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

(based on 765 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 578-031-16, approved through 4/30/2018
Florida Board of Clinical Laboratory Personnel Credit Hours - General (Blood Banking / Immunohematology): 2 hour(s)
Course number 20-547689, approved through 9/1/2018

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 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.

Customer Ratings

(based on 765 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
      • Introduction
      • Development of Anti-D
      • Factors That Affect Production of Anti-D
      • Primary versus Secondary Response
      • Pathophysiology in Severe HDFN Due to Anti-D
      • HDFN Due to Anti-D
      • ABO HDFN
      • 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.
      • HDFN Due to Other Antibodies
      • Phototherapy helps to prevent which symptom of HDFN?
      • 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 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 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
      • Rh Immune Globulin (RhIg)
      • Constituents
      • Use in Pregnancy
      • Related Uses
      • RhIg and Rh Complexity
      • RhIg and 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.
      • 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...
      • The Kleihauer-Betke test used to quantitate FMH has poor reproducibility.
  • 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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Primary vs secondary immune response

Keywords

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

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


Primary vs secondary immune response