HDN
Terms
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- What are the 3 types of HDN?
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1. Rh -> most severe
2. Other
3. ABO -> most common - For Rh/ABO, what type is the mother and infant?
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Rh: mom=neg, baby=pos
ABO: Mom=Otype, baby=A or Btype - How often do Rh/ABO occur in first births?
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Rh = 5%
ABO = 40-50% - Do Rh/ABO cause stillborn/hydrops?
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Rh = frequent
ABO = rarely - Do Rh/ABO cause severe anemia?
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Rh = frequent
ABO = rare - What type of DAT resuults for Rh/ABO?
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Rh = strong pos
ABO = weak or neg - What type of RBC morphology is seen in Rh or ABO HDN?
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Rh = macrocytic, nRBCs
ABO = spherocytes. - Do you give Rh/ABO Hdns exchange transfusions?
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Rh = frequently
ABO = infrequently - Do you give phototherapy to Rh or ABO HDNs?
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Rh = along with exch. transf.
ABO = often it's the only treatment.
so YES to both. - What is Erythroblastosis fetalis?
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FETAL:
-Acceler. RBC destruction
-Inrease nRBCs - What 2 things result from SEVERE HDN?
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-Hydrops fetalis
-Cardio failure, tissue hypoxia. - What is the best indicator of the clinical signif of HDN?
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Cord blood Hb/Hct.
Hb < 13 is mild
Hb < 8 is severe. - What complication develops from HDN after birth? Why?
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-Hyperbilirubinemia;
-Mom conjugates baby's bili before birth
-Baby liver can't do it after. -
What results from buildup of bilirubin in baby?
Why is this especially bad? -
-Kernicterus.
-Can cross into the brain and cause damage b/c BBB undevelopd. - How do you knwo whether or not to do an exchange transfusion?
- If the indirect bilirubin level is over 20 mg/dL
- Only over 20 mg/dl?
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That's for a healthy 2500 g baby
For a 1250 g baby, if the level is over 9-12 - What tests are required to be done on Cord Blood evaluation?
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-ABO type
-Rh type
-DAT - What are 3 main categories of adverse transfusion rxns?
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1. Immune
2. Non-immune
3. Infectious - What are 2 categories of immune rxns?
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1. Recipient vs. Donor
2. Donor vs. Recipient - what are 4 types of Recip:donor reactions?
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1. RBC
2. WBC
3. Platelet
4. Plasma protein - What are 2 types of RBC rxtns?
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1. Acute hemolytic
2. Delayed hemolytic - Which is worse, acute or delayed?
- Acute
- What is a distinct symptom of Acute hemolytic anemia?
- Impending doom
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what type of hemolysis is in
-Acute
-Delayed -
Acute = intravascular
Delayed = extravascular - what is febrile nonhemolytic transf rxn caused by?
- Recipient's antibodies to donor's WBCs.
- When do you see a febrile reaction?
- at the end of the transfusion.
- How do you treat febrile?
- with tylenol
- What is PTP?
- post transfusion purpora; rare reaction in previously immunized patients; develop an autoantibody and allogeneically destroys platelets.
- What 2 types of reactions occur with platelets?
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1. Anaphylactic
2. Urticarial - What causes anaphylactic reactions?
- IgA reacts with IgA-neg patients.
- What kind of blood should you transfuse to Iga-neg pateints?
- Only washed RBCs.
- What causes urticarial reactions?
- Ab in the recipient to donor's serum proteins.
- What are 2 types of Donor:Recip transf. rxtns?
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1. GVHD - graft vs host disease
2. TRALI - transfusion related acute lung injury - What causes GVHD?
- the donor's WBCs recognize recipient as foreign and attack.
- What causes TRALI?
- damage to the microvasculature of lungs by antibodies to the WBCs in recipient.
- What symptoms are associated with TRALI?
- Edema in the lungs, but no heart damage.