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Hemolytic Disease of the Fetus and Newborn (Online CE Course)

(based on 869 customer ratings)

Author: Pat Letendre, MEd
Reviewer: Erin Tretter, MT(ASCP)

This course presents current information related to hemolytic disease of the fetus and newborn (HDFN). It provides you with an opportunity to review and update your knowledge of significant aspects of HDFN and its laboratory investigation and prevention. This course provides a broad overview of many important topics including causative antibodies, laboratory findings in severe HDFN, and pre- and postnatal treatments. Rh immune globulin (RhIg) is covered in depth, since it prevents the most severe form of HDFN and is one of the biggest success stories of modern medicine.

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Continuing Education Credits

P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 2 hour(s)
Course number 578-031-18, approved through 6/30/2020
Florida Board of Clinical Laboratory Personnel Credit Hours - General (Blood Banking / Immunohematology): 2 hour(s)
Course number 20-626427, approved through 9/1/2020

Objectives

  • Describe and interpret typical clinical symptoms and associated laboratory test results in hemolytic disease of the fetus and newborn (HDFN) and relate findings to the pathogenesis of HDFN and its treatment.
  • Describe the progression of HDFN due to anti-D historically and discuss the effect of Rh immune globulin (RhIG) and other factors on its incidence.
  • Compare and contrast ABO HDFN and HDFN due to anti-D and other antibodies in terms of clinical symptoms, fetal monitoring procedures, laboratory investigation, typical test results, and criteria for donor RBC transfusions.
  • Identify current best practices for perinatal testing programs and investigation of HDFN and interpret serologic tests done on the mother, father, and fetus / newborn.
  • Discuss the criteria for administration, dosage calculation, and causes of failures of RhIG.
  • Describe the principles, uses, and limitations of the rosette test, Kleihauer-Betke test, and flow cytometry used in perinatal testing programs.

Customer Ratings

(based on 869 customer ratings)

Course Outline

Click on the links below to preview selected pages from this course.
  • Pathophysiology of HDFN and Blood group systems most commonly implicated in the disease
      • Introduction
      • Development of Anti-D
      • Factors That Affect Production of Anti-D
      • Primary versus Secondary Response
      • Pathophysiology in Severe HDFN Due to Anti-D
      • HDFN Due to Anti-D
      • ABO HDFN
      • ABO HDFN: Diagnostic Tests
      • ABO HDFN: Expected Findings
      • ABO HDFN: Treatment
      • ABO incompatibility between a D-negative mother and a D-positive fetus eliminates the possibility of HDFN due to anti-D.
      • HDFN Due to Other Antibodies
      • Phototherapy helps to prevent which symptom of HDFN?
      • For which of the following antibodies is the DAT most likely to be negative when testing a newborn for possible HDFN?
      • Kernicterus due to high levels of unconjugated bilirubin can cause brain damage in newborns suffering from severe HDFN.
  • Fetal Monitoring and HDFN Treatments
  • Perinatal Testing Programs
  • Review of Rh Immune Globulin
      • RhIG Prophylaxis
      • RhIG Uses
      • RhIG and Variants of D
      • RhIG Policies for Weak D
      • Clinical Relevance of D Phenotypes
      • RhIG 'Failures'
      • Passive Anti-D following RhIG Administration
      • Protocols to Deal with RhIG-Derived Anti-D
      • When given during pregnancy, RhIG may cross the placenta and sensitize fetal D-positive RBCs.
      • Ectopic pregnancy is an indication for administering RhIG to an Rh negative woman.
      • A Rh positive individual has produced an anti-D antibody. Which D variant possesses the ability to stimulate this production of anti-D? (Choose all th...
      • What dose of RhIG can suppress immunization of 30 mL of D-positive whole blood?
  • Post-delivery Testing of RhIG Candidates
      • Introduction
      • Screening for Fetomaternal Hemorrhage (FMH)
      • Rosette Test
      • Quantifying FMH
      • Kleihauer-Betke (KB) Test
      • Flow Cytometry
      • Calculating RhIG Dosage
      • Which of the following tests are suitable for quantifying the size of fetomaternal hemorrhage (FMH)? Select all that apply.
      • A rosette test may be FALSELY POSITIVE if the mother is weak-D positive.
      • The appropriate dosage of Rh immune globulin (RhIG) to administer post-delivery to an Rh-negative mother delivering an Rh-positive child is calculated...
  • Summary and Conclusions
      • Main Learning Goals
  • Further Reading
  • References

Additional Information

Level of instruction: Intermediate

Intended Audience: Clinical laboratory technologists, technicians, and pathologists. This course is also appropriate for clinical laboratory science students and pathology residents.
 
Author information:
 
Pat Letendre, MEd is a laboratory technologist, educator, and consultant. Currently, she consults full-time in the areas of transfusion medicine, education, professional development, and use of the Internet in education. Ms. Letendre is the Webmaster for Canada's transfusion safety officers and the TraQ website coordinator. She holds a Masters of Education degree in adult education from the University of Alberta and a Bachelor of Science degree from the University of Manitoba.  
   
Reviewer information:

Erin Tretter, MT(ASCP), is currently the STAT Laboratory Supervisor at Penn Presbyterian Medical Center in Philadelphia, PA. She received her BS in Medical Technology from California University of Pennsylvania and has nearly 8 years of experience as a Generalist, including Blood Bank, Hematology and Chemistry. Erin is the Blood Bank Clinical Instructor for the Clinical Laboratory Science Program at St. Christopher’s and has 4 years experience teaching immunohematology concepts and laboratory procedures to Medical Technology students. She has also provided blood bank training for laboratory technologists and medical students. Erin is currently obtaining a Master’s in Business Administration from Florida Institute of Technology where she is a member of the Phi Kappa Phi Honor’s Society.

Course information:

This course will:

  • Recap relevant background information on HDFN and its treatment
  • Review the characteristics and uses of Rh immune globulin (RhIg)
  • Discuss typical laboratory findings and their interpretations
  • Examine current best practices in perinatal testing programs

It is a companion course to "Rh negative female with anti-D at delive

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Primary vs secondary immune response

Keywords

These are the most common topics and keywords covered in Hemolytic Disease of the Fetus and Newborn:

prenatal anti-b vials procedures immunogenic donor appears fetuses serum treatment globulin bleeds dats gene hyperbilirubinemia plasma cells liver crossmatched diagnostic trauma concentration cordocentesis antibody-sensitized rhce assessment diagnosis d-negative rbcs guidelines tamul water-soluble antibody fat-rich amniocentesis rosette amniotic fluid prophylaxis phenotypes survey intravenous transfused anti-fya chorionic immune decimal symptom antibodies phototherapy caucasians safety sensitivity bringing rh-positive plasma postnatal excretable hydrops villus utero management gestational transferase immunized red blood cells platelet post-delivery capillaries kleihauer-betke disease down-regulation pregnancy donors dosage serologic medicine placenta neonatal d-positive ectopic pregnant reagents harmless contains titration graft-versus-host anemia kernicterus bilirubin mmol phenotype diagnose fetomaternal hemorrhage reconstituted immunization newborn epitopes prescribed pubs diagnosing jaundice perinatal elution alleles anti-d hemoglobin agglutination antenatally irradiated blood dcece ultrasonography heterozygous anti-k soluble laboratory antigen protocols allele fresher fetal heart cytometry transfusions rhigs ivts pregnancies percutaneous rh-negative reticulocyte exposure hemolytic doubling complements sensitize umbilical genetics leukoreduced titer antiglobulin extensively hdfn kell samples methods transfusion antenatal hematocrit doppler antepartum enzyme previa rigor fetal-maternal cells gestation clinical genotype fetus glucuronyl cerebral immunohematology investigative inject cell-free identification intrauterine sonography abdominal vial anti-e antigen-specific hemolysis hypoxia-induced physician brain anti-a iuts fathers oxygen genotyping homozygous antigen-negative symptoms combinations antigens
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p19 table


Primary vs secondary immune response