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Hemolytic Disease of the Fetus and Newborn (Online CE Course)

(based on 857 customer ratings)

Author: Pat Letendre, MEd
Reviewer: Erin Tretter, MT(ASCP)

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.

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Continuing Education Credits

P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 2 hour(s)
Course number 578-031-18, approved through 6/30/2020
Florida Board of Clinical Laboratory Personnel Credit Hours - General (Blood Banking / Immunohematology): 2 hour(s)
Course number 20-626427, approved through 9/1/2020

Objectives

  • 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 criteria for administration, dosage calculation, and causes of failures of RhIG.
  • Describe the principles, uses, and limitations of the rosette test, Kleihauer-Betke test, and flow cytometry used in perinatal testing programs.

Customer Ratings

(based on 857 customer ratings)

Course Outline

Click on the links below to preview selected pages from this course.
  • Pathophysiology of HDFN and Blood group systems most commonly implicated in the disease
  • Fetal Monitoring and HDFN Treatments
      • Fetal Monitoring
      • 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
      • Introduction
      • HDFN Diagnosis and Management
      • Newborn Serologic Testing Protocols
      • Molecular Genotyping
      • Molecular Genotyping: Differentiating Between Weak D and Partial D
      • 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 reliable indicator of fetal disease.
  • Review of Rh Immune Globulin
      • RhIG Prophylaxis
      • RhIG Uses
      • RhIG and Variants of D
      • RhIG Policies for Weak D
      • Clinical Relevance of D Phenotypes
      • 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.
      • A Rh positive individual has produced an anti-D antibody. Which D variant possesses the ability to stimulate this production of anti-D? (Choose all th...
      • What dose of RhIG can suppress immunization of 30 mL of D-positive whole blood?
  • Post-delivery Testing of RhIG Candidates
      • Introduction
      • Screening for Fetomaternal Hemorrhage (FMH)
      • Rosette Test
      • Quantifying FMH
      • Kleihauer-Betke (KB) 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 may be FALSELY POSITIVE if the mother is weak-D positive.
      • The appropriate dosage of Rh immune globulin (RhIG) to administer post-delivery to an Rh-negative mother delivering an Rh-positive child is calculated...
  • Summary and Conclusions
      • Main Learning Goals
  • Further Reading
      • Resources
  • References
      • References

Additional Information

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.
 
Author information:
 
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 of Alberta and a Bachelor of Science degree from the University of Manitoba.  
   
Reviewer information:

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.

Course information:

This course will:

  • Recap relevant background information on HDFN and its treatment
  • Review the characteristics and uses of Rh immune globulin (RhIg)
  • Discuss typical laboratory findings and their interpretations
  • Examine current best practices in perinatal testing programs

It is a companion course to "Rh negative female with anti-D at delive

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Keywords

These are the most common topics and keywords covered in Hemolytic Disease of the Fetus and Newborn:

genotype newborn phototherapy phenotypes platelet symptoms graft-versus-host antigen-specific enzyme d-negative medicine survey dats complements transfused heterozygous utero hemolysis prophylaxis transfusions genotyping fetomaternal investigative anti-b reagents hdfn combinations fetuses oxygen dosage protocols glucuronyl red blood cells fathers irradiated abdominal antigens amniocentesis crossmatched blood immunohematology diagnostic samples dcece sensitize fetal-maternal soluble extensively hemoglobin alleles diagnosing hypoxia-induced doppler gestation fetal homozygous rh-negative plasma cells symptom gene vials methods caucasians antigen sonography rbcs intrauterine hyperbilirubinemia down-regulation kleihauer-betke antibodies intravenous ectopic titration antenatally donor immunized procedures water-soluble serum pregnancy heart physician concentration ultrasonography elution plasma cells phenotype perinatal chorionic sensitivity genetics antepartum rhce decimal post-delivery iuts cerebral bleeds antibody-sensitized cordocentesis serologic diagnosis harmless anti-fya rigor capillaries anti-d percutaneous pregnant assessment allele previa bilirubin neonatal guidelines prescribed gestational antibody clinical titer donors kell pregnancies umbilical treatment transferase antenatal hemolytic vial rosette anemia appears reticulocyte doubling anti-k inject rhigs immune amniotic fluid hemorrhage anti-e hematocrit kernicterus reconstituted mmol fetus contains epitopes agglutination placenta hydrops tamul transfusion trauma liver pubs disease prenatal ivts d-positive bringing identification laboratory villus jaundice anti-a immunization fresher brain exposure management antigen-negative fat-rich cytometry cell-free antiglobulin excretable diagnose rh-positive globulin leukoreduced immunogenic postnatal safety
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p19 table


Primary vs secondary immune response