PERINATAL ISSUES / NEONATAL & PEDIATRIC TRANSFUSION PRACTICE Flashcards
Which of the ff is the most common cause of HDFN?
A. Anti-D
B. ABO incompatibility
C. Anti-K
D. Anti-Fya
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B. ABO incompatibility
This is the #1 cause since prophylactic RhIG use is widespread to prevent D senstization
This condition occurs when there is an increase in hematopoietic drive in fetal development caused by hemolysis due to maternal IgG crossing the placenta. A. Erythroblastosis fetalis B. Hydrops fetalis C. Kernicterus D. Jaundice
A. Erythroblastosis fetalis
This condition occurs when there is liver enlargement of the fetus, leading to decreased plasma osmotic pressure, edema, ascites and effusion due to hemolysis in fetal circulation. A. Erythroblastosis fetalis B. Hydrops fetalis C. Kernicterus D. Jaundice
B. Hydrops fetalis
A condition where there is an increase in unconjugated bilirubin in newborns causing permanent brain damage. A. Erythroblastosis fetalis B. Hydrops fetalis C. Kernicterus D. Jaundice
C. Kernicterus
Which of the ff ethnicity-blood group is most likely affected by ABO HDFN?
A. Group O mom of European ancestry, group B infant
B. Group O mom of Asian ancestry, group A infant
C. Group O mom of African ancestry, group A infant
D. Group O mom of African ancestry, group O infant
B. Group O mom of Asian ancestry, group A infant
Euro and Asian mom Group O, Group A baby
African mom group O, Group B baby
These are more likely to be affected
At what titer is anti-D considered to be critical in a sensitized pregnancy? A. 2 B. 4 C. 8 D. 16
D. 16
At what titer is anti-K considered to be critical in a sensitized pregnancy? A. 2 B. 4 C. 8 D. 16
C. 8
What is the best treatment for a newborn with HDFN who is unresponsive to initial treatments for severe jaundice? A. Phototherapy B. IVIG C. Exchange transfusion D. IUT
C. Exchange transfusion
choices A and B are usually the first treatment of choice, but if newborn becomes unresponsive to these, exchange transfusion is recommended unless infant already received IUT
Which of the ff is NOT a suitable candidate for RhIG administration?
A. A neg female, with anti-G, but no Anti-D
B. O neg female, with weak D RHD genotype other than weak D type 1,2,3
C. O neg female with D pos infant, has allo anti-D
D. A neg female who underwent CVS, has no anti-D
C. O neg female with D pos infant, has allo anti-D
Which antibody to human platelet antigen is the most common cause of fetal and neonatal immune thrombocytopenia (FNAIT)? A. Anti - HPA-1a B. Anti - HPA-5b C. Anti - HPA-1b D. Anti - HPA-4b
A. Anti - HPA-1a = 98% of cases?
B = 10% C = 4% D = more implicated in Asian ancestry
True / false - similar to HDFN, FNAIT cases develop during the first pregnancy, and affects the second and subsequent pregnancies.
False.
First part is true. But it affects the 1st and subsequent pregnancies
Neonates <4 months have immature kidneys and are unable to excrete out excess potassium and calcium. Which of the ff RBC unit requirements ensures that the unit transfused have the lowest amount of excess potassium delivered to the patient?
A. Anticoagulant additive solution used in collection bag
B. Age of RBCs/ <14 days old RBCs
C. Irradiation
D. CMV negative units
A. Anticoagulant additive solution used in collection bag
AS-1, 3, 5, 7, SAGM units have less K+ than CPDA-1
Irradiation results in K+ leakage from RBCs
Neonates are unable to effectively compensate for hypoxia due to their low levels of intracellular 2,3- DPG. Which of the ff RBC unit requirements ensures that the units transfused is not depleted of 2,3-DPG?
A. Anticoagulant additive solution used in collection bag
B. Age of RBCs/ <14 days old RBCs
C. Irradiation
D. CMV negative units
B. Age of RBCs/ <14 days old RBCs
2,3-DPG rapidly decreases after 1-2 weeks of storage
What is the major indication for transfusion in neonates? A. Low birth weight B. Symptomatic anemia C. Hypoxia D. Premature birth
B. Symptomatic anemia
What is the most common indication for exchange transfusion in neonates? A. Premature birth B. HDFN C. Low birth weight D. Hyperbilirubinemia
D. Hyperbilirubinemia
What is the first treatment of choice for neonates with hyperbilirubinemia? A. Simple transfusion B. Exchange transfusion C. Phototherapy D. IVIG
C. Phototherapy
Exchange tx is done when pohototherapy fails
Which of the ff is the most common hemostatic abnormality in preterm and full term infants? A. Symptomatic anemia B.. Hyperbilirubinemia C. Thrombocytopenia D. Hypoxia
C. Thrombocytopenia
When plt count is <150,000/uL
__________ is a prolonged treatment whereby blood is removed from the patient’s venous circulation, circulated through the machine to remove CO2 and replenish O2 and then returned to the patient.
ECMO
Extracorporeal Membrane Oxygenation
_______ is characterized by ischemic necrosis of the intestinal mucosa, associated with the inflammation, invasion of enteric gas forming organisms, and dissection of gas into the abdominal cavity.
Necrotizing Enterocolitis
True/ false - Transfusion was found to be a risk factor for the development of necrotizing enterocolitis in neonates.
False
Severe anemia was independently found to be associated with NEC
Which of the ff is the most common indication for transfusion in infants older than 4 months and in children? A. Symptomatic anemia B. Low birth weight C. Hypoxia D. Premature birth
C. Hypoxia
Hypoxia may be due to decreased red cell mass, anemia
________ is characterized by the destruction of patient’s own red cells along with the transfused cells in patients with sickle cell disease (evident in decrease in Hgb after transfusion)
Hyperhemolytic syndrome
What is the indication for platelet and plasma administration in older infants and children? A. Thrombocytopenia due to chemo B. factor deficiency C. Low platelet count D. Prophylaxis / pre-op infusion
A. Thrombocytopenia
Plt and plasma tx is a prophylactic for this
Which of the ff is NOT a benefit of leukocyte reduction of components?
A. Prevents transfusion transmitted CMV
B. Prevents FNHTR
C. Decreases the risk of HLA alloimmunization
D. Prevents occurrence of TRALI
D. Prevents occurrence of TRALI
Prevention for this is to infuse components from male donors
Which of the ff can occur in neonates who are given units that were irradiated >24 hours before infusion? A. Hypercalcemia B. Hypoxia C. Hyperkalemia D. Liver failure
C. Hyperkalemia
This is an increase in K+; neonates have poor kidney function and are unable to excrete excess K+
IgM and IgG antibody class can be differentiated by which method?
A. Adsorption of antibodies
B. Treatment of sulfhydryl reagents
C. Acid elution
D. Neutralization treatment
B. Treatment of sulfhydryl reagents
DTT and 2-mercaptoethanol are examples of sulfhydryl reagents. This destroys the J chains of IgMs (will inactivate it) while IgGs are not affected and will remain active
What is the half life of IgG antibodies in the fetal circulation?
25 days
Which titer usually indicates an active immunization to the D antigen?
higher than 4
Passive anti-D due to rhogam usually has a very low titer
What antibody titer is considered critical in prenatal studies?
16
Doppler ultrasound to check for fetal anemia is indicated when maternal antibody level reaches ____ ?
32 or greater
Which of the ff is NOT true about Wr(a) antibodies?
A. They are commonly seen in patients with anti-D who recently delivered
B. Anti-Wr(a) causes HDFN
C. Anti-Wr(a) is a naturally occurring antibody
d. Anti-Wr(a) is a rare antibody since Wr(a) is low prevalence antigen
B. Anti-Wr(a) causes HDFN
Which of the ff is NOT true about passive anti-D due to rhogam?
A. Has a titer strength of 4 or less
B. Usually weakly reactive
C. Usually present in the circulation for 3 months
D. Is made of both IgM and IgG antibodies
D. Is made of both IgM and IgG antibodies
Passive-D is IgG only. If IgM is present, it usually indicated a primary immune response/ alloimmunization to the D antigen
What us the threshold titer for Anti-K in fetal anemia monitoring?
8
All other alloantibody threshold is 16
