(P) Hemolytic Disease of the newborn part 1 Flashcards

1
Q

Most important red cell antigen after A and B antigens in blood banking

A

D antigen

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2
Q

What is the other name for the hemolytic disease of the newborn

A

erythroblastosis fetalis

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3
Q

It is termed as erythroblastosis fetalis due to the
presence of ______

A

erythrolasts

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4
Q

T or F

A person with Rh negative blood can develop Rh antigens if he / she receives blood from a person with Rh positive blood

A

F (develop Rh ANTIBODIES)

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5
Q

T or F

A person with Rh positive blood can receive blood from a person with Rh negative blood without any problems

A

T

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6
Q

A condition in which the fetus or neonate’s red blood cell
are destroyed by IgG antibodies produced by the
mother.

A

HEMOLYTIC DISEASE OF THE NEWBORN

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7
Q

Definition of terms

breaking down of RBC

A

hemolytic

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8
Q

Definition of terms

The making of immature red blood cells resulting to the preence of erythroblasts in the blood

A

erythroblastosis

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9
Q

Definition of terms

refers to the fetus

A

fetalis

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10
Q

True for the causes of HDFN except:

a. Rh incompatibility
b. ABO
c. other system antibodies incompatibility
d. Rh positive mother, Rh negative baby
e. none of the above

A

d

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11
Q

A. Rh-HDN
B. ABO-HDN

  1. rare, declining, severe, clinically significant
  2. more common, mild, subclinical
A
  1. A
  2. B
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12
Q

other causes of HDN except

a. Anti-c (hr’)
b. Anti-E (rh’’)
c. IgM
d. Anti-Lea, Anti-Leb
e. Anti-P1, Anti-M, and Anti-N

A

c

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13
Q

familiarize the factors of HDN

A
  1. pregnancy
  2. factors affecting immunization
  3. immune response
  4. antigenic exposure
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14
Q

Factors of HDN

required for HDN to occur, as it is vital for antigenic exposure leading to HDN

A

Pregnancy

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15
Q

types of immune response

a. Non-responders
b. hyper-responders

  1. increases the titer of Anti-D or IgM
  2. Indifferent to antigenic stimulation
A
  1. B
  2. A
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16
Q

In hyper-responders, what is the product of the increase in titer of anti-D?

A

multiple antibody formation

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17
Q

Rh negative individual exposed to one unit of Rh-positive blood are ______% immunized

A

50%

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18
Q

Rh negative women with Rh positive fetus are ___%
immunized

A

10

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19
Q

____mL is needed in immunization to stimulate a response and create
antibodies in the process of stimulation

A

0.5mL

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20
Q
  • Occurs when the volume of fetal red cells is insufficient.
  • This occurs in primary immunization, and within the
    secondary immunization is the rapid production of
    antibody.
A

ANAMNESTIC RESPONSE

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21
Q

which pregnancy is of higher risk for Rh-HDN?

a. first
b. second
c. third
d. fourth

A

b

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22
Q

Rh incompatibility greatly affects a person’s quality of life and give rise to problems during pregnancy

a. first statement is true, second is false
b. second statement is true, first is false
c. both statements are true
d. neither statements are true

A

b

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23
Q

a. first pregnancy
b. second pregnancy

  1. antibodies are produced due
    to the exposure of the maternal blood to the neonate’s blood
  2. In the ___________ antibodies produced from
    the x pregnancy attacks the fetus with Rh positive
    blood
  3. It is still considered safe but the mother who is RhD-
A
  1. a
  2. b
  3. a
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24
Q

what are the symptoms in mild cases of HDN

A

mild anemia and jaundice

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25
what are the presenations in severe HDN
*death * increased bilirubin * CNS damage (kernictus) DIK / DIC
26
Explain the progression of Rh factor sensitization
1. Rh- Mother’s and Rh+ Baby’s blood mix 2. Mother forms antibodies agains Rh positive antigens 3. Mother’s antibodies enter baby’s blood and attack
27
familiarize the effects of red cell distribution
a. anemia b. marked erythrophagocytosis c. organ enlargement d. hyperbilirubinemia e. hydrops fetalis
28
what type of anemia is in HDN
Hemolytic anemia
29
* Due to the immature liver of the newborn and inability to conjugate the unconjugated _________ result in the unconjugated __________increasing and crossing the blood brain barrier causing _______________.
1. bilirubin 2. bilirubin 3. kernictus / CNS damage
30
matching type a. 18 mg/dL b. 20 mg/dL c. >30 mg/dL 1. Already considered increased 2. Kernicterus, death 3. Mental Retardation
1. a 2. c 3. b
31
_________ results from high levels of unconjugated bilirubin in the fetus blood which is more than 20 mg/dL
kernictus / bilirubin encelopathy
32
Because unconjugated bilirubin are lipid soluble and toxic, it can cross the blood brain barrier and it will penetrate __________ and ________________causing neurotoxicity
neuronal and glial membranes
33
familiarize the severe permanent neurologic symptoms secondary to kernicterus
*choreoathetosis * spaticity * muscular rigidity * ataxia * deafness * mental retardation
34
hydrops fetalis these are the organs that increase in size due to the increased production of red cells as the fetus's anemia worsen
liver and spleen
35
is an abnormal accumulation of fluid beneath the skin. This condition in the detus is known as hydrops fetalis
edema
36
process of the removal of amniotic fluid which is used in bilirubin testing
amniocentesis
37
who performs amniocentesis? a. RMT b. RN c. MD d. all of the above
c
38
aminotic fluid is measured using??
spectrophotometry
39
for infants with HDN amniocentesis is done during the _______ week of gestation
28th week
40
for infants with severe HDN amniocentesis is done during the _______ week of gestation
22nd week
41
enumerate the tests for neonatal studies
1. ABO typing 2. Rh typing 3. Direct antiglobulin test
42
Direct coombs test employed using
anti-human globulin
43
Direct coombs test reagent:
coomb's reagent
44
Direct coombs test detect:
antibody that coats the RBC in vivo, producing agglutniation
45
The baby’s sample is positive for the presence of the mother’s antibody on the surface of RBCs in condition called erythroblastosis fetalis What is the best blood that can be given if this is blood transfusion?
Rh -, ABO type specific
46
Maternal _____ antibodies with specificity for the ABO blood group system pass through the placenta to the fetal circulation where they can cause hemolysis of fetal red blood cells which can lead to fetal anemia and HDN
IgG
47
ABO HDN occurs commonly in the a. first born b. second born c. equally in all offsprings
a
48
which is more common in ABO HDN a. symptomatic b. asymptomatic
symptomatic
49
ABO HDN commonly occurs in mothers that are of what blood type? a. A b. B c. O
c
50
familiarize the complications of ABO HDN
* High at birth or rapidly rising bilirubin * Prolonged hyperbilirubinemia * Bilirubin induced Neurological Dysfunction * Cerebral Palsy * Kernicterus * Neutropenia * Thrombocytopenia * Hemolytic Anemia: MUST NOT be treated with iron * Late onset anemia: MUST NOT be treated with iron. This can persist up to 12 weeks after birth.
51
Causes of ABO HDN (3)
1. exposure 2. fetal-maternal transfusion 3. blood transfusion
52
What type of antibody are anti-a and anti-b usually?
IgM
53
what type of antibody are anti-a and anti-b that can cross the placenta?
IgG
54
Exposure to A-antigens and B-antigens, which are both widespread in nature, usually leads to the production of (IgM/IgG) anti-A and IgM anti-B antibodies but occasionally IgG antibodies are produced
IgM
55
* In about a third of all ABO incompatible pregnancies maternal IgG anti-A or IgG anti-B antibodies pass through the placenta to the fetal circulation leading to a _______ direct Coombs test for the neonate’s blood
weakly positive
56
ABO HDN is generally mild and short-lived and only occasionally severe because
1. IgG anti-A and anti-B enter fetal circulation 2. fetal RBC surface A and B antigens are not fully developed
57
ABO serology If mother has IgM, she is treated with ___ and ___, neutralizing A and B substances
2-mercaptoethanol and dithiothreidol
58
T or F Routine antenatal antibody screening blood tests or indirect Coombs test does notscreen for ABO HDN
T
59
T or F If IgM anti-A or IgM anti-B antibodies are found in the pregnant woman's blood, they are not reported with the test results, because they do not correlate well with ABO HDN
F (IgG)
60
HDN diagnosis is usually made by investigation of a newborn baby who has developed jaundice during the ________of life.
first week
61
ABO SEROLOGY test is run using cord blood a. Direct Coombs b. Hemoglobin c. both d. neither
c (+ bilirubin also)
62
ABO SEROLOGY Tested in vitro a. Direct Coombs b. Indirect Coombs c. both d. neither
b
63
Why is Direct Coombs test done after the birth of the baby?
to confirm the antibodies attached to the infant's RBC
64
high reticulocyte count: a. infant needs transfusions b. infant does not need additional transfusion
b
65
low reticulocyte count a. HDN from anti-kell b. ABO-HDN
A (and in infants that have been treated with intrauterine transfusion)
66
why is ferritin checked in infants?
most infants with HN are have iron overload syndrome
67
What type of cells is predominant in Rh?
macrocytes
68
CONSEQUENCES OF HDN Jaundice in ABO: ___ Jaundice in Rh : ____
o Jaundice in ABO: Icterus praecox o Jaundice in Rh: Icterus gravis
69
T or F hydrops fetalis and kernicterus are common in ABO HDN
F (uncommon)
70
INDICATIONS OF HDN bilirubin at birth: ___ mg/dl Cord bilirubin: ____ mg/dl
* Bilirubin at birth: 5 mg/dL * Cord Bilirubin is more than 4
71
INDICATIONS OF HDN * 12 hours: ____mg/dL * 24 hours: ____mg/dL * Hgb: ___g/dl
* 12 hours: 11.5mg/dL * 24 hours: 16 mg/dL * Hgb: 8 g/dL
72
Intrauterine Fetal Blood Transfusion for Rh Disease: ___________ is done to determine the position of the fetus and placenta
fetoscopy
73
The risk of Intrauterine Blood Transfusion (IUT) depends on (2)
prior condition of fetus and gestational age
74
What are the three conditions that signals the need for the analysis of amniotic fluid
1. titer >32 for anti-D 2. titer > 8 for anti-kell 3. fourfold increase of the titer
75
INDICATIONS FOR AMNIOCENTESIS To perform amniocentesis at ___ weeks of gestation in the previous child
26
76
INDICATIONS FOR AMNIOCENTESIS To perform amniocentesis at __ weeks of gestation if the previous child is severely affected
22
77
INDICATIONS FOR AMNIOCENTESIS Perform if the maternal antibody of the mother increases before the __ week. The mother’s antibody is being monitored.
34th
78
INDICATIONS FOR AMNIOCENTESIS High values of bilirubin shown by ____ method or hemoglobin concentration of cord blood below ____
Liley method 10
79
LILEY’S GRAPH a. bottom zone b. middle zone c. upper zone 1. minimally affected 2. affected or very mildly affected 3. moderate to marked hemolysis in the fetus
1. b 2. a 3. c
80
BLOOD TO BE USED 1. if anti-D is present 2. if anti-D is absent 3. for intrauterine transfusion
1. Rh positive 2. Rh negative 3. O negative
81
at what bilirubin levels is phototherapy not effective?
0.5 to 2 mg/dL
82
familiarize the treatments available
1. intravenous immunoglobulin therapy 2. exchange transfusion 3. plasma exchange 4. intravenous immune globulin
83
TREATMENT * used to successfully treat many cases of HDN * used on anti-D and anti-E * reduces the need for exchange transfusion and shortens length of phototherapy * recommended for treatment in isoimmune hemolytic disease by the American Association of Pathologist * reduce the need for exchange transfusions in Rh and ABO hemolytic disease.
Intravenous Immunoglobulin therapy (IVIG)
84
IVIG is recommended for what total serum bilirubin levels?
TSB level is within 2 to 3 mg/dL (34-51 μmol/L) of the exchange level
85
Can IVIG be repeated within 12 hours (yes / no)
yes if necessary
86
T or F infants always needs both exchange transfusion and phototherapy
F ( rarely needs exchange transfusion)
87
At what total bilirubin level is exchange transfusion done?
as high as 20 mg/dL and continues to rise
88
what blood type is used for exchange transfusion
fresh, O negative packed RBCs and type specific fresh frozen plasma
89
T or F the O negative packed RBCs for exchange transfusion is crossmatched against the baby
F (against the mother)
90
TREATMENT *widely used treatment of immune-mediated disease *applied to the pregnant women with high antibody titer, or that has past history of stillbirth due to HDN * effective in decreasing the antibody titer and quantity of antibody. * a way to delay the need for fetal intervention that has been hydrops fetalis (edema) in which before 22 week gestation in a previous pregnancy.
Plasma exchange
91
TREATMENT plasma exchange can reduce the antibody titer up to how many percent?
75%
92
TREATMENT * use strengthened body immune system beside to treat immune deficiency * found to decrease hemolysis leading to reduction in serum bilirubin level. * The immunoglobulin could act by occupying the FC receptors of reticulo-endothelial cells preventing them from taking up and lysing antibody coated RBCs. This subsequently leads to decrease in the need for exchange transfusion.
Intravenous Immune Globulin
93
What is the prevention done against HDFN?
Rh immune globulin (RhIG or Rhogam)
94
PREVENTION Antenatal (during pregnancy): The first injection of RHIG is recommended to be administered during the ________ week of pregnancy.
28th week of pregnancy
95
PREVENTION Postnatal (after birth): Another injection is advised within ____hours after delivery. The injection contains 1 vial, and each vial is composed of 300 μg/15 mL of Rh-positive fetal red blood cells (RBCs).
72 HOURS
96
PREVENTION What is prevented by the administration of Rh immune globulin in pregnant women
alloimmunization
97
RhIG is a concentrate of __________ prepared from pooled human plasma of D-negative people who have been exposed to the D antigen and who have made antibodies to it.
IgG anti-D
98
SIGNIFICANCE OF RhIG * RhIG prevents alloimmunization in D-negative mother exposed to D-positive fetal red cells. In the meantime, it protects mother from being __________ to D antigen of fetal during pregnancy and after delivery of infant.
sensitized
99
SIGNIFICANCE OF ADMINISTRATION OF RhIG The following are true except: a. RhIG suppress the mother's immune response following exposure to D-positive fetal red cells b. RhIG encourages the mother to produce anti-D c. RhIG protects subsequent D-positive pregnancies. d. none of the above
b
100
USE OF RhIG RhIG is administered to (Rh-negative / Rh-positive) patients who have received Rh-positive (Rh+) cells, such as Whole Blood Concentrate or Platelet Concentrate
Rh-negative
101
In Hemolytic Disease of the Newborn (HDN), RhIG is administered except for when: a. Mother is Rh (-) and Du (-) b. Mother is not immunized yet to D antigen c. infant is Rh (-) Du (-) d. in abortion: the infant is assumed to be Rh+
c
102
GUIDELINES FOR RhIG ADMINISTRATION IN D-NEGATIVE PREGNANT WOMAN: 1. All doses should be given within ___ hours of delivery or procedure. If she is not given RhIG within ___ hours after the birth of an Rh-positive baby, she will begin to make antibodies to the fetal blood cells
72
103
GUIDELINES FOR RhIG ADMINISTRATION IN D-NEGATIVE PREGNANT WOMAN: Woman (should / should not) be sensitized to D antigen
should not be
104
Provide the dose needed: Up to 12 weeks of gestation for abortion, miscarriage and end period of ectopic pregnancy.
50ug
105
Provide the dose needed ✓ End period of pregnancy which is after 12th week of gestation. ✓ After amniocentesis. ✓ After delivery of D-positive infant.
120ug
106