Professional Documents
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Fetal =
+ RBC
destruction
Mother¶s
antibodies
ï
' Although transfer of maternal antibodies is
good, transfer of antibodies involved in HaN
are directed against antigens on fetal RBCs
inherited by the father
' Most often involves antigens of the Rh and
ABO blood group system, but can result from
any blood group system
' Remember: The fetus is ï for an
antigen and the mother is for the
same antigen
ï
' HaN develops in utero
' The mother is sensitized to the foreign
antigen present on her child¶s RBCs usually
through some seepage of fetal RBCs
(
) or a previous
transfusion
' HaN occurs when these antibodies cross the
placenta and react with the fetal RBCs
|
' ABO incompatibilities are the most common
cause of HaN but are less severe
' About 1 in 5 pregnancies are ABO-incompatible
' 65% of HaN are due to ABO incompatibility
' Usually, the mother is type O and the child
has the A or B antigen«Why?
' Group O individuals have a high titer of
in addition to having IgM anti-A and anti-B
|
' ABO HaN can occur during the FIRST
pregnancy b/c prior sensitization is not
necessary
' ABO HaN is less severe than Rh HaN
because there is less RBC destruction
' Fetal RBCs are less developed at birth, so there
is less destruction by maternal antibodies
' When delivered, infants may present with mild
anemia or normal hemoglobin levels
' Most infants will have hyperbilirubinemia and
jaundice within 12 to 48 hours after birth
|
' Infant presents with jaundice 12-48 hrs after
birth
' Testing done after birth on cord blood
samples:
' Sample is washed 3x to remove Wharton¶s jelly
' Anticoagulated EaTA tube (purple or pink)
' ABO, Rh and aAT performed
' Most cases will have a positive aAT
' If aAT positive, perform elution to Ia antibody
|
' Only about 10% require therapy
' Phototherapy is sufficient
' Rarely is exchange transfusion needed
ï
' Antibody Ia
' Weakly reacting anti-a may be due to FMH or passively
administered anti-G (RhIg)
' If antibody is IgG, anti-a is most common followed by anti-K and
other Rh antibodies
!
' Paternal phenotype
' Amniocyte testing
' If mother has anti-a, then father probably is heterozygous for a
antigen
' Amniocytes can be tested as early as 10-12 weeks gestation to
detect the gene for the a antigen and any other antigens
!
' Antibody titration
' Antibody concentration is determined by antibody titration
' Mother¶s serum is diluted to determine the highest dilution that
reacts with reagent RBCs at 37°C (60 min) and AHG phase
' First sample is frozen and run with later specimens
' Testing is repeated at 16 and 22 weeks and 1- to 4- week
intervals after
' A aifference of >2 dilutions; or a score change of more than 10 is
considered a significant change in titer (
)
' A titer of 16-32 is significant
' >16 should be repeated at 18-20 weeks¶ gestation
' >32 indicates a need for amniocentesis or cordocentesis between
18-24 weeks¶ gestation
' <32 is repeated every 4 weeks (18-20 weeks) and every 2-4
weeks (third trimester)
' The agglutination reactions for each dilution are given a
corresponding score; scores are added:
' 4+ 12
' 3+ 10
' 2+ 8
' 1+ 5
' w+ 3
3+ +3 +3 +2 +2 +2 1+
10 + 10 + 10 + 8 + 8 + 8 + 5
= 59
"Oa
ð
' The ǻOa is plotted on the Liley graph
according to gestational age
' Three zones estimate the severity of HaN
' Lower: mildly or unaffected fetus (Zone 1)
' Midzone: moderate HaN, repeat testing (Zone 2)
' Upper: severe HaN and fetal death (Zone 3)
ð
a ǻOa of .206 nm
at 35 weeks
* correlates with
severe HaN
O
' Intrauterine transfusion is
done if:
' Amniotic fluid ǻOa is in high
zone II or zone III
' Cordocentesis has hemoblobin
<10 g/dL
' Hydrops is noticed on
ultrasound
' Removes bilirubin
' Removes sensitized RBCs
' Removes antibody
Fetomaternal Hemorrhage:
<1 rosette per 3 lpf = 1 dose of RhIg
>1 rosette per 3 lpf = Quantitate bleed
ù
' Quantitates the number of fetal cells in
circulation
' Fetal hemoglobin is resistant to acid and retain
their hemoglobin (appear bright pink)
' Adult hemoglobin is susceptible to acid and
leaches hemoglobin into buffer (³ghostÚ cells)
ù
Step 1) stain and count the amount of
fetal cells out of 1000 total cells counted
Step 2) calculate the amount of fetal
blood in cirulation by multiplying %fetal
cells by 50 mL
Step 3) divide mL of fetal blood by 30
(each vial protects against a 30 mL bleed
Step 4) Round the calculated dose up
add one more vial for safety
¢
a Positive a negative
Mother not a
candidate for a Negative a Positive
RhIg
Rosette test:
Screens for
FMH
Calculate dose
of
RhIg