Part 2 Flashcards by Hagar Grace

Used to prevent immunization to D antigen

Rh Immune globulin (RhIG)

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Cannot be used in weak-D typing due to its composition as IgM

Saline reactive

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Newborn test that is not needed unless the cause of HDFN is in question

Elution

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Rh blood group that you can transfuse to Rh positive patient

Rh + and Rh -

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Amniocentesis or Chorionic villus sampling can be performed as early as

10-12 weeks gestation

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Usually a combination of monoclonal anti-D reagents from different clones (due to D antigen with many epitopes) to ensure reactivity with broad
spectrum of Rh positive RBCs

Monoclonal Antibody

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Recommended interval of RhIG administration for Non-immunized Rh negative mothers w/ Rh + fetus after delivery

72 hours

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During hemolysis, IgG coated RBCs are removed from the circulation by the

Littoral cells

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During antenatal RhIG immunization, DAT may result ___ in newborn

positive

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have been linked to production of high tittered IgG ABO antibodies and severe HDFN during pregnancy (2 pts)

Tetanus toxoid administrations
helminth parasite infection

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Rh antibodies are produced after exposure to foreign RBCs via (2 pts)

transfusion and pregnancy

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method Used for massive Fetomaternal hemorrhage

Fetal Screen Rosette Method

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True or False: First born is unaffected with Rh HDFN due to the mother hasn’t been immunized.

True

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reagent that Can cause false positives

High protein anti D reagent

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How much bilirubin can
cause “Kernicterus” or brain tissue damage

18-20mg/dL

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True of False: RhIG can be use for mother with a D-negative infant

False; RhIG is not for mother with a D-negative infant

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rh typing reagent that contains IgM immunoglobulins

Saline reactive

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method for fetomaternal hemorrhage wherein Maternal blood is smeared and treated with acid and then stained with counter stain

Kleihauer-Betke test – Acid Elution stain

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antibody screening should be done during

first trimester

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True of False: History of past transfusions or pregnancies is
unrelated to the occurrence and severity of ABO HDFN

True

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True or False; ABO incompatibility of the newborn and mother can cause HDFN

True

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appearance of Rh antibodies during primary exposure

within 120 days

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Why does saline reactive reagent CANNOT be use in weak D typing?

Because saline active reagent composes IgM that are too big to recognized small amounts of Rh antigen

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In HDFN, Anemia develops due to

hemolysis

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Occurs when IgG attaches to specific antigens on the fetal RBCs

Hemolysis

ABO HDFN is always limited to A or B infants with what blood type of mother

O mother

Severe anemia and hypoproteinemia leads to development of high-output cardiac failure with generalized edema, effusions, and ascites which results to

Hydrops fetalis

True or False: ABO HDFN can occur in first pregnancy and in any pregnancy

True

Most potent antigen

D-antigen

reticuloendothelial system rapidly clears RBCs coated with these IgG class

IgG1 and IgG3

When was High-Protein anti-D reagents developed

1940s

In Kleihauer-Betke test – Acid Elution stain, Fetal Cells remain

pink

Give 5 Factors to consider during HDFN

1. antigenic exposure 2. Host factors 3. Influence of ABO group 4. Immunoglobulin Class 5. Antibody Specificity

RBC destruction happens mostly

extravascular

In making monoclonal antibody, Antibody producing cells are hybridized with this cells to increase reproduction

myeloma cells (Why? because myeloma cells are capable of unlimited growth (can divide indefinitely w/ B cells) thus, produces antibodies that resembles normal antibodies

These could be observed microscopically in ABO HDFN

-Microspherocytes -Increased RBC fragility

positive result for Fetal Screen Rosette Method

The indicator cells surrounds the fetal cells

True of False: incidence of D immunization is less in mothers with major ABO compatibility with the fetus

False; major ABO INCOMPATIBILITY

reported first case of HDFN

Levine and Stetson

ABO HDFN is observed via hyperbilirubinemia and jaundice within

12-48 hours of birth

This has been used to identify D-positive DNA in the peripheral blood from preterm and full term D-negative newborns

PCR testing

Effects of maternal antibody to the fetus:

1. hemolysis 2. anemia 3. increase indirect bilirubin

True or False: A person with single Rh antibody cannot produce additional Rh antibodies if further stimulated

False; A person with single Rh antibody canproduceadditional Rh antibodies if further stimulated

Low protein based and can be used to test cells that are already coated with IgG antibody

Saline reactive

The ability of an individual to produce antibodies in response to antigenic exposure varies, depending on complex genetic factors

Host factors

True or False: First born is unaffected with Rh HDFN due to the mother has been immunized.

False; HASN't been immunized

what do the scientist chemically modified for the chemically modifed reagent in 1970s?

IgG anti D molecule

UK RhIG Regular-dose vial contains about

100 ug

True or False; Small amount of Fetomaternal bleeding occurs in all pregnancies

True

RhIG IV preparations in USA contains

300ug per vial

True or False: Monoclonal antibodies are derived from humans

False; Not a human derived therefore cannot transmit infectious disease

most important test for diagnosing HDFN

Direct Antiglobulin Test

bilirubin-induced neurological damage

Kernicterus

True or False: IgA are formed during second exposure and can be routinely tested?

False; IgA can form but are extremely rare and not routinely tested

When do Rh antibodies during secondary exposure appears

2-7 days

Exposure of D antigen to Rh positive RBCs can stimulate antibody production with just how many ml of rh + rbcs?

0.1 ml

RhIG Should be given early in the

3rd trimester (28 weeks gestation)

Other causes of FMH that triggers alloimmunization (Give 3)

Ectopic pregnancy  Spontaneous abortion  Elective abortion  Fetal death  Chorionic villus sampling  Amniocentesis  Fetal blood sampling  Delivery  Abdominal trauma  Placental abruption

derived from single clones of antibody-producing cells

Monoclonal Antibody

How did the scientists chemically modify the IgG anti-D molecule?

breaking the disulfide bonds

Subclass of IgG that can more efficiently transport across placenta

IgG1 and IgG3

True of False: HDFN happens when there is a Destruction of RBCs of the fetus or neonate by antigens produced by the mother

False; HDFN is due to the Destruction of RBCs of the fetus or neonate by ANTIBODIES produced by the mother

During Fetal DNA testing, these can be performed as early as 10-12 weeks gestation to determine whether the fetus has the gene for D antigen

Amniocentesis or Chorionic villus sampling

True of False: Rh HDFN is due to the fetus inherited the Rh of the mother but the father is Rh negative

False; Due to the fetus inherited the Rh of the father but the mother is Rh negative

High-Protein anti-D reagents potentiators that enhance reactivity (2 pts)

1. bovine albumin 2. macromolecular additives (dextran or polyvinyl pyrrolidone)

Relative concentration of all antibodies capable of crossing the placenta and causing HDFN is determined by

Antibody Titers

caused severe HDFN that required intervention and treatment

Anti-E and Anti-c

US RhIG regular-dose vial – protects against

15ml of packed RBCs or 30 ml WB

First available typing reagent to test the D antigen.

Saline reactive

True of False; RhIG is no benefit if the person has already been passively immunized

True

Newborn tests:

1. ABO typing 2. Rh typing 3. DAT 4. Elution

For detemination of fetomaternal hemorrhage, A maternal sample should be collected within ___ and screened.

1hour of delivery

T or F; Based on the grandmother effect theory, If the D-negative female fetus that was exposed to D-positive mother female reaches adulthood, she may produce anti-D before or early in her first pregnancy

cause significant increase in maternal antibody titers during pregnancy

Fetomaternal hemorrhage

macromolecular additives of High protein anti D reagent (2 pts)

dextran or polyvinyl pyrrolidone

Organs that contributes to Extramedullary hematopoiesis

spleen and liver

Advantages of High protein anti D reagent

1. reduced incubation time 2. can perform 3. weak-D testing 4. polyspecific

With IgG anti-D (from pooled human plasma with high-titer D-specific antibody)

High-Protein anti-D reagents

Rh antibody production reaction includes (4 pts)

- unexplained fever - mild bilirubin elevation - decrease hemoglobin & haptoglobin - DAT (+)

Reagents for antigens other than D

Can be: 1. low-protein (monoclonal or polyclonal or blends) 2. High-protein based

Rate of destruction of RBCs during HDFN depends on: (2 pts)

1. antibody titer specificity and 2. number of antigenic sites on the fetal RBCs

maternal plasma can be tested for fetal DNA to determine genotype during what trimester

Second