Flashcards in Rhesus Allo-immunisation Deck (16):
What are the principles of antibody mediated disease
Mother exposed to antigen mother produces an Ab Ab cross placenta fetal sequelae
Define autoimmunity and alloimmunity. Give examples.
Autoimmunity is antibody against an antigen the mother has herself (thyroid, connective tissue disease, immune thrombocytopenic purpura)
Alloantibody is Ab against antigen mother does not have (red cell alloimmunisation, perinatal alloimmune thrombocytopenia, perinatal alloimmune neutropenia).
Red cell allo immunisation, list harmful and harmless types
Harmful: Rhesus D, c, C, E, Kell, Kidd, Duffy, MNS
Harmless: ABO (A, B) IgM doesn't cross placenta; Lewis IgG fetus don't have this; P
Perinatal allo immune neutropenia --> consequence and treatment.
infection (bacterial sepsis)
Abx & immunoglobulin (NOT white cell infusion b/c will attack self)
Consequence of red cell immunisation by severity.
Mild (50%) - mild jaundice
Moderate (25%) - severe jaundice, mild anaemia
Severe (25%) - severe anaemia, hydrops, FDIU
Class severity of Red Cell immunisation via Ab Titre
Incidence of red cell immunisation in pregnancy
1% all pregnancies
85% AntiD, 15% others (Kell, c, E, Fya)
Primary immunisation occurs via?
Feto maternal haemorrhage (bleeding = abortion, miscarriage, ectopic, APH); (trauma = amniocentisis, CVS, ext version, MVA)
Occult (usually after 28/40, prophylactic antiD at 28-34 wks 90% prevented)
Secondary immunisation how does it work?
passively give anti-D, it blocks antigenic sites on foetal RBCs circulating in mother so mother's WBCs can't see antigen and cannot initiate antibody production.
Who is screened for anti red cell Abs?
Everyone is screened (all pregnancies screened for anti-red cell Ab at first antenatal visit) 1% positive.
Rh-ve women (15% of population) screened at 1st antenatal visit, 28wks AND delivery
Mx of woman with anti-red cell antibodies in pregnancy - 1st antenatal visit
confirm pregnancy, gest age, routine screen
-risk allocation (Ab titre)
-partner grouping (dd = no issue, DD = treat, Dd = fetal DNA typing via amniocentesis (NO CVS to avoid fetal-maternal haemorrhage) or use free fetal DNA from maternal blood)
- general advice
- booking for maternal fetal medicine subspecialist
Mx of woman with anti-red cell antibodies in pregnancy - subsequent antenatal visit
Low risk (Ab titre each visit; deliver 38 wks)
Med risk (Ab titre each visit; U/S from 20wks for MCA; CTG 32 wks b/c MCA PSV less reliable in later pregnancy; deliver at 38 wks)
High risk (U/S from 17wks; fetal blood sampling if MCA PSV increased; intrauterine transfusion if fetal anaemia)
Intrauterine transfusion - what type of blood?
Maternal RBC but w/o plasma as Ab inside it
Prevention of immunization
Blood transfusion for women (RhD compatible, Kell-ve)
Feto maternal haemorrhage (administer passive anti-D; use at sensitizing events e.g. bleeding/trauma/ routine 28 and 34wks/post delivery; volume use Kleihauer test to estimate haemorrhage amount; timing within 72hrs of event; contraindication if already immunised it won't help)
Principal of passive anti D?
You passively give anti-D, it blocks antigenic sites on foetal RBCs circulating in mother so mother's WBCs can't see antigen and cannot initiate antibody production