Red Cell Iso-Immunization

Question 1

2 kinds of antibodies

Answer 1

Auto-antibodies + fetus

Allo-antibodies, no damage to mother, damage fetus

Question 2

Common maternal autoimmune

Answer 2

-Thyroid auto-immune: grave’s
-Connective tissue diseases - SLE,
Schrogen’s: Auto Rho, LA
-Fetus: heart block/cardiomyopathy
-Immune Thrombocytopenia Pupura

Question 3

3 iso-antibodies

Answer 3

Red Cell Isoimmunisation
Perinatal allo-immune thrombocytopaenia
Perinatal neutropenia

Question 4

If no platelets, where does fetus bleed from?

Answer 4

GI

Intracranial

Question 5

Neutropaenia

Answer 5

Overwhelming bacterial infection.

In birth: ecoli, GBS, GAS

Question 6

What to give baby with no white cells?

Answer 6

Abx

IgG

Question 7

Why don’t give baby with no white cells…. White cells?

Answer 7

Graft vs. Host

Question 8

Harmful Red cell antigens

Answer 8

Rhesus c/C, d/D, E/e
Kell, Kidd, Duffy
MNS

Question 9

What most important red cell antigen?

Answer 9

D +/-c,E (85%)

Kell, c,E,Fya

Question 10

What happens in severe neonatal jaundice? From red cell haemolysis?

Answer 10

Kernicterus: permanent brain damage
Hydrops: cardiac failure
FDIU

Question 11

Primary immunisation? 3

Answer 11

1. Blood transfusion

2. Feto-Maternal haemorrhage

Question 12

When does is feto-maternal haemorrhage happen?

Answer 12

Abortion, miscarriage, ectopics, Antepartum haemorrhage

CVS, Amnio, Version, MVA
Spontaneous

Question 13

How to protect against occult feto maternal haemorrhage?

Answer 13

Prophylactic Anti-D at 28&24 weeks (90%)

Question 14

anti-body titre threshold?

Answer 14

> 512

Question 15

Low risk ab titre?

Question 16

Moderate ab titre?

Answer 16

64-256

Question 17

Medium risk antenatal care?

Answer 17

U/s Screen at 20 weeks
-MCA peak systolic velocity
CTG at 32 weeks
Deliver at 38

Question 18

Intrauterine transfusion, if need to give mother blood, can you do it?

Answer 18

Yes, only the red cells, no plasma, but in practice would use donor blood.

Question 19

Most sensitive thing for hypovolaemia in young person?

Answer 19

Postural hypotension

Question 20

Store what blood in hospitals for any woman of child-bearing age?

Answer 20

Kell -ve

D -ve blood

Question 21

Contraindication to passive-antiD?

Answer 21

If already imunised

Question 22

Timing of Anti-D passive administration?

Answer 22

Within 72 hours

Question 23

Anti-D what kind of ab?

Answer 23

IgG

Won’t harm baby because titre is too low