Hemolytic Diseae of Newborn

Question 1

Fetal and Neonatal Erythropoiesis

Answer 1

Fetal Sites of Hematopoiesis
- Yolk sac, Liver, Bone Marrow
- Hgb F

Question 2

Newborn RBC

Answer 2

45-70 day life
53-90% Hgb F (high O2 affinity)

Question 3

Newborn RBC at 40 weeks

Answer 3

Cord Blood Hgb = 19 +/- 2.2 g/dl

Question 4

Infant Size

Answer 4

Smaller transfusion volume

Question 5

Hypovolemia

Answer 5

Not enough volume, not right blood pressure
Leads to decreased O2 in tissues and acidosis
Transfuse “whole blood” - transfuse pRBC O cells using AB plasma

Question 6

Cold Stress

Answer 6

0% fat
MUST use blood warmers

Question 7

Newborn Immunologic Status

Answer 7

Maternal Antibodies
- Baby has mom IgG, transfuse with antigen negative blood
Graft vs Host - give irradiated pRBCs

Question 8

Metabolism Concerns

Answer 8

K+ Levels and 2,3 DPG Levels
Need Fresh Blood

Question 9

CMV

Answer 9

MUST give true CMV negative blood

Question 10

Decreased RBC Survival

Answer 10

Increased RBC production
Nucleated RBCs

Question 11

Erythroblastosis fetalis

Answer 11

Hct - 15% or less

Question 12

Size of Liver and Spleen

Answer 12

Increased

Question 13

Anemia

Answer 13

Hydrops fetalis
Severe anemia
Cardiac Failure and Death
Likely Requires Intrauterine Transfusion

Question 14

Three Main Categories of HDN

Answer 14

ABO HDN
Rh HDN
HDN due to other antibodies

Question 15

ABO HDN

Answer 15

Maternal IgG ABO Antibody (Type O mothers IgG)
Less Severe

Question 16

Rh HDN

Answer 16

Maternal IgG Anti-D
Most Severe

Question 17

HDN Due to other antibodies

Answer 17

Maternal IgG Antibody

Question 18

Maternal Immunization for ABO HDN

Answer 18

Naturally occuring antibodies
A or B infants with Group O Mother
- Tyoe AB mother do NOT cause HDN

Question 19

Maternal Immunization Rh Immune Globulin (Rhogam)

Answer 19

IgG Anti-D
Administered at 28 weeks
Administered Post Partum
Mimics ABO Incompatibility Effect (may cause pos DAT on baby)

Question 20

Prenatal Testing on Mother

Answer 20

ABO/Rh - includes weak D testing
Antibody Screen
- Antibody Identification
- Antibody Titer (if High Risk)
- 1:32 titer or higher associated with severe HDN

Question 21

Other Prenatal Testing

Answer 21

Father’s Antigen Status

Question 22

28 week Prenatal Testing

Answer 22

For Rh Negative Mothers
- ABO/Rh
- Antibody Screen
- Rh Ig

Question 23

Monitor of HDN Severity

Answer 23

Amniocentesis
- Rh neg mothers with high-titer anti D or previously affected pregnancies
- LEvel of bile pigment in amniotic fluid - Optical Density 450nm

Question 24

PUB Sample Testing (Percutaneous Umbilical Blood)

Answer 24

Very risky procedure
Umbilical Vein
ABO/Rh
DAT
Cord Hgb
Bilirubin
CBC
Antigen Typing

Question 25

Fetal Lung Maturity

Answer 25

Consideration of Early Delivery Ratio of Lecithin to Sphingomylin (L/S Ratio) If fetus <29 weeks or severe HDN indicated

Question 26

L/S Ratio >2.0:1

Answer 26

Mature

Question 27

L/S Ratio 1.5:1

Answer 27

40% respiratory distress Physician and mom call if should deliver early

Question 28

L/S Ratio <1.5:1

Answer 28

70% respiratory distress Choose to do intrauterine transfusion

Question 29

Intrauterine Transfusion

Answer 29

Risky Procedure RBCs infused through fetal abdominal wall or umbilical vein Repeated with small volumes until delivery

Question 30

Intrauterine Transfusion Products

Answer 30

Fresh RBCs (<7 days old); Hct = 80% Washed RBCs CMV Negative or Leukodepleted Irradiated Group O, Rh Negative reconstituted with AB plasma - MUST be negative for antigen corresponding to mom Ab

Question 31

Post Delivery Testing

Answer 31

ABO/Rh DAT

Question 32

ABO/Rh Post Delivery

Answer 32

No reverse Group Weak D Testing

Question 33

DAT Post Delivery

Answer 33

anti IgG AHG Positive - elute Ab and identify ID Ab in maternal or cord serum

Question 34

Exchange Transfusion Helps

Answer 34

Remove antibody-coated RBCs Controls anemia Removes Bilirubin - Prevents Kernicterus

Question 35

Blood Products for Exchange Transfusion

Answer 35

Group O RBCs Must be compatible with maternal antibody Rh compatible with mother and infant

Question 36

Complications of Exchange Transfusion

Answer 36

Cardiac (if go to fast) Vascular-Mechanical (destroy too many cells) Infections Hematologic-Coagulation Immunologic (GVHD) Hypothermia

Question 37

Post Delivery Testing Mother

Answer 37

ABO/Rh (weak D) IAT FMH Screen (possibly) Kleihauer-Betke Stain

Question 38

FMH Screen

Answer 38

Performed on D negative mom Must be anti-D negative

Question 39

Kleihauer-Betke Stain

Answer 39

Determine amount of fetal blood mom was exposed to Hgb F resistant to acid denaturation

Question 40

RhIg Calculation

Answer 40

(% fetal cells x 50)/30

Question 41

First dose of RhIg

Answer 41

28 weeks Rh Negative mother No Immune Anti D

Question 42

RhIg After Delivery

Answer 42

Within 72 hours Rh Negative Mother No Immune Anti D Rh Positive Baby

Question 43

Group O Mother Group O, A, B Baby

Answer 43

pRBCs Group O

Question 44

Group A Mother Group O or B Baby

Answer 44

pRBCs Group O

Question 45

Group A Mother Group A or AB Baby

Answer 45

pRBCs Group A or O

Question 46

Group B Mother Group O or A

Answer 46

pRBCs Group O

Question 47

Group B Mother Group B or AB Baby

Answer 47

pRBCs B or O

Question 48

Group AB Mother Group A Baby

Answer 48

pRBCs Group A or O

Question 49

Group AB Mother Group B Baby

Answer 49

pRBCs Group B or O

Question 50

Group AB Mother Group AB Baby

Answer 50

pRBCs Group AB, A, B, or O