Hemolytic Disease of the Fetus and Newborn (Online CE Course)
(based on 2013 customer ratings)
This course presents current information related to hemolytic disease of the fetus and newborn (HDFN). It provides you with an opportunity to review and update your knowledge of significant aspects of HDFN and its laboratory investigation and prevention. This course provides a broad overview of many important topics including causative antibodies, laboratory findings in severe HDFN, and pre- and postnatal treatments. Rh immune globulin (RhIg) is covered in depth, since it prevents the most severe form of HDFN and is one of the biggest success stories of modern medicine.
Continuing Education Credits
- P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 2 hour(s)
- Florida Board of Clinical Laboratory Science CE - General (Blood Banking / Immunohematology): 2 hour(s)
- Describe and interpret typical clinical symptoms and associated laboratory test results in hemolytic disease of the fetus and newborn (HDFN) and relate findings to the pathogenesis of HDFN and its treatment.
- Describe the progression of HDFN due to anti-D historically and discuss the effect of Rh immune globulin (RhIg) and other factors on its incidence.
- Compare and contrast ABO HDFN and HDFN due to anti-D and other antibodies in terms of clinical symptoms, fetal monitoring procedures, laboratory investigation, typical test results, and criteria for donor RBC transfusions.
- Identify current best practices for perinatal testing programs and investigation of HDFN and interpret serologic tests done on the mother, father, and fetus / newborn.
- Discuss the sources of RhIg, its preparation, constituents, safety, types, mechanisms of action, criteria for administration, dosage calculation, and causes of failures.
- Describe the principles, uses, and limitations of the rosette test, Kleihauer-Betke test, and flow cytometry used in perinatal testing programs.
(based on 2013 customer ratings)
- Advance Organizer
- Review of hemolytic disease of the fetus and newborn
- Immunization to D Antigen
- Factors That Affect Production of Anti-D
- Primary versus Secondary Response
- Typical Case of Rh HDFN (Prior to RhIg)
- The incidence of HDFN due to anti-D varies significantly according to race and ethnicity.
- ABO HDFN - Etiology and Symptoms
- ABO HDFN - Diagnostic Tests
- ABO HDFN - Expected Findings
- ABO HDFN - Treatment
- ABO incompatibility between a D-negative mother and a D-positive fetus eliminates the possibility of HDFN due to anti-D.
- Symptoms and Laboratory Findings in Severe HDFN Due to Anti-D
- HDFN Due to Other Antibodies
- Which symptom of HDFN is associated with low levels of glucuronyl transferase?
- Which symptom of HDFN does phototherapy help prevent?
- For which of the following antibodies is the DAT most likely to be negative when testing a newborn for possible HDFN?
- For the test results shown above, which of the following antibodies is most likely to be causing the newborn's positive DAT?
- Kernicterus due to high levels of unconjugated bilirubin can cause brain damage in newborns suffering from severe HDFN.
- Fetal Monitoring: Doppler Ultrasonography
- Fetal Monitoring: Amniocentesis
- Fetal Monitoring: Cordocentesis
- Prenatal Treatment
- Choosing Donor RBC for IUT and IVT
- Postnatal Treatment: Exchange Transfusion
- Criteria for Transfused Red Blood Cells
- Other Postnatal Treatment
- All of the following criteria for donor RBC to be used for an exchange transfusion relate to both ABO HDFN and HDFN due to anti-D:Less than or equal t...
- Which procedure used to obtain a fetal blood sample to monitor severity of HDFN can also be used to deliver intravenous transfusions?
- Perinatal Testing Programs
- Routine Serologic Tests - Mother
- Routine Serologic Tests - Father
- Newborn Serologic Testing Protocols
- For infants born to Rh negative females, a test for weak D is optional when initial D typing shows the newborn to be Rh negative.
- Molecular Genotyping - Introduction
- Molecular Genotyping - Mother
- Molecular Genotyping - Father and Fetus
- Determining Risk for HDFN Using Molecular Genotyping
- For which of these reasons would a molecular method be used to determine a pregnant woman's Rh type?
- An Rh negative pregnant female has produced anti-D and the physician has decided to use molecular typing to determine if the fetus is at risk. Is the ...
- Follow-up Investigative Tests (Mother)
- Follow-up Investigative Tests (Father)
- Follow-up Investigative Tests (Fetus)
- Follow-up Investigative Tests (Newborn)
- Maternal antibody titer is a good indicator of severity of HDFN.
- When monitoring maternal antibody strength using a doubling dilution, an increase in titer from 16 to 32 is considered a significant rise in titer.
- Review of Rh Immune Globulin
- Mechanism of Action
- RhIg prevents anti-D production mainly by clearing antibody-sensitized D-positive rbc from maternal circulation.
- Use in Pregnancy
- Related Uses
- RhIg and Rh Complexity
- RhIg & Variants of D
- RhIg Policies for Weak D
- International RhIg Policies
- Clinical Relevance of D Phenotypes
- RhIg Dosage
- RhIg 'Failures'
- Passive Anti-D following RhIg Administration
- Protocols to Deal with RhIg-Derived Anti-D
- When given during pregnancy, RhIg may cross the placenta and sensitize fetal D-positive RBCs.
- Ectopic pregnancy is an indication for administering RhIg to an Rh negative woman.
- Which D variant can produce anti-D? (Choose all that apply.)
- A 300 µg dose of RhIg can suppress immunization to how many mL of D-positive whole blood?
- Post-delivery Testing of RhIg Candidates
- Screening for FMH
- Rosette Test
- Quantifying FMH
- Kleihauer-Betke Test
- Flow Cytometry
- Calculating RhIg Dosage
- Which of the following tests are suitable for quantifying the size of fetomaternal hemorrhage (FMH)? Select all that apply.
- A rosette test to screen for FMH is contraindicated if the newborn is weak D.
- The appropriate dosage of Rh immune globulin (RhIg) to administer post-delivery to an Rh-negative mother delivering an Rh-positive child is calculated...
- The Kleihauer-Betke test used to quantitate FMH has poor reproducibility.
- Summary and Conclusions
- Further Reading
- Literature and Online Resources
Level of instruction: Intermediate
Intended Audience: Clinical laboratory technologists, technicians, and pathologists. This course is also appropriate for clinical laboratory science students and pathology residents.
Pat Letendre, MEd is a laboratory technologist, educator, and consultant. Currently, she consults full-time in the areas of transfusion medicine, education, professional development, and use of the Internet in education. Ms. Letendre is the Webmaster for Canada's transfusion safety officers and the TraQ website coordinator. She holds a Masters of Education degree in adult education from the University
and a Bachelor of Science degree from the University of Manitoba
Erin Tretter, MT(ASCP), is currently the STAT Laboratory Supervisor at Penn Presbyterian Medical Center in Philadelphia, PA. She received her BS in Medical Technology from California University of Pennsylvania and has nearly 8 years of experience as a Generalist, including Blood Bank, Hematology and Chemistry. Erin is the Blood Bank Clinical Instructor for the Clinical Laboratory Science Program at St. Christopher’s and has 4 years experience teaching immunohematology concepts and laboratory procedures to Medical Technology students. She has also provided blood bank training for laboratory technologists and medical students. Erin is currently obtaining a Master’s in Business Administration from Florida Institute of Technology where she is a member of the Phi Kappa Phi Honor’s Society.
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