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WACS > RHESUS INCOMPATIBLE PREGNANCY > Flashcards

RHESUS INCOMPATIBLE PREGNANCY Flashcards

1
Q

% of whites, blacks and Asians that are RH negative

A

Whites - 15%
Blacks - approx, 6%
Asians - <1%

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2
Q

% prevalence of Rh D negativity in pregnancy in Nigeria

A

4.5 - 5.5%

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3
Q

How many ml of Rh D positive blood can cause sensitization

A

< 1ml

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4
Q

T/F: With sensitization, all Rh D negative women become isoimmunized

A

F
30% of rhesus D-ve will not be isoimmunized despite sensitization

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5
Q

% of Rh D negative women that will not be isoimmunized despite sensitization

A

30%

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6
Q

After sensitization how long does it take for antibodies in maternal blood to reach equilibrium in fetal circulation

A

1 month

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7
Q

How many antigens are in the rhesus system

A

61

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8
Q

The 5 major types of antigens in the rhesus system that can cause significant transfusion reactions are

A

C, c, D, E, e and anti-kell

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9
Q

List the 5 antigens of the rhesus system in the order of decreasing immunogenicity

A

D>c>E>C>e

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10
Q

T/F: Anti-D antibody is the most common cause of haemolytic dx

A

T in most countries

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11
Q

4 in-utero effects of Rh isoimmunization on the fetus

A

Hyperbilirubinaemia
Fetal anaemia
Hydrops fetalis
Intrauterine fetal death

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12
Q

4 short term effects of Rh isoimmunization in neonatal life

A

Neonatal jaundice
Neonatal anaemia
Early neonatal death
Hyporegenerative anaemia
(Hyporegenerative anaemia due to transient suppression of erythropoiesis, common with multiple in-utero transfusions)

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13
Q

2 long term effects of Rh isoimmunization on the baby

A

Brain damage
Sensorinueral deafness

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14
Q

9 potential sensitizing events for Rh disease

A
  1. Miscarriage
  2. Termination of pregnancy
  3. Antepartum haemorrhage
  4. Invasive prenatal testing e.g.
    CVS, amniocentesis,
    cordocentesis
  5. Fetal medicine procedures e.g.
    shunt insertions
  6. Delivery
  7. External cephalic version
  8. IUFD
  9. Abdominal trauma
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15
Q

3 factors determining risk of sensitization

A
  1. Volume of fetomaternal blood
    exchanged
  2. Maternal immune response
  3. Concurrent ABO incompatibility
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16
Q

What is the routine prophylactic management of unsensitized Rh negative women in pregnancy

A

Blood for Rh antibodies at 28 & 34wks before anti-D

17
Q

Outline with 4 points the antenatal management of unsensitized Rh D negative women using free fetal DNA

A

Free fetal DNA at 15 – 16wks

FBC and Rh antibodies at 28wks regardless of FFDNA results

Fetus positive
Give Anti-D 1500iu stat

Fetus negative
Do not give Anti-D

18
Q

T/F: To prevent isoimmunization Anti-D prophylaxis should be given within 72 hours of any sensitizing event

A

T

19
Q

The test used to estimate the degree of fetomaternal haemorrhage (FMH)

A

Kleihauer Betke test

20
Q

T/F: Kleihauer Betke test can be used to calculate the amount of anti D to be given

A

T

21
Q

What is the prevalence of massive fetomaternal haemorrhage at delivery

A

1/1000 deliveries

22
Q

At what GA should anti D be given prophylactically

A

28 weeks and 34 weeks

23
Q

T/F: Administration of 1dose of 1500iu (300µg) of Anti-D between 28 - 30weeks gestation is as effective at reducing haemolytic disease as 2 doses of 500iu (100µg) at 28 and 34 weeks gestation

A

T

24
Q

T/F: Once sensitized, it is not reversible with anti-D

A

T

25
Q

T/F: Rhesus disease gets worse with successive pregnancies

A

T

26
Q

How often should you monitor antibody levels in an already sensitized pregnant woman

A

every 4 weeks from booking till 28 weeks, then 2-weekly till delivery

27
Q

T/F: Antibody titre - does not correlate well with development of HDFN

A

T

28
Q

HDFN is unlikely at what level of antibody titre

A

< 4 IU/ml

29
Q

At what level of antibody titre is the risk of HDFN moderate

A

4 – 15 IU/ml

30
Q

At what level of antibody titre is the risk of hydrops fetalis very high

A

> 15 IU/ml

31
Q

With high antibody, 2 methods of checking for fetal anaemia

A

Bilirubin concentration in amniotic fluid

Middle cerebral artery doppler (MCA) peak velocity measurement – increased risk of anaemia if raised

32
Q

At what GA will you deliver an already sensitized woman

A

Aim at delivery at 36- 37 weeks unless there are specific reasons to conduct this earlier, e.g. severe hydrops unresponsive to transfusion or services unavailable

33
Q

4 methods of in utero blood transfusion

A

Intra-umbilical
Intrahepatic
Intraperitoneal
Intracardiac

34
Q

6 qualities of blood that should be used for in utero transfusion

A
  1. Rh negative
  2. Crossmatched with maternal
    blood’
  3. Densely packed (30g/dl)
  4. Irradiated
  5. CMV negative
  6. White cell depleted
35
Q

T/F: For all Rh-ve mothers, take cord blood at delivery for FBC, blood group and indirect Coomb’s test

A

T

36
Q

T/F: All women should have their blood group and antibody status determined at booking and at 28 weeks of gestation

A

T

37
Q

Timing of delivery for women with red cell antibodies that can cause fetal anaemia will depend on –, – and –

A

The antibody levels/titres

The rate of rise of antibodies

History of having had any fetal therapy in index pregnancy

WACS (19 decks)

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