Chapter 13Hemolytic Disease of the Fetus        and Newborn     Mosby items and derived items © 2009 by Mosby, Inc., an af...
Hemolytic Disease of the Fetus       and Newborn (HDFN)   A disorder of the fetus or newborn in which    fetal red blood ...
Etiology in Fetus   The mother is exposed during first    pregnancy   In a subsequent pregnancy, IgG    antibodies cross...
Etiology in Newborn   After delivery, red cell destruction continues   Indirect bilirubin is still being released   New...
Figure 13-1From Ortho Diagnostics: Blood group antigens and antibodies as applied to hemolytic disease of the fetus and ne...
Rh HDFN   Anti-D responsible for most severe cases    of HDFN   Alloimmunization occurs during first    pregnancy if bab...
ABO HDFN   More common, but most cases are    subclinical and do not need treatment   If jaundice develops, mild cases c...
Alloantibodies Causing HDFN   Any IgG antibody is capable of causing    HDFN if the fetal red cells possess    antigens t...
Table 13-1Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.   9                  Some mat...
Prediction of HDFN   Prenatal testing should be done   D-negative mothers need to be identified   Mothers who have anti...
Box 13-1Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.   11                  Some mate...
Antibody Titration   Commonly used to predict severity of HDFN   Titer done early in pregnancy   Repeated at 16 to 22 w...
Amniocentesis   Measurement of bilirubin in amniotic fluid    can help indicate level of red cell    destruction   Aspir...
Figure 13-2From Mollison PL, Engelfriet CP, Conteras M: Blood transfusion in clinical medicine, ed 9, London, 1993, Blackw...
Liley GraphThe Liley graph defines three zones to  estimate severity:   Correlates with severe if results are in the top ...
Interpretation of Liley Graph   Based on amniotic fluid analysis   Three alternatives exist:    - Allow pregnancy to con...
Postpartum Testing   Collect sample of cord blood   Sample should be labeled and stored up to    7 days   All infants b...
Testing on Infants with Suspected              HDFN   A diagnosis is based on medical history,    physical examination, a...
Prevention of HDFN   RhIG provides protection for 30 mL of fetal whole    blood   A 300-µg dose is routinely administere...
Postpartum Administration   Cord blood from all infants born to D-    negative women should be tested for D    antigen  ...
Screening for Fetomaternal         Hemorrhage (FMH)   If during delivery a woman exceeds an    FMH greater than 30 mL of ...
Figure 13-4                     Courtesy Gamma Biologicals, Houston.Mosby items and derived items © 2009 by Mosby, Inc., a...
Quantifying FMH   Kleihauer-Betke acid elution is the method most    frequently used to quantify the number of fetal    c...
Figure 13-5Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.   24                  Some m...
Treatment of HDFN   In utero treatment includes intrauterine    transfusions to correct anemia   Recently PUBS has been ...
Postpartum Treatment   Phototherapy: Infants are exposed to blue    light in the 420- to 475-nm range   If infant fails ...
Box 13-5Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.   27                  Some mate...
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Ppt hemolytic disease of the newborn & fetus

  1. 1. Chapter 13Hemolytic Disease of the Fetus and Newborn Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Some material was previously published.
  2. 2. Hemolytic Disease of the Fetus and Newborn (HDFN) A disorder of the fetus or newborn in which fetal red blood cells are destroyed by maternal IgG antibodies The IgG antibodies cross the placenta and shorten red cell survival The premature red cell destruction results in disease varying from mild anemia to death in utero Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Some material was previously published.
  3. 3. Etiology in Fetus The mother is exposed during first pregnancy In a subsequent pregnancy, IgG antibodies cross the placenta The antigens bind to fetal cells and red cells are destroyed, liberating hemoglobin The hemoglobin is metabolized to indirect hemoglobin Anemia occurs, which can lead to death Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Some material was previously published.
  4. 4. Etiology in Newborn After delivery, red cell destruction continues Indirect bilirubin is still being released Newborn liver does not produce glucuronyl transferase to process the indirect bilirubin High indirect bilirubin levels result in jaundice and also can cause brain damage, deafness, mental retardation, or death Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Some material was previously published.
  5. 5. Figure 13-1From Ortho Diagnostics: Blood group antigens and antibodies as applied to hemolytic disease of the fetus and newborn, Raritan, NJ, 1968, Ortho Diagnostics. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Some material was previously published.
  6. 6. Rh HDFN Anti-D responsible for most severe cases of HDFN Alloimmunization occurs during first pregnancy if baby is D-positive but rarely results in clinical symptoms Following antibody production, subsequent pregnancies with a D-positive infant are affected to varying degrees Rh immune globulin (RhIG), introduced in 1968, dramatically reduced the incidence of Rh HDFN Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Some material was previously published.
  7. 7. ABO HDFN More common, but most cases are subclinical and do not need treatment If jaundice develops, mild cases can be treated by phototherapy Usually group O mothers with group A or B infants Unlike D, can affect first pregnancy Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Some material was previously published.
  8. 8. Alloantibodies Causing HDFN Any IgG antibody is capable of causing HDFN if the fetal red cells possess antigens that the mother lacks Anti-c is the second most common cause of HDFN; can be in combination with anti- D Next is anti-K Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Some material was previously published.
  9. 9. Table 13-1Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Some material was previously published.
  10. 10. Prediction of HDFN Prenatal testing should be done D-negative mothers need to be identified Mothers who have antibodies capable of causing HDFN need to be identified Maternal history is also important Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Some material was previously published.
  11. 11. Box 13-1Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Some material was previously published.
  12. 12. Antibody Titration Commonly used to predict severity of HDFN Titer done early in pregnancy Repeated at 16 to 22 weeks and repeated at 1- to 4-week intervals A twofold rise in titer is an indication for further monitoring To ensure significance, titers should be done using the same method and cells Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Some material was previously published.
  13. 13. Amniocentesis Measurement of bilirubin in amniotic fluid can help indicate level of red cell destruction Aspirated fluid is scanned on a spectrophotometer from 350 to 700 nm. The change in optical density above the baseline 450 nm is plotted on a Liley graph Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Some material was previously published.
  14. 14. Figure 13-2From Mollison PL, Engelfriet CP, Conteras M: Blood transfusion in clinical medicine, ed 9, London, 1993, Blackwell Science. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Some material was previously published.
  15. 15. Liley GraphThe Liley graph defines three zones to estimate severity: Correlates with severe if results are in the top zone Mid zone correlates with moderate Bottom zone correlates with mild HDFN Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Some material was previously published.
  16. 16. Interpretation of Liley Graph Based on amniotic fluid analysis Three alternatives exist: - Allow pregnancy to continue - Perform intrauterine transfusion - Induce labor If labor is to be induced, L/S ratio needs to be done to determine fetal lung maturity Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Some material was previously published.
  17. 17. Postpartum Testing Collect sample of cord blood Sample should be labeled and stored up to 7 days All infants born to D-negative mothers should be tested for D, including weak D D-negative mothers of D-positive infants, including weak D-positive infants, are candidates for RhIG Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Some material was previously published.
  18. 18. Testing on Infants with Suspected HDFN A diagnosis is based on medical history, physical examination, and lab testing on mother and infant Tests to be performed:  ABO only forward type  D testing  Direct antiglobulin test if positive elution is done  Eluate should be tested against A, B, and O cells  Negative with all cells, low-frequency antibody Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Some material was previously published.
  19. 19. Prevention of HDFN RhIG provides protection for 30 mL of fetal whole blood A 300-µg dose is routinely administered to D- negative mothers antepartum at 28 weeks’ gestation Also administered to D-negative mothers after amniocentesis, abortion, termination of ectopic pregnancy, chorionic villus sampling, percutaneous umbilical blood sampling (PUBS), or abdominal trauma Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Some material was previously published.
  20. 20. Postpartum Administration Cord blood from all infants born to D- negative women should be tested for D antigen Any D-negative woman who delivers a D- positive infant is given a full dose of RhIG within 72 hours of delivery There should be a history of negative antibody screen during the current pregnancy Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Some material was previously published.
  21. 21. Screening for Fetomaternal Hemorrhage (FMH) If during delivery a woman exceeds an FMH greater than 30 mL of D-positive fetal cells, it is essential that she receive more than one dose of RhIG Currently most frequently used method to screen for FMH is the rosette test Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Some material was previously published.
  22. 22. Figure 13-4 Courtesy Gamma Biologicals, Houston.Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Some material was previously published.
  23. 23. Quantifying FMH Kleihauer-Betke acid elution is the method most frequently used to quantify the number of fetal cells in the mother’s circulation Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Some material was previously published.
  24. 24. Figure 13-5Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Some material was previously published.
  25. 25. Treatment of HDFN In utero treatment includes intrauterine transfusions to correct anemia Recently PUBS has been used to transfuse directly into the umbilical vein Blood for intrauterine transfusion should be group O, D-negative RBCs less than 7 days old, irradiated, cytomegalovirus (CMV) negative, and hemoglobin S negative Donor cells are crossmatched with mother’s serum Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Some material was previously published.
  26. 26. Postpartum Treatment Phototherapy: Infants are exposed to blue light in the 420- to 475-nm range If infant fails to respond, exchange transfusion is needed For exchange transfusion, ABO and D testing is done on infant. Mother’s plasma is used for antibody screen CMV and hemoglobin S negative blood used Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Some material was previously published.
  27. 27. Box 13-5Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Some material was previously published.
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