Competency: 18

Details

Provide transfusion support for pregnant women with red cell antibodies.

Considerations

• Aetiology, and clinical presentation of HDFN, and the specificities of red cell antibodies implicated.
• The antenatal testing requirements of those antibodies known to cause HDFN:
  • anti-D
  • anti-c
  • Kell-related antibodies.
• Prediction of risk/severity of HDFN from laboratory testing during pregnancy:
  • titration of antibodies and the selection of cells and reagents to perform the titration
  • quantification of antibodies
  • significant levels for anti-D, anti-c, anti-K and other potentially clinically significant red cell antibodies
  • which specificities do not cause HDFN and why
  • role of immunoglobulin class and subclasses in the severity of HDFN
  • phenotyping of the father to predict the phenotype of the fetus and likelihood of HDFN
  • the criteria and limitations when free fetal DNA testing for the fetal genotype can be employed
  • non-serological monitoring of the fetus throughout pregnancy, e.g. middle cerebral artery Doppler and ultrasound.
• The significance of a positive DAT in a neonatal sample.
• Strategies for the reduction of impact on the fetus of HDN:
  • IUT
  • premature delivery
  • exchange transfusion, top-up transfusions and phototherapy
  • new and emerging strategies.
• Logistics of ongoing support throughout pregnancy and delivery for women requiring rare blood and liaison with reference services.
• Additional specifications of units suitable for IUT, neonatal top-up and neonatal exchange.
• Cross-matching considerations for neonates.

Relevant learning outcomes