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A group A, Rh-positive infant of a group O, Rh-positive mother has a weakly positive DAT and a moderately elevated bilirubin 12 hours after birth. The most likely cause is:
An obstetrical patient has had 3 previous pregnancies. Her first baby was healthy, the second was jaundiced at birth and required an exchange transfusion, and the third baby was stillborn. Which of the following is the most likely cause?
hydrops fetalis caused by maternal anti-K; HDFN involving Kell system antibodies are typically the most severe because of the expression of Kell antigens on fetal RBCs and on fetal RBC precursors. The fetal anemia can result in severe hydrops fetalis that can lead to fetal death without intervention.
Fetal Rosette Test
detects the presence of D positive fetal cells in the mother's circulation
Which is the primary concern for the fetus experiencing HDFN?
Which of the following is the most appropriate way to determine how many vials of RhIg should be administered?
Purposes of exchange transfusion include:
-Decrease in the concentration of bilirubin
-reduction of maternal antibody
-increase in oxygen carrying capacity
Twenty-eight fetal red blood cells are counted in a Kleihauer-Betke stain of maternal blood. How many vials of RhIg are needed?
3; Use 5,000 mL for maternal blood volume if unknown.
28 fetal cells x 5,000 mL
2,000 total cells
Volume of fetomaternal hemorrhage (FMH) = 70 mL
If the standard dose of RhIg is being administered, divide the volume of FMH by 30.
70 / 30 = 2.3 Round down and add one vial. 2.0 + 1 = 3 vials
Which of the following antibodies has NOT been implicated in HDFN?
What does a two-fold increase in a pregnant person's antibody titer indicate?
-fetal stimulation of maternal antibody
-increased monitoring for fetal stress
An Rh-negative labor and delivery patient has just delivered a baby. Cord blood testing should include:
-Weak D if negative upon initial testing
-ABO forward typing; ABO reverse typing of neonates is unnecessary because any antibodies detected in the reverse typing would be of maternal origin. For the same reason, antibody screen (IAT) testing of cord blood is unnecessary as the sample from the mother should be sufficient to screen for the presence of unexpected antibodies to antigens present on the fetal cells.
Blood for an intrauterine transfusion should be:
-antigen-negative for the antigens the maternal antibodies are directed against
The normal Hgb range for a full-term neonate is:
A "transfusion trigger" for a neonate could include:
-Zone III of Liley Graph
-Hgb of 8.9 g/dL
Mucopolysaccharide derived from the extra-embryonic mesoderm, responsible for the physiologic clamping of the umbilical cord upon exposure to temperature changes is known as:
Anti-D used to make injectable RhIg is of:
human origin and is collected from plasma
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