Session 1 - Group Work Flashcards
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
a) What are the main blood groups defined by the ABO system?
A
B
O
AB
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
b) Describe the role of antibodies involved in blood transfusion reactions
Antibodies attack the different antigens in the
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
c) What is the other common antigen group present on red blood cells?
Rhesus positive and negative
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
d) The baby is found to have a profound anaemia and jaundice.
Describe the symptoms or signs of jaundice.
Yellow skin, sclera and nails.
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
e) Describe how lysis of red blood cells cause jaundice in the newborn
Lysis of RBC releasing bilirubin. Bilirubin is conjugated in liver so this will lead to unconjugated bilirubin build up.
Prehepatic jaundice
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
f) What is the main complication of increased bilirubin levels for the baby?
Kernicterus - a form of cerebral palsy that is a problem with the DEVELOPING brain, hence doesn’t occur in adults but only newborns.
(In adults it’s hepatic encephalopathy.
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
g) Which lab tests could be performed during pregnancy to confirm destruction of red blood cells?
Amniocentesis - look for evidence of bilirubin
Can sample foetal blood through umbilicus
?Direct Coombs test
Give every Rhesus -ve woman anti-D.
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
h) The baby is found to suffer from the Haemolytic Disease of the Newborn (HDN). This condition frequently occurs when a rhesus D negative mother carries a rhesus D positive baby like the father.
Explain the type of hypersensitivity reaction responsible for the HDN.
Birth of first child you get mixing of the two bloods, but Rhesus +ve antibodies only crosses at trauma i.e. birth.
Type II hypersensitivity
IgG
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
The baby is found to suffer from the Haemolytic Disease of the Newborn (HDN). This condition frequently occurs when a rhesus D negative mother carries a rhesus D positive baby like the father.
i) There are different classifications of haemolytic anaemia and the list of possible causes is long. I suggest you write down 3 or 4 causes identifying those that were mentioned during year 1.
Autoimmune haemolytic anaemia
Microangiopathic haemolytic anaemia
Thalassemia
Sickle cell anaemia
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
The baby is found to suffer from the Haemolytic Disease of the Newborn (HDN). This condition frequently occurs when a rhesus D negative mother carries a rhesus D positive baby like the father.
j) How could the medical team predict the development of HDN?
Test the blood type of the parents - firstly the mother then if Rhesus -ve then the ‘man friend’.
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
The baby is found to suffer from the Haemolytic Disease of the Newborn (HDN). This condition frequently occurs when a rhesus D negative mother carries a rhesus D positive baby like the father.
k) Explain why the couple’s first baby was born with no complications
The first reaction so the IgM antibodies are being made in the first presentation because they don’t cross the placentas. However, now the mother has been exposed, she now has the IgG antibodies which can cross the placenta and will attack the baby.
1) A 24-year-old woman, who is a recent refugee from a developing country, is pregnant for the second time. She is worried because she feels that something is not quite right, as the baby is not moving as often as her first one who was born abroad without complications and is currently healthy. The doctor discovered that the woman has blood type of A rhesus negative while her husband is also blood group A but positive for the rhesus D antigen. The doctor immediately ordered an ultrasound scan that reveals signs of foetal distress. Labour is induced and a baby girl is born.
The baby is found to have a profound anaemia and jaundice.
The baby is found to suffer from the Haemolytic Disease of the Newborn (HDN). This condition frequently occurs when a rhesus D negative mother carries a rhesus D positive baby like the father.
i) Why does a mismatch of the ABO system rarely causes HDN?
IgG anti-A (or IgG anti-B) antibodies that enter the fetal circulation from the mother find A (or B) antigens on many different fetal cell types, leaving fewer antibodies available for binding onto fetal red blood cells.
Fetal RBC surface A and B antigens are not fully developed during gestation and so there are a smaller number of antigenic sites on fetal RBCs
Rhesus must be a stronger antigen.
