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What are the 3 types of HDN?
1. Rh -> most severe
2. Other
3. ABO -> most common
For Rh/ABO, what type is the mother and infant?
Rh: mom=neg, baby=pos
ABO: Mom=Otype, baby=A or Btype
How often do Rh/ABO occur in first births?
Rh = 5%
ABO = 40-50%
Do Rh/ABO cause stillborn/hydrops?
Rh = frequent
ABO = rarely
Do Rh/ABO cause severe anemia?
Rh = frequent
ABO = rare
What type of DAT resuults for Rh/ABO?
Rh = strong pos
ABO = weak or neg
What type of RBC morphology is seen in Rh or ABO HDN?
Rh = macrocytic, nRBCs

ABO = spherocytes.
Do you give Rh/ABO Hdns exchange transfusions?
Rh = frequently

ABO = infrequently
Do you give phototherapy to Rh or ABO HDNs?
Rh = along with exch. transf.
ABO = often it's the only treatment.
so YES to both.
What is Erythroblastosis fetalis?
-Acceler. RBC destruction
-Inrease nRBCs
What 2 things result from SEVERE HDN?
-Hydrops fetalis
-Cardio failure, tissue hypoxia.
What is the best indicator of the clinical signif of HDN?
Cord blood Hb/Hct.
Hb < 13 is mild
Hb < 8 is severe.
What complication develops from HDN after birth? Why?
-Mom conjugates baby's bili before birth
-Baby liver can't do it after.
What results from buildup of bilirubin in baby?
Why is this especially bad?
-Can cross into the brain and cause damage b/c BBB undevelopd.
How do you knwo whether or not to do an exchange transfusion?
If the indirect bilirubin level is over 20 mg/dL
Only over 20 mg/dl?
That's for a healthy 2500 g baby

For a 1250 g baby, if the level is over 9-12
What tests are required to be done on Cord Blood evaluation?
-ABO type
-Rh type
What are 3 main categories of adverse transfusion rxns?
1. Immune
2. Non-immune
3. Infectious
What are 2 categories of immune rxns?
1. Recipient vs. Donor
2. Donor vs. Recipient
what are 4 types of Recip:donor reactions?
1. RBC
2. WBC
3. Platelet
4. Plasma protein
What are 2 types of RBC rxtns?
1. Acute hemolytic
2. Delayed hemolytic
Which is worse, acute or delayed?
What is a distinct symptom of Acute hemolytic anemia?
Impending doom
what type of hemolysis is in
Acute = intravascular
Delayed = extravascular
what is febrile nonhemolytic transf rxn caused by?
Recipient's antibodies to donor's WBCs.
When do you see a febrile reaction?
at the end of the transfusion.
How do you treat febrile?
with tylenol
What is PTP?
post transfusion purpora; rare reaction in previously immunized patients; develop an autoantibody and allogeneically destroys platelets.
What 2 types of reactions occur with platelets?
1. Anaphylactic
2. Urticarial
What causes anaphylactic reactions?
IgA reacts with IgA-neg patients.
What kind of blood should you transfuse to Iga-neg pateints?
Only washed RBCs.
What causes urticarial reactions?
Ab in the recipient to donor's serum proteins.
What are 2 types of Donor:Recip transf. rxtns?
1. GVHD - graft vs host disease
2. TRALI - transfusion related acute lung injury
What causes GVHD?
the donor's WBCs recognize recipient as foreign and attack.
What causes TRALI?
damage to the microvasculature of lungs by antibodies to the WBCs in recipient.
What symptoms are associated with TRALI?
Edema in the lungs, but no heart damage.

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