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HDFN Flashcards

1
Q

term used to describe the condition in which maternal antibody is reacting with antigens on the baby’s rbcs

A

hemolytic disease of the fetus and newborn

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2
Q

pathophysiology of HDFN

A

maternal antibody crosses placental barrier to fetal circulation, attaches to corresponding antigens on baby’s RBCs, and antibody-coated cells are destroyed by macrophages in fetal spleen

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3
Q

HDFN maternal antibodies are what antibody class

A

IgG

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4
Q

placental transfer factor found on what antibody class?

A

IgG

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5
Q

pathophysiology behind name erythroblastosis fetalis

A

fetal marrow responds to moderate or severe disease by increasing red cell production (ERYTHROPOIESIS) and releases red cells into circulation before they mature resulting in nucleated red cells (ERYTHROBLASTS)

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6
Q

IgG subclasses more efficient at causing hemolysis

A

IgG1 and IgG3

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7
Q

which IgG subclass is associated with more severe HDFN?

A

IgG1

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8
Q

most common cause of ABO HDFN

A

anti-A,B from O mother

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9
Q

offending antibody in Rho HDFN

A

anti-Rho(D) or its combinations, anti-rh’(CD) and anti-rh’‘(DE)

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10
Q

most common reason for positive DAT in cord blood testing

A

ABO antibodies

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11
Q

jaundice in ABO HDFN

A

not present at birth, appears 6-24 hours after birth, resolved by bili lights

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12
Q

expected findings in ABO HDFN

A 
mild jaundice 24 hours after birth
spherocytosis
polychromasia
nRBCs
ABO incompatibility between mother and child
maternal Ab screen negative
cord DAT weakly positive or negative
presence of IgG anti-A, anti-B, or anti-A,B in cord plasma and eluate
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13
Q

can ABO HDFN occur in first pregnancy?

A

yes

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14
Q

can Rho HDFN occur in first pregnancy?

A

not expected

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15
Q

amount of D positive fetal blood needed to immunize D negative mother

A

0.1 mL

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16
Q

___ HDFN protects the fetus against ___ HDFN

A

ABO - Rh
ABO incompatible fetal cells will be rapidly removed from maternal circulation by anti-A or anti-B before anti-D can be produced

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17
Q

most common “other” HDFN

A

anti-K
anti-c
anti-E

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18
Q

what makes anti-K HDFN the most clinically significant “other” HDFN?

A

suppresses fetal erythropoiesis, which exacerbates fetal anemia

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19
Q

effects of HDFN in utero

A

anemia
increased hematopoiesis
hepatosplenomegaly
hydrops fetalis

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20
Q

what causes hepatosplenomegaly in HDFN?

A

liver and spleen enlarge due to increased RBC production, spleen removes baby’s antibody coated cells

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21
Q

what form of bilirubin is increased in HDFN?

A

indirect

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22
Q

how is indirect bilirubin cleared in utero in HDFN?

A

passes back into maternal circulation, conjugated by mother’s liver, excreted

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23
Q

hydrops fetalis

A

generalized edema
effusions
portal hypertension
cardiac failure

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24
Q

what causes kernicterus in HDFN?

A

unconjugated bilirubin builds up in infant because liver cannot process into direct bili and clear product (maternal liver no longer clearing after birth)
excess bili is toxic to brain tissues, leads to irreversibly damage to CNS and mental retardation

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25
effects of HDFN after birth
continued risk of hydrops fetalis/anemia jaundice 6 hrs after delivery kernicterus
26
why are premature infants more likely to be affected by kernicterus than full-term infants?
immaturity of blood-brain barrier
27
specific transferase that breaks down indirect bili to direct bili
uridine diphosphoglucuronyl transferase
28
half-life of IgG antibody
25 days
29
physiologic causes of neonatal jaundice other than HDFN
hyperbilirubinemia of premature infants hereditary spherocytosis congenital hemolytic anemia
30
metabolic causes of neonatal jaundice
maternal diabetes galactosemia G6PD deficiency pyruvate kinase deficiency
31
infection causes of neonatal jaundice
congenital syphilis hepatitis rubella CMV
32
drug cause of neonatal jaundice
overdose of vitamin K
33
prenatal testing to diagnose HDFN
``` identify at-risk women serologic testing on mom antigen type dad ultrasounds to monitor amniocentesis cordocentesis ```
34
semi-quantitative means of measuring the amount of antibody
antibody titration
35
prozone phenomenon in first titer tube due to?
excess antibody to antigen ratio
36
clinically significant antibody titer
initial 32 | change of 2 tubes or more
37
PUBS
percutaneous umbilical sampling of baby's blood
38
PUBS usually done when:
mother has history of HDN in her kids Ab titer is 32 or higher significant change in titer
39
PUBS can be performed as early as ___ weeks gestation
16
40
fluid drawn from amniotic sac about 26 weeks of pregnancy
amniocentesis
41
amniocentesis results plotted on _____
Liley Graph
42
analysis of amniotic fluid:
``` color turbidity contamination with blood pH dilution L/S ratio ```
43
antigen typing of father: homozygous
fetus is at risk of HDFN
44
antigen typing of father: heterozygous
fetus may be at risk of HDFN. genotype of fetus can be determined by PCR
45
what does fetal blood flow in brain show in HDFN?
increased flow = anemia in fetus. faster blood flows is greater degree of anemia
46
why may red cells from babies with Rho-HDN appear Rn negative at immediate spin?
D antigen site covered with mother's anti-D
47
weak D test result if baby has positive DAT
invalid
48
most important diagnostic test for HDN
Direct Coombs
49
lab testing on cord blood samples
Abo and Rh (Weak D on IS negative to Rh negative mom)
50
what is done if cord blood DAT is positive?
elution and ID of antibody | bilirubin testing
51
why is cord blood testing done on babies from type O mothers?
assess risk of ABO HDN due to anti-A,B
52
why is cord blood testing done on babies from Rh negative moms?
to determine need for RhIg
53
other testing ordered on some cord blood samples
RPR | agar gal on black and asian babies
54
prenatal management and treatment of ABO HDN
not routinely done
55
postnatal treatment of ABO HDN
phototherapy | exchange transfusion in severe cases
56
why is ABO HDN not routinely treated with prenatal management?
anti-A, anti-B titers don't correlate to disease severity | risks of fetal monitoring and fetal trx are greater than risk of ABO HDFN
57
ABO HDN occurrence in first born
40-50%
58
Rh HDN occurrence in first born
5%
59
DAT in Rh HDN
positive
60
DAT in ABO HDN
positive or negative
61
which HDN are spherocytes present?
ABO
62
which HDN frequently requires exchange transfusion?
Rh
63
treatment of severe HDFN
intrauterine transfusion early induction of labor exchange transfusion after birth human serum albumin
64
purpose of human serum albumin transfusion for HDFN
binds unconjugated bilirubin, preventing deposition in fat-rich brain cells
65
risk of human serum albumin transfusion for HDFN
can aggravate congestive heart failure
66
2 routes of transfusion for intrauterine transfusion
intraperitoneal | intravascular
67
intrauterine transfusion route where needle is inserted across maternal abdominal wall and uterine wall into fetal peritoneal cavity and catheter is threaded into peritoneal cavity of the fetus
intraperitoneal route
68
intrauterine transfusion route where fetal circulation is accessed through placental cord
intravascular route
69
IUT route that requires several days for absorption into vascular space
intraperitoneal
70
where are RBCs absorbed in fetus in intraperitoneal route?
subdiaphragmatic lymphatics
71
risks of IUT
``` perforation of internal structures bleeding from cord puncture site infection fetal bradycardia premature labor premature leakage of amniotic fluid ```
72
why does jaundice not occur before delivery?
bilirubin produced by breakdown of cells in fetal spleen passes via placenta to maternal circulation and excreted by liver
73
purpose of exchange transfusion
remove sensitized cells from baby's circulation introduce antibody-free cells with oxygen carrying capacity reduction of plasma bilirubin to prevent kernicterus reduction of circulating maternal antibody restore normal cardiac function
74
blood requirements for intrauterine or exchange transfusion
``` irradiated CMV reduced risk hemoglobin S negative lack corresponding antigen less than 7 days old preferred ```
75
what may be used for red cells in exchange transfusion if it is difficult to find antigen negative blood due to high antigen frequency or multiple antibodies?
mother's washed red cells

CCHS SBB (40 decks)

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