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IMMUNOHEMA REV > RH - Hemolytic Disease of Newborn > Flashcards

RH - Hemolytic Disease of Newborn Flashcards

1
Q

IgG that can cross the placenta

A

Anti D

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2
Q

Immunoglobulin class that are only actively transported across the placenta

A

IgG

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3
Q

Fetal RBCs enter the maternal circulation

A

FETOMATERNAL HEMORRHAGE

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4
Q

3 important factors that must be present for HDN to occur:

A
  1. The mother must lack the antigen
  2. The fetus must possess the antigen
    a. Father homozygous- 100% HDN
    b. Father heterozygous- 50% HDN
  3. the antigen present in fetus must be WELL-DEVELOPED AT BIRTH
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5
Q

Cause significant increases in maternal antibody titers that increase severity of HDN

A

FETOMATERNAL HEMORRHAGE

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6
Q

When does the active transport of IgG begins?

A

2nd trimester until birth

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7
Q

Immunoglobulins that are more efficient in RBC hemolysis.

A

IgG1 and IgG3

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8
Q

Most antigenic RBC antigens

A

D

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9
Q

Blood that is transfused to Rh negative females of childbearing potential.

A

Rh negative

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10
Q

Most clinically significant non-Rh antibody to cause HDN.

A

Anti-Kell

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11
Q

When the mother is ABO incompatible with the fetus, the incidence of detectable FETOMATERNAL HEMORRHAGE is _____________.

A

Decreased

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12
Q

Anemia and the appearance of immature RBC’S in the peripheral blood if the fetus.

A

Erythroblastosis Fetalis

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13
Q

Development of high-output CARDIAC FAILURE with generalized edema, effusions, and ascites.
Severe anemia and hyponatremia.

A

Hydrops Fetalis

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14
Q

Greatest threat of fetus in Rh HDN

A

Cardiac Failure

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15
Q

EFFECT OF RH HDN IN POST-PARTUM
- RBC destruction continues with the release of _______________.
- The new born liver is deficient with _______________.
- As the indirect bilirubin is released, it binds to ____________ and cirlated harmlessly.
- However, when the binding capacity of the albumin is exceeded the indirect bilirubin BINDS TO TISSUES which results to ____________.
- In particular, it may bind to the tissues of the CNS and Cause a Permanent and irreversible brain damage called _________.

A
  • INDIRECT BILIRUBIN
  • GLUCORONYL TRANSFERASE
  • ALBUMIN
  • JAUNDICE
  • KERNICTERUS
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16
Q

SEROLOGIC TEST:
Must be able to detect clinically significant IgG alloantibodies that are reactive at 37C and in the antiglobulin phase.

A

Antibody Screen
* If nonreactive- REPEAT TESTING
- Ab IDENTIFICATION

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17
Q

SEROLOGIC TEST:
The serum is treated with sulfhydryl reagents and then retested with appropriate controls.

A

Antibody identification
* Cold IgM Ab are ignored
IgM - destroyed by J chain
IgG - remain active

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18
Q

Sulfhydryl reagents that can be used in Rh HDN Antibody identification.

A

Dithiotreitol
2- mercaptoethanol

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19
Q

SEROLOGIC TEST:
A specimen of the fathers blood should be obtained and tested for the presence and zygosity of the corresponding antigen.

A

Paternal Phenotype

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20
Q

SEROLOGIC TEST:
Amniotic is tested to determine whether the amniocytes carry the gene for the D antigen.

A

Amniocyte testing

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21
Q

Amniocentesis can be done in how many weeks of gestation.

A

10-12 weeks

22
Q

SEROLOGIC TEST:
Used to determine the relative concentration of all antibodies capable of crossing the placenta and causing HDN.

A

Antibody titer
* Critical titer: 16-32

23
Q

An indication of amniocentesis or percutaneous umbilical blood sampling between 18-24 weeks gestation.

A

Constant titer of 32 or above

24
Q

Insertion of a needle through the mothers abdominal wall and uterus and extraction of fluid from the amniotic sac.

A

Amniocentesis

25
Q

Analyte tested in amniocentesis

A

BILIRUBIN

26
Q

Mild or no disease , which do not require intervention in optical density of liley graph according to gestational age.

A

Zone 1

27
Q

Liley graph OD:Moderate disease that may require intervention.

A

Zone 2

28
Q

Liley graph OD: Severe and life threatening hemolysis and require urgent intervention.

A

Zone 3

29
Q

Process of obtaining fetal blood using ultrasound guided needle in the umbilical vein near the pont of placental insertion.

A

Cordocentesis/ Percutaneous Umbilical Cord Sampling

30
Q

Cordocentesis is used for what tests?

A

DAT
Hgb
Hct
Bilirubin
ABO and Rh typing
Ag phenotype and genotype

31
Q

Serologic test that indicates direction of blood flow

A

COLOR DOPPLER MIDDLE CEREBRAL ARTERY PEAK CYSTOLIC VELOCITY
Red- arterial blood
Blue- venous blood

32
Q

What intervention is needed when amniotic fluid change in OD 450 nm results are in high zone 2 or in zone 3, cordocentesis blood has <10g/gL Hgb, and fetalhyrops is present?

A

Intrauterine transfusion

33
Q

Performed intraperitoneally by injecting the rbc’s into fetal peritoneal cavity where the rbc’s can be absorbed into the circulation.

A

Intrauterine transfusion

34
Q

Ultimate goal of intrauterine transfusion?

A

Maintain fetalhemoglobin above 10g/dL

35
Q

Blood to be transfused in child using uterine transfusion should be:

A

Group O, D negative
Less than 7 days old
Hct: 70% (75-80%)
Irradiated
CMV negative
HbS negative
Crossmatch compatible with maternal serum

36
Q

After delivery, it used to change unconjugated bilirubin to conjugated bilirubin with ultraviolet light?

A

Phototherapy

37
Q

In infants with mild-to-modrrate hemolysis, the used of ______________ may avoid the need for exchange transfusion to treat hyperbilirubinemia and anemia.

A

PHOTOTHERAPY

38
Q

What needs to be done when you have a BLOCKED RH that causes Rh- negative Rh type in infants RBC to reveal anti-D?

A

Do ELUTION:
An eluate from these Rbc’s will reveal anti-D, and typing of the eluate Rbc’s show reaction with anti-D.

39
Q

The most important serologic test for diagnosis of HDN using anti IgG reagent.

A

DAT

40
Q

Used primarily to remove high levels of unconjugated bilirubin and thus to prevent kernicterus.

A

Newborn Transfusions

41
Q

NEWBORN TRANSFUSIONS: Blood to be transfused should be…

A

Group O, D negative
Less than 7 days old resuspended in blood type AB fresh frozen plasma
Hct: 40-50%
Irradiated
CMV neg
HbS neg
Crossmatch compatible with maternal serum

42
Q

This principle has been used to prevent immunization to D antigen by the used of high-titered Ig.

A

RhIg

43
Q

DOSE of RhIg Antepartum Administration and when to give.

A

Full dose (300ug) privdes protection up to 15 ml of D + RBC’S

GIVEN: at 28th week of gestation ( 3rd trimester)

44
Q

Postpartum administration dose of RhIg and when to give.

A

Full dose of RhIg
GIVEN within 73 hours of delivery
If during delivery, a woman experiences FMH exceeding 30ml of D + RBCs, it is essential she receives more than one dose of RhIg

45
Q

IN postpartum administration, sample should be obtained within hour many hours to test massive fetomaternalhemorrhage?

A

Within 1 hour of delivery

46
Q

Rosette assay screen in ng test results.

A

< 1 rosette/ LPF = one dose of RhIg
> 1 rosette/ LPF = quantitate bleed -> Kleihauer Betke Test

47
Q

Screening test of postpartum administration.

A

Rosette assay

48
Q

Confirmatory test for postpartum administration

A

Kleihauer Betke test

49
Q

Used to quantify the nummer of fetal red cells in maternal circulation

A

Kleihauer Betke Test

50
Q

Kleihauer Betke Test result

A

Hemoglobin F - remain pink ( resistant to acid)
Maternal cells - ghost cells

51
Q

Blood smear morphology in RH HDN

A

Spherocytosis
Macrocytes
Hypochromia

IMMUNOHEMA REV (7 decks)

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