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Blood Banking > (P) Hemolytic Disease of the Newborn part 2 > Flashcards

(P) Hemolytic Disease of the Newborn part 2 Flashcards

1
Q

the second most common cause of severe hemolytic
disease of the newborn (HDN) after Rh disease.

A

KELL HEMOLYTIC DISEASE OF THE NEWBORN

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2
Q

Hemolytic disease of the newborn (anti-Kell1) is caused by a
mismatch between the _____ antigens of the mother and
fetus.

A

Kell

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3
Q

T or F

There are more people that are Kell positive than negative

A

F (t 91% of the population are Kell1 negative and about
9% are Kell1 positive.)

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4
Q

T or F

Kell antigens can cross the placental barrier

A

T

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5
Q

What are the two effects of Kell hemolytic disease of the newborn

A
  • anemia
  • alloimmune hemolysis
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6
Q

when does the Kell hemolytic disease of the newborn take place?

A

20 weeks (occurs early)

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7
Q

What is the disease associated with Kell hemolytic disease of the newborn

A

hydrops fetalis

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8
Q

What is the laboratory test used to find Anti-Kell antibodies in antenatal screening blood test assessment

A

Indirect antiglobulin test (IAT)

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9
Q

T or F

The main cause of Kell hemolytic disease of the newborn is due to a previous pregnancy of a Kell negative mother with a kell positive baby

A

F (multiple blood transfusions)

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10
Q

a
condition where the passage of maternal antibodies
results in the hemolysis of fetal/ neonatal red cells.

A

hemolytic disease of the newborn

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11
Q

_____________ occurs when the maternal immune system is sensitized to RBC surface antigens

most common causes
* blood transfusion
* fetal-maternal hemorrhage

A

isoimmunization

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12
Q

What are the three results of the hemolytic process

A
  1. Hyperbilirubinemia
  2. Neonatal thrombocytopenia
  3. Neonatal neutropenia.
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13
Q

The following are true except:

a. Anti-Kell can cause severe anemia regardless of titer.
b. Anti-Kell suppresses the bone marrow, by inhibiting the lymphoid progenitor cells.
c. HDN can also be caused by anti-Kell2, anti-Kell3 and anti
Kell4 IgG antibodies
d. HDN by other kell antibodies are milder than anti-kell1

A

b. (Anti-Kell suppresses the bone marrow, by inhibiting the
erythroid progenitor cells. )

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14
Q

Testing for HDN

all of the following are true except one

a. testing for HDN involves blood tests from both the mother and the father
b. assessment uses amniocentesis
c. Middle cerebral artery scans are done and interpreted by radio technologists

A

c. (done by rad techs, interpreted by medical doctors)

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15
Q

Familiarize the HDN tests for mothers (3)

A
  1. Indirect Coombs test (ICT) or Indirect Agglutination test (IAT)
  2. Middle Cerebral Artery scans (MCA)
  3. Alloimmunization to the c, E, or C antigens.

(IMA)

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16
Q

determine the HDN test (mother’s)

  • Purpose: to detect antibodies in the maternal plasma. If
    positive, the antibody is identified and given a titer
  • Critical titers — Risk of fetal anemia and hydrops fetalis
    o Critical for Kell: Titers of 1:8 or higher critical for Kell.
    o Titers of 1:16 or higher critical for all other
    antibodies
A

ICT / IAT

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17
Q

determine the HDN test (mother’s)

  • needed if antibodies are low and have a sudden increase later in
    pregnancy
  • This test is done noninvasively with ultrasound. By
    measuring the peak velocity of blood flow in the middle
    cerebral artery, a MoM (multiple of the median) score can
    be calculated.
A

Middle Cerebral Artery (MCA) scans

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18
Q

In Middle Cerebral Artery (MCA) scans

a titer of 1.5 or greater indicates what?

What should be done if titer is greater than 1.5?

A
  1. severe anemia
  2. treat with INTRAUTERINE
    TRANSFUSION (LUT).
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19
Q

T or F

If the titer undergoes a 4-fold increase, it should be
considered significant regardless of if the critical value has
been reached.

A

T

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20
Q

T or F

Maternal titers are not useful in predicting fetal anemia
after the first affected gestation and should not be used for
the basis of care.

A

T

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21
Q

Maternal titers should be tested every _______ until _______, after which they are done every ________.

A
  1. month
  2. 24 weeks
  3. 2 weeks
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22
Q

Alloimmunization to the c, E, or C antigens

  • hemolysis may occur in patients with a titer lower than _____
23
Q

If the initial titer is 1:4 and stable but increases at 26
weeks’ gestation to 1:8, assessment with MCA Doppler
velocity at that point is reasonable. However, if the patient presents in the first trimester with a
1:8 titer that remains stable at 1:8 throughout the second
trimester, the fetus is not viable for life.

a. only the first statement is true
b. only the second statement is true
c. both statements are true
d. both statements are false

A

a. (serial antibody titers are appropriate if 1:8 first trimester until second trimester)

24
Q

Severe fetal hemolysis with anti-kell antibodies have occured in low titers. In the case of a positive ICT/IAT, the woman must carry a
medical alert card or arm band/wrist band for life
because of the risk of a transfusion reaction

a. only the first statement is true
b. only the second statement is true
c. both statements are true
d. both statements are false

25
Q

Father testing

  1. If the father is homozygous for the antigen, there’s a _____% chance for all of the offspring to be positive for the antigen at risk for HDN
  2. If the father is heterozygous, there is a _____% chance of offspring to be positive for the antigen
26
Q

Familiarize the three ways to test the fetal antigen status

A
  1. Cell-free DNA
  2. Amniocentesis
  3. Chorionic Villus Sampling (CVS)
27
Q

this method of testing for fetal antigen status is no longer used due to risk of worsening the maternal antibody response

A

Chorionic Villus sampling (CVS)

28
Q
  • This blood test is non-invasive to the fetus and is an easy
    way of checking antigen status and risk of HDN.
  • Blood is taken from the mother, and using PCR, can
    detect the K, C, c, D, and E alleles of fetal DNA.
A

Cell-free DNA

29
Q

familiarize the three labs that does the Cell-free DNA testing

A
  1. International Blood Group Reference
    Laboratory In Bristol, UK
  2. Sanequin laboratory in Amsterdam, Netherlands
  3. Sensigene is done by Sequenome to determine
    fetal D status, in the USA
30
Q

Fetal testing method where fetal antigen status can be tested as early as 15 weeks by PCR of fetal cells

A

amniocentesis

31
Q

Intervention options in early pregnancy

A
  1. Intravenous immunoglobulin (IVIG)
  2. plasmapherersis
32
Q

Intervention options for Mid to late pregnancy

A
  1. Intrauterine transfusion
  2. steroids
  3. Phenobarbital
33
Q

what are the two methods of intrauterine transfusion (IUT), and which one is more preferred?

A
  1. Intraperitoneal transfusion (IPT)
  2. intravenous transfusion (IVT)

IVT>IPT

34
Q

IUTs are only done until __ weeks as its risk is greater than the post birth transfusion

35
Q

why are sterooids and phenobarbital given to the mother?

A

to help mature than fetal lungs (steroids) liver (phenobarbital)

36
Q

T or F

phenobarbutal reduces hypobilirubinemia

37
Q

What test is done after birth?

A

Direct coomb’s test

38
Q

What are the two causes of immune-mediated acute hemolytic transfusion reaction:

A
  1. immunoglobulin M (IgM) anti-A, anti-B, or
    anti-A, B
  2. IgG,
    Rh, Kell, Duffy, or other non-ABO antibodies
39
Q

Immune-mediated hemolytic transfusion reactions
caused by immunoglobulin M (IgM) anti-A, anti-B, or
anti-A, B typically result in_____

A

complement-mediated intravascular hemolysis

40
Q

Immune-mediated hemolytic reactions caused by IgG,
Rh, Kell, Duffy, or other non-ABO antibodies typically
result in ______

A
  • extravascular sequestration
  • shortened transfused RBC survival
  • mild clinical reactions
41
Q

Acute hemolytic transfusion reactions due to immune
hemolysis may occur in patients who (has / lacks) antibodies
detectable by routine laboratory procedures.

42
Q

a screening test for Fetomaternal hemmorrhage (FMH) that detects
fetal D+ red cells in maternal Rh negative blood.

A

Cell Rosette test

43
Q

The rosette test may be falsely positive if the mother
is weak-D (negative/positive)

may be falsely negative if the baby is
weak-D (negative/positive).

A

positive for both

44
Q

Principle of rosette test:

______________ cells will bind to the
antibody-coated infant RBCs causing
agglutination (“rosettes”) that can be detected
microscopically.

A

Ficin-treated R2R2

45
Q

What is a positive rosette test?

__ or more in 10 fields or
___ or more in 5 fields

A

3 or more in 10 fields or 7 or more in 5 fields

46
Q

What is needed in case of a positive rosette test

47
Q

Measures amount of fetomaternal hemorrhage (FMH)..
* CRITICAL VOLUME: Isoimmunization represented by 5 fetal
cells in 50 low power microscopic field of peripheral maternal
blood.
* 1 ml is represented by 20 fetal cells.

A

KLEIHAUER-BETKE TEST PRINCIPLE

48
Q

What is being detected in Kleihauer-Betke Test?

49
Q

T or F
fetal hemoglobin is soluble in a citrate buffer with pH 3.2 and will elute out of the red blood
cell.

A

F (adult hemoglobin is soluble, NOT fetal hemoglobin)

50
Q

Why do we need to determine the size of the FMH?

A

to calculate RhIG dose

51
Q

Cells containing HbF will stain _____ with eosin

A

bright red

52
Q

Study the computation for the Kleihauer-Betke test

A

thanks mwah

53
Q

Matching type

a. adsorption
b. elution
c. absorption

  1. removal of antibody from serum
  2. uptake of antibody by cells
  3. process of removing antibodies from the RBC surface
54
Q

familiarize the absorption techniques

A
  1. Separating a mixture of antibodies
  2. Removing an autoantibody in order to detect presence
    of concomitant alloantibody
  3. Removing an unwanted antibody
  4. Confirming the presence of specific antigens on red cell
    membrane
  5. Confirming specificity of antibody

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