1. The Role Of Blood Banking in the Diagnosis and Treatment of a
Patient with Hemolytic Disease of the Fetus and Newborn
Allyson Raley and Kaitlyn Pumphrey | MLT-1060 Immunohematology l Professor Tiffany Gill | September 28, 2022
Abstract
Pathophysiology
Required Specimen
Instrument Methodology
Diagnostic Results
Additional Testing Results
MCV: Decreased
Hemoglobin: Decreased
Hematocrit: Decreased
Retic Count: Greatly increased
Nucleated RBCs: Greatly increased
Interfering Substances
Treatment
Utero and exchange transfusion –
correct anemia, remove sensitized
RBCs & lower maternal antibody &
bilirubin
• Must be fresh blood, irradiation,
collect <7 days.
• Usually Group O, D negative RBCs
resuspended in AB plasma.
Fresh frozen plasma – reconstitute the
RBCs to a hematocrit between 45-60%.
• Must be given immediately after
thawing or stored at 1-6 C, stored no
longer than 24 hours
References
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newborn: Current trends and perspectives. Asian journal of transfusion
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00136R1.pdf
Canadian Blood Services. (2022). Cord / neonate testing (ABO/Rh/DAT - HDFN
investigation). Cord / Neonate Testing (ABO/Rh/DAT - HDFN Investigation) |
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https://www.blood.ca/en/laboratory-services/cord-neonate-testing-aborhdat-
hdfn-investigation-0
Center, S. B. (2018). Rh Negative Blood. Stanford Blood Center. Retrieved
September 27, 2022, from https://stanfordbloodcenter.org/can-two-rh-
positive-parents-have-an-rh-negative-child/
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Retrieved September 27, 2022, from https://lug.hfhs.org/ood.htm
Howard, P. R. (2020). Basic and Applied Concepts of Blood Banking and
Transfusion Practices (5th ed.). Retrieved September 27, 2022, from
Elsevier.
Krautscheid , P., Leonard, N., & Metcalf, R. (2022). Hemolytic disease of the
fetus and newborn. Hemolytic Disease of the Fetus and Newborn | Choose
the Right Test. Retrieved September 27, 2022, from
https://arupconsult.com/content/hemolytic-disease-newborn
LearnHaem. (2020). Blood film showing HDFN disease. Learn Haem. Retrieved
September 27, 2022, from https://www.learnhaem.com/courses/frcpath-
morph/lessons/acquired-haemolytic-anaemias/topic/haemolytic-disease-of-
the-newborn/
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newborn (HDN). Hemolytic Disease of the Newborn (HDN) - Health
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27, 2022, from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=
90&ContentID=P02368
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laboratory.blogspot.com/2015/02/audit-of-use-of-fresh-frozen-plasma-
in.html?spref=pi
Mother's test results:
• Rh D negative
• Positive antibody screen, Positive DAT, Anti-D
Baby's test results:
• Rh D Positive
• Positive DAT, Elution shows Anti-D
• Mother is showing anti-D in serum with suspected HDFN, fetal red cells may
falsely type as D-negative due to a blocking phenomenon.
• Testing red cells sensitized with antibodies can cause a false negative weak
D test
• Newborns do not have ABO antibodies present, reverse ABO typing can lead
to misinterpretation or delays because of discrepancies.
• Newborns that receive intrauterine transfusions may demonstrate weak-field
reactions with ABO and anti-D antisera because Group O D-negative blood is
used for transfusions.
Rh(D) HDFN is caused by baby's red blood cell antigen being different then the mothers.
As a result, the mothers' immune system is triggered to produce an antibody against the
antigen. This immune response is not triggered unless there is an exposer through a
hemorrhage during pregnancy, birth, or IgG antibodies that are able to cross the
placenta.
How HDFN affects the fetus:
• Slight cases: minimal red cell destruction
• Moderate Cases: jaundice and elevated bilirubin levels (usually for a short period)
• Serious cases: anemia or fetal death
Organs affected: the body is trying to fixed the levels of RBC by creating RBC faster
resulting in organs swelling.
• Liver
• Spleen
• Heart (in severe cases where anemia occurs, as the oxygen carrying, and delivery
functions are affected.)
• Population at risk: Mothers that are D negative.
Methodology: Agglutination (RBC particles
clumping)
• Tube testing is the most common
testing used to diagnose HDFN
• Rh(d) can be done simultaneously with
ABO typing.
• Agglutination a positive result -
serological response caused by a
reaction with a specific antibody.
Specimen: Whole Blood collected by venipuncture
Specimen Container:
• EDTA tube- cord blood or mother's blood
• Red top tube- cord blood after birth
• EDTA microtainer- baby's blood
Specimen Storage:
• Specimen can be left at room temperature for up to an hour after collection, if
testing needs to be ran later the specimen can be refrigerated at 2-6°C for up to
12 hours.
Rh(D) HDFN is also called Erythroblastosis Fetalis, this is a disease
where the fetus has antigens in their blood that does not match the mother.
This causes problems once the mother has been exposed to the antigen
either by childbirth, hemorrhaging during pregnancy, or IgG antibodies that
are able to cross the placenta. The ideal specimen is whole blood collected
by venipuncture in either a EDTA or red top tube. The methodology of
agglutination is used. Tube testing is used to diagnosis HDFN in the lab.
Testing is done on the mother before birth and can be done of the baby from
cord blood as well after birth. Diagnosis results show positive antibody screen
and a positive DAT, with an antibody panel identifying anti-D. Treatment is
either whole blood transfusions or an injection of RHIG (Rh immunoglobin)