This chapter discusses hemolytic diseases including hemolytic transfusion reaction, autoimmune hemolytic anemia, and hemolytic disease of the fetus and newborn. HDFN is caused by maternal IgG antibodies crossing the placenta and destroying fetal red blood cells. The major causes of HDFN are Rh and ABO incompatibility. RhIG is given to Rh-negative mothers to prevent Rh alloimmunization. Severe HDFN may be treated with exchange transfusions to reduce bilirubin levels and antibody concentrations in the infant.
hemolytic disease of new born is an aquire alla immune hemolytic anemia characterize by production extravascular destruction of RBC within the spleen of new born baby resulting anemia, positive coomb,s test
hemolytic disease of new born is an aquire alla immune hemolytic anemia characterize by production extravascular destruction of RBC within the spleen of new born baby resulting anemia, positive coomb,s test
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. 2
Content
Hemolytic transfusion reaction
Autoimmune Hemolytic Anemia (AIHA)
Hemolytic Disease of the Fetus and New born
(HDFN)
Rho (D) Immune Globulin (Human) – RhIG -mod
Treatment of Infants Suffering from HDFN
3. 3
Learning objectives
At the end of this chapter, the student will be able to:
Explain the cause and laboratory diagnosis of the
different hemolytic diseases .
Explain the cause and consequence of HDN due
to ABO and Rh incompatibility.
Name the major immunoglobulin class responsible
for hemolytic disease of the new born
4. 4
Learning..
Explain the different etiology HDN
Describe the prenatal treatments that are
significant in HDN caused by anti-D.
Compare and contrast the HDN caused due to
ABO and Rh incompatibility.
Describe how to prevent Rh-alloimmunization.
5. 5
6.1 Hemolytic Transfusion reaction (HTR)
Is a condition in which there is intravascular
destruction of transfused RBCs
Is mainly caused by antibodies of the ABO and
Rh system.
Clinical consequences include
Disseminated intravascular hemolysis(DIC)
Hypotension
Irreversible shock and renal failure
6. 6
6.2 Autoimmune Hemolytic Anemia (AIHA)
Brought about through the interaction of red
cells and auto antibodies.
Classified into four groups
warm-reactive auto antibodies
cold- reactive auto antibodies
paroxysmal cold hemoglobinuria and
drug induced hemolysis.
7. 7
AIHA…
The diagnosis depends on the demonstration of
auto antibodies on the patient’s red cells using
the DAT.
The autoimmune antibodies are either
‘warm antibody’ type or
‘cold antibody’ type.
8. 8
AIHA…
The warm antibodies are active at 370C
The cold types are optimally active at 20C but
with a temperature range which may go as high
as 320C.
9. 9
AIHA…
A positive DAT will be found in both types;
In the cold type , complements rather than the bound
antibody sensitizes the cells and give rise to the
positive DAT
In the warm type, the attached antibody sensitizes the
cells, although occasionally it may be complement.
10. 10
6.3 Hemolytic Disease of the Fetus and New
born (HDFN)
Originally known as erythroblastosisfetalis
Initially observed in babies from D- negative
women with D-positive mates.
Initial pregnancies were not usually affected.
Infants from subsequent pregnancies were often
still born or severely anemic and jaundiced.
11. 11
HDFN…
Rh immune globulin (RhIG)
Protects D- negative mothers against the
production of anti- D following delivery.
Anti-C, anti-c, anti-E, anti-e are not protected by
RhIG and can cause HDN.
12. 6.3.1 Overview of HDFN
HDFN is a condition in which the red blood cells of
a fetus or neonate are destroyed by IgG Abs
produced by the mother.
Y
+
Fetal
RBC
Fetal RBC destruction
=
13. 13
Overview of HDFN…
Factors that must be present for HDFN to occur:
1. The mother must lack the Ag, and, following
exposure to the Ag should produce Abs of the
IgG class.
2. The Fetus must possess the Antigens
3. The Antigen must be well developed at birth
14. 14
Etiology of HDFN
The placental barrier limits the number of fetal
RBCs entering the maternal circulation during
pregnancy and thus reduces the chances of Ab
production during pregnancy.
15. 15
Etiology of HDFN……
At the time of delivery , a fetal RBCs escape into
the maternal circulation (known as feto maternal
hemorrhage (FMH).
Immunization can result from fetal RBC
exposure following:
- Abortion
- Ectopic pregnancy, or
- Abdominal trauma.
16. 16
Etiology of HDFN……
Antigens on the fetal RBC can stimulate the
maternal immune system which results in the
production of IgG antibodies .
In a subsequent pregnancy the IgG antibodies
cross the placental barrier by active transport
mechanism.
17. 17
Etiology of HDFN……
The antibodies bind to the fetal antigens which
results in RBC destruction by macrophages in
fetal liver and spleen.
Hemoglobin liberated from the damaged RBCs
metabolized to indirect bilirubin.
18. 18
Etiology of HDFN….
Bilirubin is harmlessly excreted by the mother.
If the RBC destruction continues, the fetus
becomes increasingly anemic
Fetal liver and spleen enlarge as erythropoiesis
increases in an effort to compensate for the RBC
destructions.
19. 19
Etiology of HDFN……
Erythroblasts are released into the fetal
circulation
Erythroblastosisfetalis
If this condition is left untreated, cardiac failure
can occur accompanied by hydropusfetalis, or
edema and fluid accumulation in fetal peritoneal
and pleural cavities.
20. 20
Etiology of HDFN……
Thus the greatest threat to the fetus is cardiac
failure resulting from uncompensated anemia.
Following delivery, red blood cell destruction
continues with the release of indirect bilirubin
The new born liver is deficient in glucuronyl
transferase
21. 21
Etiology of HDFN……
The indirect bilirubin binds to tissues results in
jaundice.
Bind with tissues of the CNS & cause permanent
damage (kernicterus)
resulting in deafness, mental retardation, or death.
22. 22
Etiology of HDFN….
HDN is often classified into three categories based
on Ab specificity:
Rh
ABO and
Other (non-Rh) Antibodies.
23. 23
6.3.2.HDFN due to RH
Anti- D is responsible for the most severe cases of
HDFN.
In most cases, D-Negative women become
alloimmunized (produce anti- D) after the first D-
Positive pregnancy.
24. 24
HDFN due to RH…
In rare cases, alloimmunization occurs during the
first pregnancy but rarely results in clinical signs of
HDFN.
In some cases, the maternal anti-D binds to fetal
D-positive red blood cells and causes a positive
direct antiglobulin test .
25. 25
HDFN due to RH…
Moderately affected infants develop signs of
jaundice, and
corresponding elevations in bilirubin levels, during the
first few days of life.
Severely affected D- positive infants
experience anemia inutero and develop jaundice
within hours of delivery.
27. 27
6.3.3.HDFN due to ABO
Occurs most frequently in group A or B babies
born to group O mothers.
Is due to the increased incidence of IgG ABO Abs
in group O individuals compared to other ABO
groups.
ABO incompatibility often affects the first
pregnancy because of the presence of non-RBC
stimulated ABO Abs
28. 28
HDFN due to ABO…
Red blood cell destruction by ABO Abs is more
common than by anti-D.
Fortunately, most cases are sub clinical and do
not necessitate treatment.
29. 29
HDFN due to ABO…
Some infants may experience mildly elevated
bilirubin levels and some degree of jaundice with
in the first few days of life.
These cases can usually be treated with
phototherapy.
30. 30
HDFN due to ABO…
Mild red blood cell destruction, despite high levels
of maternal antibody occurs because:
A or B substances are present in the fetal tissues and
secretions & bind or neutralize ABO Abs, which
reduces the amount of ABO Ab available to destroy fetal
RBCs.
31. 31
HDFN due to ABO…
Poor development of ABO Ags on fetal or infant RBCs .
Presence of reduced number of A and B Ag sites on
fetal or infant RBCs.
This also explains why the DAT is only weakly
positive in most cases of ABO HDN.
32. 32
Alloantibodies causing HDN other than
anti-D
Other Rh-system antibodies are known to cause
HDN alone or in combination with anti D.
Anti-c is the second most common cause of
HDN, followed by anti-K.
33. 33
6.3.4 Assessment of HDFN
Postpartum testing
It is advantageous to collect a sample of cord
blood from every new born.
The specimen should be properly labeled and
stored for up to 7 days.
for testing if the mother is D Negative or if the new born
develops signs or symptoms of HDFN.
Cord blood should be washed free of wharton’s
jelly.
35. 35
Assessment…
Postpartum Testing of infants with suspected
HDFN
Is based on medical history, physical examination
of the new born, and results of Laboratory testing
on both mother and child
36. 36
Assessment…
ABO Testing
In cases of HDFN the DAT may be positive,
which can lead to false positive or false negative
Rh- testing results.
False Rh- negative results may be due to a
blocking phenomenon requiring gentle elution
to resolve.
37. 37
Assessment…
DAT
Its result may be weak especially in cases of ABO
HDFN.
When positive, performing an elution is optional if
Ab identification test were performed on the
mother at the time of admission.
If a maternal sample is unavailable, testing the
elute may be useful to confirm HDFN.
38. 38
Assessment…
If the maternal Antibody screen is negative and
the DAT is positive, ABO HDN should be
suspected.
ABO HDN can be confirmed by performing either
a heat or freeze thaw elutes.
The elute should be tested against A1, B and O
cells using an antiglobulin technique.
39. 39
Assessment…
Positive results with A1 and/or B cells and negative
results with the O cells is indicative and /or ABO
HDN.
If the elute is negative with all cells, an antibody to a
low frequency antigen should be suspected and
maternal serum tested against the paternal cells.
40. 40
6.4. Rho (D) Immune Globulin (Human)-RhIG
Administer
to non immunized Rho- negative mothers
who deliver Rho- positive babies
Use
prevent Rh- alloimmunization.
41. 41
RhIG…
Candidates for this prophylaxis are:
mothers who are Rh-negative and
Du - negative, and
have an Rh-positive or Du positive new born.
All Rh-negative women who have abortions are
candidates unless the father or fetus is known to be
Rh-negative.
42. 42
RhIG…
The following are not RhIG candidates:
Rho-negative women
Who deliver Rh-negative babies.
Whose serum contains anti-Rho (D).
Who are Rho- positive or Du- positive
43. 43
RhIG….
Is a concentrate of IgG anti-D prepared from pools
of human plasma.
Is given intramuscularly
to non-sensitized D-negative women at 28 weeks of
gestation (ante partum) and
again within 72 hours of delivery (post partum) of a D
positive infant.
45. 45
RhIG…
Mechanism of action
Suppresses the immune response following
exposure to D positive fetal red blood cells and
prevents the mother from producing anti-D.
46. RhIG …
Rosette Test-Qualitative test
Purpose
To detect the presence of Rh positive RBCs in
the circulation of Rh negative person
to detect FMH > 30 ml
47. Rosette …
Principle
Fetal Rh+ve RBCs in the maternal sample react
with the anti-D. The unbound antibody is
washed away and a suspension of group O,
Rh+ve cells is added.
The anti-D reacts with both the Rh+ve and the
fetal Rh+ve RBCs. The RBCs agglutinate in a
rosette pattern, and the suspension is examined
microscopically.
48. Rosette test…
A Positive test is indicated by the presence of a
certain no of clumps (rosettes) in a defined no of
microscopic fields (eg. 7 clumps in 5 fields)
A negative test means that the fetal bleed was
less than 30ml. The administration of RhIG,
however is still indicated in these cases
49. 49
Rosette Test - Procedure
Use EDTA mother’s sample drawn after delivery
Wash cells, add chemically modified anti-D and
enhancement
Incubate 37oC
Wash times four with normal saline
Add R2R2 cells
Centrifuge, mix, read microscopically
51. 51
Acid Elution Stain Procedure
EDTA sample
Make a slide
Fix smear
Treat with acid
Stain with Eosin
Count number of stained HbF cells within 2000
HbA cells
52. 52
RhIG…
Acid Elution Stain Calculations
Number of fetal cells/2000 adult cells x 100 = %of
fetal cells
% of fetal cells X 50 = number of mls of fetal blood
53. 53
RhIG…
Determine number of vials RhIG
FB/30 = number of vials needed
300 ug RhIG will neutralize 30 ml of D+ whole blood
If number calculated is <0.5 round down,
> or =0.5 round up
- 1.4 round down to 1 and add 1 vial=give 2 vials
- 1.6 round up to 2 and add 1 vial = give 3 vial
54. 54
RhIG Dose
Recommended dose (contained in one vial) is
about 300 µg
offers protection against a feto-maternal hemorrhage
(FMH) of 30 ml (15 ml packed cells) or less.
If a massive FMH has occurred, the volume of the
hemorrhage must be determined to calculate the
number of vials to administer.
55. 55
6.5 Treatment of Infants Suffering fr HDFN
For infants who develop hyperbilirubinemia
and/or anemia due to HDFN, exchange
transfusion is usually carried out.
57. 57
Treatment…
Exchange transfusion:
is a continuous removal of small amounts of blood from the
neonate with simultaneous continuous infusion of donor
blood until a one or two-volume exchange is accomplished.
Helps to reduce the concentration of bilirubin and
incomplete antibodies
58. 58
Treatment…
Provides the infant is with compatible donor red
cells.
To give exchange transfusion to an infant clinical
and laboratory findings must be considered.
Cord Haemoglobin(<10g/dl) and
raised serum bilirubin are strong indicators for treatment.
59. 59
Treatment…
For compatible exchange transfusion, donor’s
blood should be:
cross-matched with the maternal serum and
lack the RBC Ag corresponding to the maternal Abs
ABO group and Rh type compatible with the infant’s
blood group.
If the mother’s antibody is not available, group
O Rh negative red blood cells must be selected.
60. 60
Phototherapy
The use of light to degrade bilirubin in mildly
jaundiced infants
Usually ABO incompatibility
61. 61
Review Questions
1. Compare the causes and laboratory demonstrating
methods, of AIHA with HDN.
2. What is the cause of HDN? What consequences
could result from this condition?
3. What is exchange transfusion?
62. 62
Review…
4. Discuss the dose of IgG anti-D given to Rh-
pregnant women to prevent HGN?
5. When Rh HDN does occur?
6. List and discuss the postnatal laboratory
investigations to be carried out to know the
presence and extent of HDN.
63. References
1.Immunohematology for medical laboratory
science students,Yayehyirad T. and Misganaw
B., Upgraded lecture note.2008
2.Basic and applied concepts of
Immunohematology, 2nd ed. Kathy D.Blaney
and Paula R.Howard,2009
3. Blood banking and transfusion medicine: basic
principles and practice. Christopher D.Hilliyer et
al., 2nd ed.2007.
4.Safe blood donations, Module 1 WHO.2002
63
64. References…
5.Screening for HIV and other infectious agents,
Module 2, WHO. 2002
6.Blood group serology. Module 3 WHO.2002
7.Guidelines and principles for safe blood
transfusion practice, Introductory module. WHO
2002.
8.Immunohematology: Principles and Practice
Quinley. 2nd ed.1998.
9.AABB Technical Manual .15th Edition.2005
64