A 1 day y/o 👶🏽neonate, born at 40 weeks, was transferred to our NICU for anemia & hyperbilirubinemia. He is jaundice but has no signs of encephalopathy.🩸The antibody screen is positive.
👇🏽Check out his peripheral smear below and notice the increased number of nucleated RBCs.
🤔Based on the peripheral smear findings, you begin to investigate the patient’s blood bank history because you are suspecting:
🙌🏽You got it! Based on the history and the peripheral smear findings, you are suspecting hemolytic disease of the fetus and newborn (#HDFN), which is when maternal antibodies are directed against fetal RBC antigens. What is the most common cause of #HDFN?
#Blooducation
💡With the widespread use of RhIg, ABO incompatibility is the most common cause of #HDFN caused by naturally occurring A, B IgG Abs in group O mothers.
𝐁𝐔𝐓 In our case:
🤱🏽Mother is Group A, Rh-D neg
👶🏽Baby is Group A, Rh-D pos
👇🏽Check out the baby’s Ab identification panel
An anti-D is identified in the patient's antibody panel. The DAT is positive for IgG (2+), C3 is negative. The eluate identified an anti-D antibody. What would be the next step in working up this baby?
🕵️🏽Maternal history clenches the DX.
No RhIg administered. Critical anti-D titer in pregnancy, but doppler negative for fetal anemia. After delivery, continual destruction occurs leading to progression of anemia & hyperbili. Immature liver cannot🚫🪓convert conjugated bilirubi.
To learn more about this #HDFN, listen to awesome 🎧🅾️🩸@bloodbankguy with Dr. Greg Denomme 👉🏽bbguy.org/2017/09/05/038/
🙏🏽Please share your #HDFN pearls with us below!
#Blooducation

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More from @HermelinMD

3 Jun
🅰️🅱️🅾️🆎#Blooducation colleagues: Fantastic new @bloodbankguy 🎧podcast with Dr. Mark Yazer on the topic of Whole Blood in Trauma Resuscitation discussing benefits and safety, and review of many important published trials. Listen now --> BBGuy.org/091.
Dr. Yazer explains some major benefits of #wholeblood. Balanced resuscitation in just 👜ONE bag, making logistics so much easier. There are fewer donor exposures and less additives & anticoagulants. Additionally, cold stored platelets are "primed for coagulation activity"
In 2018, 31rst @AABB Standards indicates that the definition of “low titer” shall be made locally by each transfusion service, and that policy specifies which patients are eligible to receive whole blood, the maximum quantity of how to monitor for adverse events post transfusion.
Read 6 tweets
20 Oct 20
Listen now! #Blooducation Graphic Medicine @Pathologists virtual lecture with @KreuterMD
learn.cap.org/lms/activity_o… Image
"My heart beats for patient collaboration and that's why I went in Transfusion Medicine...." Image
Important to know how to approach a #DonorLookBack which is a multistep process a blood establishment must complete as a response to a donor who is newly reactive for an infectious disease test. Check out @bloodbankguy for more information 👆🏼👉🏼 bbguy.org/education/glos… Image
Read 16 tweets
10 Feb 20
🤩I am constantly marveled by the endless ways in which we #Pathology and #LabMedicine, can use Twitter to engage, share, support & learn from each other. Here is the link to my presentation that celebrates the unlimited opportunities to harness Twitter👉🏽
bit.ly/39kA627 Image
Like the #SolarEclipse that occurred in August 2017, to me, Twitter has been a community wide experience of marveling a visual process that can create a burst of awe at an organic velocity. It's really exciting to be engaged in this global experience. Image
#AcademicTwitter is using Twitter at the University and Research setting to teach. It has wide range benefits and I recommend reading the following article written by @soragnilab and @Aiims1742 published in @nature that describes this phenomenon. doi.org/10.1038/s41568… ImageImage
Read 12 tweets
29 Nov 19
A 23-year-old woman w/ a history of SLE was admitted to the hospital w/ abdominal pain & headache. Purpura is seen on her chest & thighs. Hb /Hct= 8.3,28.4, PLT= 7,000, LDH = 952, Hapto = <8, Ind Bili = 1.2, Cr = 1.2 PT/INR = 1.3. 👇🏼Take a look at her peripheral smear.
⁉️Based on the initial lab results and the peripheral smear findings above, what is your differential? #PathTweetorial #Blooducation #ApheresisRounds
The findings above (evidence of hemolysis, drop in platelet count & schistocytes on the peripheral smear) point to a thrombotic microangiopathic hemolytic anemia (TMA). The classic diseases that fall under this category are #TTP & #HUS. Let's review how we manage these patients
Read 10 tweets
27 Nov 19
A 32-year-old man with HbS/βThalassemia presented to the ED with weakness in his left arm and slurred speech. His HbS is 71%. Take a look at his peripheral smear below, notice the drepanocytes, or sickle-shaped cells.
Since you are the #BloodBank resident on-call, Heme/Onc requests urgent erythrocytaphereisis, otherwise known as #RedCellExchange. 🗣️You reply?
⚠️Yes! You immediately confirm that the line is placed. According to the ASFA Guidelines, RBC exchange is a Category I Recommendation, first-line therapy, for the acute treatment of a stroke and should be started within 6 hours of admission.
Read 9 tweets
30 Oct 19
24 y/o w/ h/o of Crohn’s Disease presents w/ worsening fatigue, weakness & dizziness. He has mild abdominal pain, but no signs of bleeding. No transfusion history. Infliximab was discontinued for autoimmune hepatitis. Hb/Hct = 4.4/13.5. 👇🏽Check out his peripheral smear below.
🤨Since you are the Heme/Onc Fellow on-call, you are 📟paged to consult on this patient’s anemia. What are the first labs you would order to assess #hemolysis?
#Blooducation #BBRounds #PathTweetorial
🔎When suspecting a hemolytic anemia, 4 hemolytic indexes can help you quickly determine the etiology of the patient's bleeding.
📰🧪Our patient’s lab results: LDH= 408, Hapto<8, IndBili =3.8 %Retic >30% which indicate a hemolytic anemia with adequate bone marrow response.
Read 10 tweets

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