HDFN

Question 1

perinatal (near birth)

Answer 1

20 weeks to 28 days after birth

Question 2

neonate (newborn)

Answer 2

day 0 to 4 weeks

Question 3

infant

Answer 3

4 weeks to 1 year

Question 4

gravid

Answer 4

pregnant

Question 5

gravida

Answer 5

number of pregnancies a single patient has had, regardless they result in a birth

Question 6

para (parity)

Answer 6

number of pregnancies a patient has had that have reach viability

Question 7

HDFN

Answer 7

destruction of RBC’s of the fetus or neonate by maternal antibodies

Question 8

2 most common types of HDFN caused by

Answer 8

Rh antibodies and ABO antibodies

Question 9

as little as ____ of fetal RBC’s are enough to stimulate formation of anti-D

Answer 9

1 mL

Question 10

what happens to fetus

Answer 10

RBC’s lyse– release Hgb– indirect bili (does not cause a problem because will cross placenta and mother will conjugate)

Question 11

what happens to neonate

Answer 11

RBC destruction after birth; can’t effectively conjugate bili and can’t excret = jaundice

Question 12

how much bili is toxic

Answer 12

18-20

Question 13

bili is brain called

Answer 13

kernicterus: seizures, poor feeding cerebral palsy

Question 14

unconjugated bili (indirect)

Answer 14

insoluble

Question 15

conjugated bili

Answer 15

water soluble

Question 16

prenatal testing

Answer 16

mother type and screen

Question 17

if screen is positive tech must do panel

Answer 17

if they have anti-D need to determine if true anti-D or had RhoGham

Question 18

if true anti-D

Answer 18

order antibody titration and antigen typed

Question 19

antibody titration

Answer 19

twofold serial dilution of maternal plasma

test against RBC’s that are homozygous for specific antigen

Question 20

express titer as

Answer 20

reciprocal of highest diltuion

Question 21

KNOW TITER SCORE

Answer 21

yeah

Question 22

if titer increases during pregnancy

Answer 22

fetus is presumed antigen positive and at risk for HDFN

Question 23

rhIG is over titer of

Answer 23

4

Question 24

if titer >8

Answer 24

a second titer needed at 18-20 weeks

Question 25

if titer >16

Answer 25

fetus will need middle cerebral artery peak systolic velocity (tells how anemic fetus is )

Question 26

if 16 or less titer

Answer 26

needs to be measured every 2-4 weeks from 2nd trimester on

Question 27

if consistently less than 16 titer

Answer 27

it is lower risk

Question 28

rho gham

Answer 28

binds positive fetal cells and removed from circulation

Question 29

1 dose of rhoghan =

Answer 29

elimnate 30 mL of fetal whole blood

Question 30

FMH

Answer 30

used to detect small amounts of rh + in maternal circulation

Question 31

if FMH +

Answer 31

specific quantity of fetal cells must be calculated and determine dosage of RhoGHAM (Kleihauer-Betke) or flow cytometrey

Question 32

if FMH -

Answer 32

still give 1 dose of rhogham

Question 33

FMH is determined by

Answer 33

how mant rossettes per field

Question 34

kleihauer-betke test

Answer 34

count 3000 cells volume of FMH= number of fetal cells x 5,000mL/ total cells round down answer and + 1

Question 35

principle of kleihauer-betke test

Answer 35

adult Hgb is not resistent to acid so washed out

Question 36

testing for newborns

Answer 36

cord blood ABO/Rh - forward and DAT

Question 37

washing is important for cord blood testing to get rid of

Answer 37

wharton's jelly

Question 38

if DAT is + for newborn perform

Answer 38

elution and ID antibody

Question 39

most common form of HDFN

Answer 39

ABO HDFN

Question 40

small pool of anti-A and anti-B can cross placenta because

Answer 40

IgG

Question 41

normal culprint of ABO HDFN is

Answer 41

anti- A,B

Question 42

who makes anti-A,B IgG

Answer 42

group. O

Question 43

what type of mothers most likely to have ABO imcompatibility

Answer 43

group O

Question 44

mothers that are imcompatible with fetal RBC's for BOTH ABO and D are

Answer 44

protected from sensitization to D

Question 45

why are they protected

Answer 45

incompatible cells are destroyed in maternal circulation before anti-D can be formed

Question 46

treatment of HDFN

Answer 46

phototherapy, intrauterine transfusion, exchange transfusion

Question 47

phototherapy

Answer 47

utilizes light box or bili blanket

Question 48

how does phototherapy work

Answer 48

the light isomerizes unconjugated bili and makes it water soluble so it can be excreted

Question 49

intrauterine transfusion

Answer 49

inject "pedi-pak" into umbilical vein (adds irradiation)

Question 50

indications of intrauterine transfusion

Answer 50

middle cerebral artery-peak systolic velocity, cordocentesis, amniocentesis, hydrops fetalis

Question 51

what is the goal intrauterine transfusion

Answer 51

maintain Hgb >10 for rest of pregnancy