Competency information
Details
Provide transfusion support for the fetus and neonate, undertaking appropriate compatibility testing and selecting blood components with the correct specifications for IUT, neonatal top-up and exchange transfusion.
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
# | Outcome |
---|---|
# 5 | Outcome Select and perform tests to predict and monitor haemolytic disease of the fetus and newborn (HDFN), and provide appropriate transfusion therapy for the fetus and neonate. |