Serologic testing, transfusion, RhIg & ABO HDN
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| Serologic testing for newborn | ABO & Rh typing; DAT; Eluate
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| Serologic testing for mother | antibody screen & compatibility testing
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| Newborn transfusion | aliquots or exchange depending on severity
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| Exchange used to | remove high levels of indirect bili & prevent kernicterus; more likely in premature infants
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| Exchange transfusion removes | maternal AB and sensitized RBCs' replaces incomp with complete RBCs; suppresses erythrpoiesis
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| Blood selection | Group O, Rh neg, reconstituted with AB plasma; CMV neg, irradiated, HgS neg, less than 7 days old, AG neg for corresponding AB
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| RH Immune Globulin | high titered RhIg, anti-D admined by IM injection; anti-D attaches to fetal D pos RBCs; AB coated cells caught in spleen & removed from circulation suppressing production of anti-D by mother
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| Indications for RhIg | Rh neg, weak D neg, unsensitized mother immed after delivery of Rh pos baby or unknown blood type; give within 72 hours
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| Indications for RhIg cont | @ 28 weeks to Rh neg, weak D neg, unsensitized mother; abortions or etopic pregnancies
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| RhIg dosage & administration | 1 vial for 15ml of RBCs or 30ml whole blood; massive FM of >30ml more than 1 vial given
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| RhIg dosage & administration cont | screen for large FHM performed on mothers blood using rosette test; if positive a quantitative test done- Kleihauer-Betke, used to calculate anount of RhIg
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| Other considerations | RhIg of no benefit of mother has anti-D; must not confuse RhIg anti-D with active immunity and vice versa
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| Other considerations cont | must not interpret large amount of fetal D pos cells in circulation with weak D pos
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| ABO HDN | IgG ABO AB cross placenta & attach to fetal RBCs; mild to moderate hyperbilirubinemia; exhcange transfusion rare; most common cause of HDN, 1:5
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