Hemolytic Disease of the Newborn, Current Methods of Dia.pptVIP

Hemolytic Disease of the Newborn, Current Methods of Diagnosis and Treatment Terry Kotrla, MS, MT(ASCP)BB Objectives List the classifications of Hemolytic Disease of the Newborn and the most antibody specificities involved. State the testing to perform on the mother to monitor the severity of HDN. List the laboratory tests and values which indicate that an infant is affected by HDN both in the fetus and newborn. State the treatment options for intrauterine treatment of HDN. State the treatment options for HDN in the moderately and severely affected newborn. State the requirements of blood to be used for transfusion of the fetus and newborn. Cause of Hemolytic Disease Maternal IgG antibodies directed against an antigen of paternal origin present on the fetal red blood cells. IgG antibodies cross the placenta to coat fetal antigens, cause decreased red blood cell survival which can result in anemia. Produced in response to previous pregnancy with antigen positive fetus OR exposure to red blood cells, ie transfusion. Three Classifications of HDN ABO “Other” – unexpected immune antibodies other than anti-D – Jk, K, Fy, S, etc. Rh – anti-D alone or may be accompanied by other Rh antibodies – anti-C, -c, -E or –e. ABO Hemolytic Disease Mother group O, baby A or B Group O individuals have anti-A, -B and –A,B in their plasma, fetal RBCs attacked by 2 antibodies Occurs in only 3%, is severe in only 1%, and 1:1,000 require exchange transfusion. The disease is more common and more severe in African-American infants. “Other” Hemolytic Disease Uncommon, occurs in ~0.8% of pregnant women. Immune alloantibodies usually due to anti-E, -c, -Kell, -Kidd or -Duffy. Anti-K disease ranges from mild to severe over half of the cases are caused by multiple blood transfusions is the second most common form of severe HDN Anti-M very rare Rh Hemolytic Disease Anti-D is the commonest form of severe HDN. The disease varies from mild to severe. Anti-E is a mild disease Anti-c can range f