
*The incidence is LOWER if the mom and fetus are also ABO incompatible
What are the tests for fetomaternal hemorrhage (FMH)?
- Rosette test (Qualitative)
- Kleihauer-Betke (acid elution) test
D- women with anti-D antibody titer:
<16, then severe hemolysis is unlikely
> 16, must monitor degree of fetal hemolysis
What are the techniques for monitoring fetal hemolysis in utero? (2)
- Amniotic fluid sampling (plot OD450 on Liley curve)
- Doppler US of MCA flow
T/F: Non-Rh HDFN is more common than Rh HDFN.
True
What is the most common type of HDFN?
ABO
HDFN due to ABO:
- Severity
- Mediated by
- 1st pregnancy
- Mild clinical effects
- IgG anti-A,B antibody
- Can affect 1st pregnancy
What is the most common setting of HDFN due to ABO?
Group O mothers w/ group A or B fetus
What is the most common cause of severe HDFN?
-Why
Anti-Kell
-K is expressed early in erythroid maturation; thus, there is destruction of marrow precursors as well as circulating erythrocytes
What is the critical maternal titer for anti-Kell?
8
What is the second most common cause of severe HDFN?
Anti-C
What testing should be performed on Cord blood for all newborns?
- ABO/Rh (+weakD)
- DAT
If the cord blood DAT is positive and the maternal antibody screen is positive, then the identity of the maternal antibody is determined by the _________.
Red Cell Panel
If the cord blood DAT is positive and the maternal antibody screen is negative, what should be considered? (3)
- ABO HDFN
- Prior RhIg administration
- Fetal low incidence antigens (need extended panel)
