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BB LECT (midterm) > RH ANTIBODIES - ABO HDFN > Flashcards

RH ANTIBODIES - ABO HDFN Flashcards

Part 2 (Quiz 2)

1
Q

IgG reacts at what temperature?

Rh antibodies

A

37C

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2
Q

Rh antibodies are produced after exposure to foreign RBCs via?

A

transfusion or pregnancy

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3
Q

Rh antibodies appears:
* primary ___
* secondary ____

A

appears within 120 days of primary exposure and within 2-7 days after secondary exposure

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4
Q

which antibodies is formed first during exposure?

Rh antibodies

A

IgM then IgG

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5
Q

t or f: Rh antibodies persist in the circulation years

A

true

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6
Q

Which IgG subclass have the greatest clinical significance due to reticuloendothelial sysem rapidly clears RBCs coated with ___

Rh antibodies

A

IgG1 ang IgG3

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7
Q

this antibody can appear but are extremely rare and not routinely tested

Rh antibodies

A

IgA

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8
Q

A person with single Rh antibody
cannot produce additional Rh
antibodies if further stimulated

True or false

A

False, it can produce additional Rh antibodies

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9
Q

why Rh antibodies does not bind complement?

A

because 2 IgG must attach to an RBC antigen in close proximity (30-40 nm) to each other.

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10
Q

Rh antigens are not situated on the RBC surface this closely that’s why it does not bind complement

true or false

A

true

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11
Q

RBC destruction is mostly __

Rh antibodies

A

extravascular

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12
Q

Rh antibodies are enhanced when testing with __

A

enzyme-treated RBCs

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13
Q

may show dosage, reacting preferentially with RBC processing ___

Rh antibodies

A

double-dose Rh antigen

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14
Q

why D antigen is most potent?

A

exposure to <0.1 mL Rh + RBCs can stimulate antibody production (D > c > E > C > e)

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15
Q

Rh antibody reaction includes?

4

A
  • unexplained fever
  • mild bilirubin elevation
  • decrease hemoglobin and haptoglobin
  • DAT (+)
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16
Q

Low titer Rh-antibody may experience an ___ if exposed to some sensitizing antigen

A

anamnestic response

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17
Q

first available typing reagent to test the D antigen

A

Saline reactive reagents

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18
Q

Saline reactive reagents contains what antibodies?

A

Saline reactive reagents

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19
Q

a low protein based typing reagent that can be used to test cells that are already coated with IgG antibody.

A

saline reactive reagents

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20
Q

why saline cannot be used in weak-D typing?

Saline reactive reagents

A

due to its composition as IgM

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21
Q

high-protein anti-D reagents was developed in what year?

A

1940s

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22
Q

this reagent has IgG anti-D also with potentiators of bovine albumin and macromolecular additives (dextran or polyvinyl pyrrolidone)

A

High-protein anti-D reagents

with IgG anti-D from pooled hyman plasma with high-titer D-specific antibody

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23
Q

enumerate the macromolecular additives of high-protein anti-D reagents

A
  • dextran
  • polyvinyl pyrrolidone
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24
Q

RBCs are held in closer proximity to each other and allows IgG anti D to cross link and it can cause false positives

identify what Rh typing reagent

A

High-protein anti-D reagents

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25
Q

how will you manage false positives caused by the high-protein anti-D reagents?

A

use a control to counter the problem

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26
Q

enumerate the advantages of high-protein anti-D reagents

3

A
  • reduced incubation time
  • can perform weak-D testing
  • polyspecific
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27
Q

Scientists chemically modified the ___ by breaking the disulfide bonds that maintain the antibody’s rigid shape

what year chemically modified was developed?

Rh typing reagent

A

IgG anti-D molecule

year 1940s

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28
Q

this reagent is derived from single clones of antibody-producing cells

A

monoclonal antibody

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29
Q

Antibody producing cells are hybridized
with myeloma cells to increase
reproduction

identify the reagent

A

Monoclonal antibody

monoclonaly antibody is 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

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30
Q

what reagent will you use for antigens other than D?

A

can be a low-protein (monoclonal or polyclonal or blends) or high-protein beased

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31
Q

monoclonal antibody reagent is a human derived therefore it cannot transmit infectious disease

true or false

A

false, it is not a human derived that’s why it cannot transmit infectious diseases

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32
Q

hemolytic disease of the fetus and newborn is caused by?

A

IgG antibodies actively transported across the placenta

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33
Q

Destruction of RBCs of the fetus or neonate by antibodies produced by the
mother

include what year and who were the people involved

A

hemolytic disease of the fetus and newborn (HDFN)

reported by Levine and Stetson in 1939

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34
Q

Rh HDFN is due to the?

A

fetus inherited the Rh of the father but the mother is Rh (-)

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35
Q

which child will be unaffected of HDFN if the mother has already 3 sons

first born, middle, or the youngest

A

first born due to the mother hasn’t been immunized.

During delivery, variable numbers of fetal RBCs enter the maternal circulation. Subsequent offspring that inherits the D antigen will be affected.

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36
Q

if the Rh (-) woman has a Rh (+), what could be the effect?

A

cells from the Rh+ will enter the woman’s bloodstream and the woman becomes sensitized

antibodies form to fight Rh+ blood cells then in the next pregnancy, maternal antibodies will attack fetal RBCs

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37
Q

enumerate the factors of Rh HDFN

5

A
  • antigenic exposure
  • host factors
  • immunoglobulin class
  • antibody specificity
  • influence of ABO group
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38
Q

this can cause significant increase in maternal antibody titers during pregnancy

antigenic exposure factor

A

Fetomaternal hemorrhage

Volume of the hemorrhage is small but as
little as 1 ml of fetal RBCs can immunize
the mother

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39
Q

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

identify the HDFN factor

A

Host factors

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40
Q

what immunoglobulin can only be transported across the placenta?

Ig class HDFN factor

A

IgG

All subclasses of IgG are transported to the
placenta with IgG1 and IgG3 the more
efficient.

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41
Q

transport of IgG begins at ___ and continues until ___

Ig class factor

A

begins at second trimester and continues until birth

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42
Q

IgG is transported via the ___ of the antibodies

HDFN factor

A

FC portion

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43
Q

what antibody is the most antigenic?

antibody specificity

A

D

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44
Q

these antibodies have caused HDFN which requires intervention and treatment

2 anti- __

A

anti-E and anti-C

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45
Q

the incompatibility protects somewhat against __

A

Rh immunization

Investigators noted that many years ago,
that the incidence of D immunization is less
in mothers with major ABO incompatibility
with the fetus

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46
Q

In ABO incompatibility, the ___ in the mother’s circulation are lysed even before it can be recognized by the mother’s immune system.

A

D positive fetal RBCs

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47
Q

effects of maternal antibody

enumerate the two

A

hemolysis and anemia

48
Q

this effect of maternal antibody occurs when IgG attaches to specific antigens on the fetal RBCs

A

hemolysis

49
Q

IgG coated RBCs are removed from the circulation by what cells?

hemolysis

A

Littoral cells

macrophages of the spleen

50
Q

rate of destruction depends on ___

enumerate the 3

hemolysis: effects of maternal antibody

A
  • antibody titer
  • specificity
  • number of antigenic sites on the fetal RBCs
51
Q

this develops due to hemolysis

A

anemia

52
Q

Stimulates fetal bone marrow to produce RBCs at accelerated rate and includes immature RBCs (Erythroblastosis fetalis)

effects of maternal antibody

A

anemia

53
Q

these organs helps (Extramedullary
hematopoiesis), resulting to hepatosplenomegaly, resulting in portal
hypertension and hepatocellular damage

effects of maternal antibody: anemia

A

spleen and liver

54
Q

Severe ___ leads to development of high-output cardiac failure with generalized edema, effusions, and ascites

effects of maternal antibody

A

severe anemia and hypoproteinemia

55
Q

refers to high-output cardiac failure with generalized edema, effusions, and ascites

this is due to severe anemia and hypoproteinemia

A

hydrops fetalis

56
Q

due to severe anemia, increase production of indirect bilirubin will be observed from the fetus

true or false

A

false, due to heavy hemolysis

57
Q

this crosses the placenta and
the mother’s liver helps in clearing
(conjugating) this out

___ of the fetus crosses…

A

B1

58
Q

at the time of delivery, the mother is in danger since it cannot process the remaining bilirubin due to damaged liver, leading to ___ and ___

true or false

A

false, the newborn is in danger

But at time of delivery, the newborn is in
danger since it cannot process the remaining bilirubin due to damaged liver, leading to Jaundice or Hyperbilirubinemia

59
Q

Around or more than ___ can cause “Kernicterus” or brain tissue damage

A

18-20mg/dL bilirubin

60
Q

Effects may persist if the infant was delivered alive. It may continue until the remaining antibodies will be eliminated.

true or false

A

true

The rate of effects decreases as long as no additional maternal antibodies are entering the newborn’s circulation

61
Q

IgGs are distributed __
intravascularly or extravascularly?

A

distributed both intravascularly and extravascularly

62
Q

enumerate the serologic tests of the mother needed for diagnosis

4

A
  • antibody screen
  • antibody identification
  • paternal phenotype and genotype
  • fetal DNA testing
63
Q

antibody screen should be done preferably during?

A

first trimester

Previous pregnancy outcomes can be asked and evaluated. Prior transfusions can be evaluated.

64
Q

this test must be able to detect significant IgG antibodies reactive at 37 and in AHG

A

antibody screen

65
Q

prenatal specimen must be typed for ABO and Rh for atibody screen

true or false

A

true

66
Q

If the antibody screen is reactive, the ___ must be __

antibody identification

A

If the antibody screen is reactive, the antibody identity must be determined

67
Q

father’s blood is tested for?

paternal phenotype and genotype

A

presence and zygosity of the antigen

68
Q

If mother has anti-D and the father is D-positive, a complete Rh phenotype can help determine his chance of being
homozygous or heterozygous for the D antigen

true or false

A

true

sensitive and precise genotype can be determined by DNA methods

69
Q

this can be performed as early as 10-12 weeks gestation to determine whether the fetus has the gene for D antigen

fetal DNA testing

A

Amniocentesis or Chorionic villus

70
Q

In second trimester, __ can be tested for fetal DNA to determine genotype

fetal DNA testing

A

maternal plasma

71
Q

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

A

antibody titers

Patient serum is serially diluted and tested against appropriate RBCs to determine the highest dilution at which a reaction occurs.

72
Q

used to confirm HDFN and test for possible transfusion

newborn testing

A

serologic testing of the cord blood

73
Q

enumerate the tests needed to perform for newborns

5

A
  • serologic testing of the cord blood
  • ABO forward typping
  • Rh typing
  • direct antiglobulin test
  • elution
74
Q

Rh typing is performed with caution due to “blocked Rh”

true or false

A

true

75
Q

Rh typing is the most important test for diagnosis HDFN

true or false

A

false, direct antiglobulin test

76
Q

this test is not needed unless the cause of HDFN is in question

newborn testing

A

elution

77
Q

this is used to prevent immunization to D antigen

A

RhIG
Rh Immune globulin
anti-D immunoglobulin

78
Q

Administered RhIG attaches to the ___ in the maternal
circulation

A

fetal Rh-positive RBCs

79
Q

the antibody-coated RBCs are then removed by the?

A

maternal spleen

80
Q

RhIG should be given ___

administered Rh immunoglobulin

A

early in the 3rd trimester (28 weeks gestation)

81
Q

this should be given early in the 3rd trimester (28 weeks gestation)

RhIG indications

A

antenatal

DAT may be positive in the newborn.

82
Q

Non-immunized mother should be given
RhIG soon after delivery of an Rh (+) infant

true or false

A

true

83
Q

recommended interval for administering RhIG to mothers

A

72 hours after deliver

It should still be given even after more than 72 hours have passed.

84
Q

US regular-dose vial

RhIG dose

A

protect against 15 mL of packed RBCs or 30 ml WB

30ml WB (equal to 300 ug of WHO referencem aterial)

85
Q

IV preparations for RhIg dose contains 300 ug per vial administered ___ or ___

A

administered intramuscular or intravenous

86
Q

Regular-dose vial contains about 100ug

A

United kingdom

87
Q

refers to the a large blood loss which is rare

A

true fetomaternal hemorrhage

88
Q

other causes of FMH that rigens alloimmunization

enumerate the 9

A
  • ectopic pregnancy
  • spontaneous absorption
  • featl death
  • cheonic villus sampling
  • amniocentesis
  • fetal blood sampling
  • delivery
  • abdominal trauma
  • plancental abruption
89
Q

enumerate the tests to determine severity

Fetomaternal hemorrhage

A
  • Fetal screen Rosette method
  • Kleihauer-Betke test
90
Q

a maternal sample should be collected within ___ of delivery and screened.

A

1 hour

91
Q

this test is used for massive Fetomaternal hemorrhage in which the Mother’s blood is tested with anti-D reagent (incubate to promote binding)

A

Fetal screen Rosette method

The mixture is washed to remove excess
antibodies.

92
Q

positive result of fetal screen rosette method

A

indicator cells surround the fetal cells

93
Q

these are Rh positive cells added in the fetal screen rosette method

A

indicator cells

94
Q

Maternal blood is smeared and treated with acid and then stained with counter stain

identify what test

A

Kleihauer-Betke test

Acid-Elution stain

95
Q

fetal cells remains __
maternal cells appear as ___

Kleihauer-Betke test (Acid Elution stain)

A

fetal cells = pink
maternal cells appear as ghost cells

96
Q

how many cells are counted in the Kleihauer-Betke test?

also know as Acid Elution stain

A

2000 cells

97
Q

in fetal screen rosette method, calculated Fetomaternal hemorrhage volume is then divided by 30 to determine the number of RhIG vials

true or false

A

false, Kleihauer-Betke test

not the FSR method

98
Q

how to calculate the volume of fetomaternal hemorrhage?

Kleihauer-Betke test

A

Number of Fetal Cells x Maternal blood Volume/# of maternal cells

Kleihauer-Betke test

99
Q

this medication has no benefit if the person has already been immunized

A

RhIG

distinguish women who have been passively immunized via antenatal administration of RhIG from those who were really immunized

100
Q

In RhIG, make sure to not interpret fetal Rh(+) RBCs as maternal (use tests available to distinguish)

true or false

A

true

101
Q

RhIG is not for mother with a D-negative infant

true or false

A

true

RhIG is not given to a new born infant

102
Q

this refers to the small amounts of maternal blood enters the fetal
circulation

A

the Grandmother Effect

103
Q

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

Grandmother effect

A

PCR testing

104
Q

in grandmother effect, if the female reaches adulthood, she may produce anti-D before or early in her first pregnancy

true or false

A

TRUE

The fetus then in the current pregnancy is at risk by maternal antibodies that was provoked by his or her grandmother’s RBCs

105
Q

ABO incompatibility of the newborn and mother can cause?

A

Hemolytic Disease of Fetus and Newborn (HDFN)

106
Q

Maternal antibodies that are IgG can cross the placenta and attach to incompatible RBCs of the fetus, this causes?

A

ABO HDFN

107
Q

Antibodies occur more frequently as
high-titer IgG antibodies in what blood ABO group?

A

group O individuals

108
Q

ABO HDFN is always limited
to A or B infants with O mother

true or false

A

true

A = whites B = blacks

109
Q

Destruction leading to severe anemia is very common in ABO HDFN

true or false

A

false, less common

110
Q

ABO HDFN is observia via ____ within 12-48 hours of birth

A

hyperbilirubinemia and jaundice

111
Q

History of past transfusions or pregnancies is unrelated to the occurrence and severity of the disease

true or false

A

true

ABO HDFN can occur in first pregnancy
and in any pregnancy (not necessarily all)

112
Q

this have been linked to production
of high tittered IgG ABO antibodies and severe HDFN during pregnancy

A
  • tetanus toxoid administrations
  • helminth parasite infection
113
Q

sample recommended for ABO HDN test

A

cord blood samples on delivered infants

114
Q

if the infant develops jaundice, which test/s should be performed?

ABO HDFN

A
  • ABO typing
  • Rh typing
  • Direct Antiglobulin Test (DAT)

If the DAT result is negative but the newborn is jaundiced, other causes of jaundice can be considered.

115
Q

ABO HDFN indication (microscopic)

A
  • microspherocytes
  • increased RBC fragility

BB LECT (midterm) (6 decks)

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