Neonatal/Intrauterine Transfusion

Question 1

RBCs for Intrauterine/Neonatal transfusion requirements.

Answer 1

• 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

Question 2

Intrauterine/Neonatal transfusion - Plasma/Platelets (plasma containing products):
-Compatibility

Answer 2

Must be compatible with neonate’s RBCs

Question 3

What causes Neonatal Alloimmune Thrombocytopenia (NAIT)?

Answer 3

Maternal antiplatelet alloantibodies that cross the placenta and cause destruction of fetal platelets.

Question 4

What is the most common maternal alloantibody directed against in NAIT?

Answer 4

HPA-1a

Question 5

T/F: NAIT can affect the first pregnancy.

Answer 5

True

*The risk is higher is subsequent pregnancies and more severe

Question 6

What is the greatest complication of NAIT?

Answer 6

Intracranial Hemorrhage (20% incidence; half occur in utero)

Question 7

What is the treatment for NAIT?

Answer 7

High dose IVIg and/or Corticosteroids

Question 8

If NAIT is confirmed in utero, when can intrauterine platelet transfusions begin?

Answer 8

18-20 weeks

Question 9

To be significant HDFN, the maternal alloantibodies must be what type of antibody? (3)

Answer 9

IgG1, IgG2, IgG4

Question 10

Without RhIg, what is the incidence of sensitization in an Rh- women bearing an Rh+ fetus?

Answer 10

15%

*The incidence is LOWER if the mom and fetus are also ABO incompatible

Question 11

What are the tests for fetomaternal hemorrhage (FMH)?

Answer 11

• Rosette test (Qualitative)

- Kleihauer-Betke (acid elution) test

Question 12

D- women with anti-D antibody titer:

Answer 12

<16, then severe hemolysis is unlikely

> 16, must monitor degree of fetal hemolysis

Question 13

What are the techniques for monitoring fetal hemolysis in utero? (2)

Answer 13

• Amniotic fluid sampling (plot OD450 on Liley curve)

- Doppler US of MCA flow

Question 14

T/F: Non-Rh HDFN is more common than Rh HDFN.

Answer 14

True

Question 15

What is the most common type of HDFN?

Answer 15

ABO

Question 16

HDFN due to ABO:

• Severity
• Mediated by
• 1st pregnancy

Answer 16

• Mild clinical effects
• IgG anti-A,B antibody
• Can affect 1st pregnancy

Question 17

What is the most common setting of HDFN due to ABO?

Answer 17

Group O mothers w/ group A or B fetus

Question 18

What is the most common cause of severe HDFN?

-Why

Answer 18

Anti-Kell
-K is expressed early in erythroid maturation; thus, there is destruction of marrow precursors as well as circulating erythrocytes

Question 19

What is the critical maternal titer for anti-Kell?

Answer 19

8

Question 20

What is the second most common cause of severe HDFN?

Answer 20

Anti-C

Question 21

What testing should be performed on Cord blood for all newborns?

Answer 21

• ABO/Rh (+weakD)

- DAT

Question 22

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 _________.

Answer 22

Red Cell Panel

Question 23

If the cord blood DAT is positive and the maternal antibody screen is negative, what should be considered? (3)

Answer 23

• ABO HDFN
• Prior RhIg administration
• Fetal low incidence antigens (need extended panel)