Deck 13: Hemolytic Disease of the Fetus and Newborn

Question 1

Select the true statement regarding ABO hemolytic disease of the fetus and newborn.

A) It is frequently seen in group A mothers with group O infants.
B) It cannot occur during prima gravida (first pregnancy).
C) Bilirubin levels often exceed 15 mg/dL in the affected infants.
D) The frequency of ABO hemolytic disease of the fetus and newborn is greater than Rh hemolytic disease of the fetus and newborn.

Answer 1

D
ABO system hemolytic disease of the fetus and newborn is more common because the occurrence of group O mothers having group A babies is more frequent.

Question 2

Which of the following best describes the principle of the Kleihauer-Betke test?

A) Fetal hemoglobin is resistant to acid elution and remains in the cell to stain pink, whereas adult cells appear as ghost cells.
B) Adult hemoglobin is resistant to acid elution and remains in the cell to stain pink, whereas fetal cells appear as ghost cells.
C) D-positive cells from the fetus form rosettes around the IgG-coated mother's cells.
D) Indicator cells form rosettes around the fetal D-positive cells.

Answer 2

A
The Kleihauer-Betke acid elution test is a stain that enables the quantification of fetal cells in the maternal circulation.

Question 3

A group O, D-positive mother gave birth to an A-negative infant. After 24 hours, the newborn's bilirubin level rose to 19 mg/dL. A direct antiglobulin test performed on the cord blood specimen was positive with anti-IgG. What is the most probable antibody causing this?

A) Anti-D
B) Anti-A
C) Anti-B
D) Anti-A,B

Answer 3

D
ABO hemolytic disease of the fetus and newborn is typically seen in group O mothers with infants who are group A.

Question 4

In testing amniotic fluid, the Liley method of predicting the severity of hemolytic disease of the fetus and newborn is based on:

A) colorimetric protein analysis.
B) optical density of bilirubin at 450 nm.
C) ratio of lecithin to sphingomyelin.
D) titration of antibody.

Question 5

To prevent graft-versus-host disease, red blood cells prepared for intrauterine transfusions should be:

A) frozen and deglycerolized.
B) saline washed.
C) ABO and D-compatible with the mother.
D) irradiated.

Question 6

All of the following are common characteristics of ABO hemolytic disease of the fetus and newborn except:

A) weak positive direct antiglobulin test.
B) mother is group A.
C) the antibody on the infant's cells is anti-A,B.
D) mild clinical symptoms.

Question 7

Which of the following antibodies have not been known to cause hemolytic disease of the fetus and newborn?

A) Anti-C
B) Anti-K
C) Anti-Le^a
D) Anti-S

Question 8

Which elution method is ideal in the investigation of ABO hemolytic disease of the fetus and newborn?

A) Glycine-acid
B) Freeze-thaw
C) Xylene
D) Chloroform

Question 9

Anti-D in the serum of a third-trimester pregnant woman with a titer of 16 is indicative of:

A) the presence of Rh immune globulin administered at 28 weeks.
B) active immunization.
C) passive immunization.
D) none of the above.

Question 10

An acid elution stain was made using a 1-hour postdelivery maternal blood sample. Results: 10 fetal cells/1000 cells counted
It is the policy to add 1 vial of Rh immune globulin to the calculated dose when the estimated volume of the hemorrhage exceeds 20 mL of whole blood. Calculate the number of vials of Rh immune globulin that would be indicated under these circumstances.

A) 2
B) 3
C) 4
D) 5

Question 11

Why is reverse grouping omitted in the neonatal period for ABO testing?

A) The maternal antibody is identical to that of the newborn.
B) Newborns do not produce their own antibody until about 4 months.
C) The newborn's antibody is the same as the paternal antibody.
D) None of the above is correct.

Question 12

A large fetomaternal bleed in a D-negative woman who delivered a D-positive infant should be suspected if the:

A) direct antiglobulin test on the infant is positive.
B) infant is premature.
C) fetomaternal hemorrhage screen result is positive.
D) maternal antibody screen is positive postpartum.

Question 13

Amniotic fluid analysis showed a marked increase into zone III of the Liley graph. Lecithin-sphingomyelin ratios indicated that the fetal lungs were not mature. Select the most appropriate decision regarding medical intervention.

A) No immediate need for intervention
B) An intrauterine transfusion
C) Delivery by cesarean section
D) None of the above

Question 14

Rh immune globulin should be given within how many hours following delivery?

A) 12
B) 24
C) 48
D) 72

Question 15

A 300- $\mu$ g dose of Rh immune globulin contains sufficient anti-D to protect against how much whole blood?

A) 25 mL
B) 30 mL
C) 50 mL
D) 100 mL

Question 16

Select the most common antibody specificity associated with hemolytic disease of the fetus and newborn.

A) Anti-A,B
B) Anti-C
C) Anti-D
D) Anti-K

Question 17

Select the situation where the administration of Rh immune globulin would be contraindicated. MOTHER NEWBORN

A) r"r; no antibody detected R_or; direct antiglobulin test (DAT) negative
B) Rr; no antibody detected R₁r; DAT negative
C) Rr; anti-E detected R₂r; DAT positive
D) r"r; anti-D detected R₂r: DAT positive

Question 18

All of the following are goals of an exchange transfusion except to:

A) correct anemia.
B) remove high levels of unconjugated bilirubin.
C) remove high levels of maternal antibody.
D) restore the platelet count.

Question 19

To identify the cause of suspected hemolytic disease of the fetus and newborn, which tests are performed?

A) ABO group
B) D testing
C) Direct antiglobulin test
D) All of the above

Question 20

A newborn phenotypes as group O, D-positive with a 1+ direct antiglobulin test. The mother's antibody screening test is negative. Assuming the antibody screen is valid, one should consider hemolytic disease of the fetus and newborn due to an antibody against __________ antigen.

A) D
B) A or B
C) low-incidence
D) high-incidence

Question 21

Rh immune globulin contains:

A) IgG anti-D.
B) immune serum globulin.
C) IgM anti-D.
D) gamma globulin.

Question 22

What immunoglobulin is capable of crossing the placenta?

A) IgA
B) IgG
C) IgM
D) IgE

Question 23

During a first-trimester prenatal examination, it was determined that a pregnant woman was group A, D-negative with an anti-D titer of 8. What is the most likely course of action?

A) The anti-D is probably from prenatal Rh immune globulin and should be given another dose at birth.
B) The titer is significant if a rise in titer is detected.
C) The pregnancy is considered high risk, and the mother should be followed up immediately with amniocentesis or percutaneous umbilical cord testing.
D) None of the above.

Question 24

In which type of hemolytic disease of the fetus and newborn is the first-born affected?

A) ABO
B) D
C) E
D) M

Question 25

Which of the following is true regarding the rosette test?

A) It is a staining procedure that differentiates fetal and adult cells.
B) The test is valid only if the mother is D-negative and the infant is D-positive.
C) Indicator cells bind to the D-positive maternal cells forming a rosette.
D) The test is a quantitative test to determine how many vials of Rh immune globulin to administer.

Question 26

To be considered a candidate for Rh immune globulin, the mother is __________ and the infant is __________.

A) D-positive, D-negative
B) D-negative, D-positive
C) D-negative, D-negative
D) D-positive, D-positive