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'\  `Roman PSbX'  99. RhIG Workuplab9(Carolyn Ragland 0 .  To perform one (1) Rh immune globul in workup. ; Aim ; To determine with 100% accuracy whether or not Rh immune globulin is indicated and how much by performing the appropriate tests. ; Introduction ; Rh immune globulin (RhIg) is used to prevent immunization of Rh negative individuals who have been exposed to the D antigen.Xc6Non-ProfitNon-Profit Stampc#$RB>z  0 @X<<<<@c d'dxd Level 1 Level 2 Level 3 Level 4 Level 5('2(U$ ^U!   ($     ('2(U$ ^U!   " !C<< c  ""  @XX%w@@<< NonProfitOrg.  @xx U.S.Postage@00 PAID@ Permit2757  @nn Austin,Texas0D4`P,BoardBoard of TrusteesC'/D4A`ArialTTC BoardofTrustees |||-%0D4`-Dr.BruceM.Murray,ChairmanDellaMayMoore,ViceChairmanRooseveltLeaks,SecretaryJanAlbersPeteFosterLindaGrayMackRayHernandezLawrenceE.JenkinsMurrayShawDr.DanAngel,President/D4A`ArialTTT{0HeadingFancy ACC Heading    xxxU)64 (Times NewRomanTTU@.. AustinCommunityCollege  6*'Fd66*'Fd66*'t"Fd664 (Times NewRomanTTP4B:FTFA MinutesFirst Pages%Xf$ hN p x (#%'0*,.8135@8:<H?AXX7hXdd7  @  FULLTIMEFACULTYASSOCIATION  @+Minutes    , 2 -'  hXXXs%Xf$ hN p x (#%'0*,.8135@8:<H?AX J(# Minutes   6*' xd6('2(U$ ^U!   ^>8ACC AddressACC Return AddressAustinCommunityCollegeP.O.Box140526Austin,Texas78714dC,EqualEqual Opportunity Statement@.. ACCisanequalopportunityinstitution. N24 labels4 line labels ,  , ,       \RA'\ X X R& 8BibliogrphyBibliography0....fp2Doc InitInitialize Document Style3S 7    I. 1. A. a.(1)(a) i) a)S456($0 ($0 0 (($0 0 0   A_ekqwDocumentDocument StyleI.1.A.a.(1)(a)i)a)jo4Tech InitInitialize Technical StyleS 9  1 .1 .1 .1 .1 .1 .1 .1 S CuyTechnicalTechnical Document Style11.11.1.11.1.1.11.1.1.1.11.1.1.1.1.11.1.1.1.1.1.11.1.1.1.1.1.1.1x?;u2PleadingHeader for numbered pleading paper ; z <(  hXXXXX6*'*d66*'*d6dd1dd2dd3dd4dd5dd6dd7dd8dd910111213141516171819202122232425262728  .+('2(U$ ^U!     -(U'   _HH>XXXbX EXERCISE10uu:$LaboratoryProcedureManual  X ?*'  xdEHQH!?'6X'A`"Sans Serif PS [ @(U)   _HH>XXXbX?*' XxdEHWH!? X 0?g$ >&%X>X_MLAB_Ԁ2431  101  ('2(U$ ^U!   'dxd Level 1 Level 2 Level 3 Level 4 Level 5($ (    ) B CAM << deUU"X#XX9ZnumberXXZofXXZfetalXXFZcellsXXI2XXI,XXI000XXxXX100XX/ XX percentXX fetalXX0cells IFUNC{{number~of~fetal~cells}over{2,000}~x~100~=~percent~fetal~cells}.4` dTable_A'\  `(Times NewRomanTT'\ `Table_BTable_C Level 1 Level 2 Level 3 Level 4 Level 5($     Q RAA<< c 7{volume~of~hemorrage}over30~=~number~of~vials&X)XX?ZvolumeXXZofXXZ hemorrageXX`I30XXXXnumberXXW ofXXR vialsp&0 d ddU34 `(Times NewRomanTT  CRight ParRight-Aligned Paragraph NumbersI.A.1.a.(1)(a)i)a)3|n'\  `Roman PSXn\  Ps: XP0D4`n PSRD4PkCP/D4A`ArialTT[D4PkCP0D4`lTT||ID4PkC|P64 (Times NewRomanTTxx/4 pTCxp'6X'A`"Sans Serif PSTTXn6XPT} XP.4` Serif PSTTS4 PCP'\  `(Times NewRomanTTXo\  PCXP'\ `s NewRomanTTS\  PCP'\ `n PSmanTT&f\  PC&P34 `(Times NewRomanTTo4 PCP( U$   - "(U"   _N:X<0f>tXNbXbXeb*fh ddd Xdd Xdd X!!,z( ,( ,( ,,( ,,( ,( ,,( ,,( ,,( ,( ,(( +  <+ @<Mom'sNameandHospitalNumber RA2@@" RMom'sType&Rh RA2@@" RDAT PA2@@" PCellTypingwithAnti F3$@@" FІ_RhIg_ @@ Yes/No ZP=  " @  @Z           &    &A ;,!II" ;B ;,!II" ;A,B ;,!II " ;D ;,!II " ;DC II  * ;,! " ;Du ;,!II " ;_DuC_ II ** 1'!" 1 >W/   @   `> 2W#;;W 2 2W#;;W 2 2W#;;W 2 2W#;;W 2 2W#;;W 2 2W#;;W 2 2W#;;W 2 2W#;;W 2 2W#;;W 2 6W#;;W 6 J;#;; `  W @J 2#77 2 2#77 2 2#77 2 2#77 2 2#77 2 2#77  2 2#77! 2 2#77" 2 2#77# 2 6#77$ 6 J;#77% @   @J 2#SS& 2 2#SS' 2 2#SS( 2 2#SS) 2 2#SS* 2 2#SS+ 2 2#SS, 2 2#SS- 2 2#SS. 2 6#SS/ 6 L;#SS0 @   @L 4#o o 1 4 4#o o 2 4 4#o o 3 4 4#o o 4 4 4#o o 5 4 4#o o 6 4 4#o o 7 4 4#o o 8 4 4#o o 9 4 6#o o : 63)'o o ; @    3eXYXe*onlyifinfantappearstobeABpositive   < **forDneginfants   = c4J  JDX0 X<66cToanswer_RhIg_Ԁyes/no: ?  J 1.0  MomDneg,babyDneg,answerNO@!!  J 2.0  MomDpos,answerNOA!!  J 3.0  MomDneg,babyDpos,answerYESB!! Onceyouhavedeterminedwhichpatientisan_RhIg_Ԁcandidate,obtainmaternalspecimenfromtheinstructor.Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5(9 Z 6Times New Roman Regular1, 2, 3,Level 1Level 2Level 3Level 4Level 5yd,Wx01'\ `Table_D4#BV2Quick 1.c  .0 cAcrobat PDFWriter,,,,,,0n, (9 Z 6Times New Roman RegularDTABLE A ^U!   _HHe  X,_=_?LH4X<0f>tXH KXYXbXExercise10#bXYXKXY6#ԀRhImmuneGlobulin_Workup_Ԁ(_RhIgW_)  ) L (,^H$H$(Task   Toperformone(1)Rhimmuneglobulin_workup_.   Aim   With100%accuracy,determinewhetherornotRhimmuneglobulinisindicatedandhow  muchbyperformingtheappropriatetests.    Introduction    Rhimmuneglobulin(_RhIg_)isusedtopreventimmunizationofDnegativeindividualswho   havebeenexposedtotheDantigen.   OnegroupatincreasedriskofexposureandsensitizationbytheDantigenareDnegative   motherswhogivebirthtoDpositiveinfants.Duringdeliveryofthebaby,Rhpositivefetal   cellsenterthematernalcirculationwhentheplacentaseparatesfromtheuterinewall.In   general,onlyasmallamountoffetalblood(lessthan30_ml_Ԁwholeblood)entersthemothers   circulation,butduetotheimmunogenicityoftheDantigen,thisisenoughtocause   sensitization.IfasensitizedwomanbecomespregnantwithanotherDpositivebaby,the   babywillbeaffectedwithsevereHDN.   HDNduetoanti-Disthemostseveretype.Thebilirubinlevelrisesquicklyafterbirth.If w itexceeds20mg/dLkernicterusmayoccur.Kernicterusiscausedwhenthebasalganglia q andotherareasofthebrainandspinalcordareinfiltratedwithbilirubinresultinginmental k retardationordeathifnottreated.Inadditiontothehighbilirubinlevels,theseinfants e becomeseverelyanemicduetothedestructionoftheirredbloodcellsbythematernal _ antibody.TopreventthissensitizationtotheDantigen,RhImmuneGlobulin(_RHIg_)was Y developedandbecameavailableintheearly1960s.Thisproductcontainsanti-Dwhich, |S wheninjectedintramuscularlywithin72hoursfollowingdeliveryofanRhpositivebaby,will vM attachtotheDantigenonthebaby'sRBCs.Thiswouldresultinthebaby'scellsbeing pG recognizedasforeignandremovedfromthemother'scirculationbeforeherimmunesystem jA couldrecognizetheDantigenasforeign,thuspreventingherfrombecomingimmunized. d ; Onevialof_RhIg_Ԁcontains300mgofantiD,enoughtocovera30_ml_Ԁwholebloodbleed ^!5 or15_mls_Ԁofpackedcells. X"/ Later,itwasdiscoveredthateventhoughtheDnegativemotherswereidentifiedandgiven L$#  _RhIg_Ԁwithintheappropriatetimeframe,therewasstilla1%failurerate.Thatistosay,one F%! percentofthemotherswhoreceived_RhIg_Ԁafterdeliveryweresubsequentlydiscoveredto @&" beimmunizedtotheDantigen.Itwasthendeterminedthatverysmall_feto_-maternal :'# hemorrhageswereoccurringduringthethirdtrimester.Itisnowroutinepracticefor 4( $  physicianstoadministeradoseof_RhIg_Ԁat28weeksgestation,inadditiontothepost_partum_ .)%! dose.Ante_partum_Ԁadministrationof_RhIg_Ԁhasdecreasedtheoverallriskofimmunizationto (*%" 0.1%.Noadverseeffectshavebeenobservedininfantsofmotherswhohavereceivedup "+&# totwodosesofantenatal_RhIg_ԀalthoughitmaycausethebabytohaveapositiveDAT. ,'$   /*' Afterdeliveryofaninfant,certaintestsareperformedtodeterminewhetherornotawoman ) istobeconsideredan_RhIg_Ԁcandidate.Thefollowingwomenare not candidatesfor_RhIg_: # 3  X X<6631.0 DnegativewomenwhohaveDnegativebabies T$ T$ 2.0 Dpositivewomen T$ T$ 3.0 DnegativewomenknowntobeimmunizedtoD.  T$ T$ _RhIg_Ԁ must begiventoDnegativewomenunderthefollowingcircumstancesinwhichthe   baby'sDisunknown:   0 P 1.0 P T$P T$afteramniocentesis  T$ T$ 0 P 2.0 P T$P T$aftermiscarriage  T$ T$ 0 P 3.0 P T$P T$afterabortion  T$ T$ 0 P 4.0 P T$P T$afterectopicpregnancy  T$ T$ 0 P 5.0 P T$P T$vaginalbleedingatanytimeduringthepregnancy  T$ T$  P 6. cordocentesis   P 7. chorionicvillussampling  _RhIg_ԀmustalsobegiveniftheDtypeoftheinfantcannotbedeterminedafterbirthasmay  beduetotheinfanthavingapositiveDAT.InthesesituationstheDand/orRhcontroltubes  arepositiveattheAHGphaseduringDutesting.ThisisthereasonthataDcontrolorDAT  mustbeperformedonanyindividualwhoappearsweakDpositive.Unlessthemotheris  Dpositive,thebestruleofthumbtofollowiswhenindoubt,giveit. | &    1,^,^ HH1Principle '  p AfteranDnegativewomangivesbirthtoaninfant,atypeandDisorderedontheinfant's p cordblood.ADATmayalsobeordered.IfthebabyisDpositive,anRhimmuneglobulin j _workup_Ԁisorderedonthemother.Thisincludes: d 0 P 1.0 P T$P T$ABO/Dtyping,includingmicroDuX T$ T$ 0 P 2.0 P T$P T$Antibodyscreen{ R T$ T$ 0 P 3.0 P T$P T$Rosetteprocedureu!L T$ T$ Eachoftheabovetestsservesaspecificpurpose: i#@ 1.0 ItisveryimportanttoaccuratelydeterminetheDtypeofthemother.Ifamother ]%4!  turnsouttobeSpositive,orweakDpositive,sheis not an_RhIg_Ԁcandidate.The W&."! Dumustbereadmicroscopically.Thisisonewayinwhichanexcessive_feto_Ԅ Q'(#" maternalhemorrhagemaybedetected.IfexcessiveDpositivefetalcellsareinthe K("$# maternalcirculationtheywillbecoatedbytheanti-Dandformclumpswhenthe E)%$ AHGserumisadded.A mixed-field appearanceintheanti-Dtubeanda ?*&% negativeRhcontrolisthefirstindicationthatanexcessivebleedhasoccurred.9+'& T$ T$ 2.0 Anantibodyscreenisroutinelyperformedtoidentifythosewomenwhohave '.)) formedorareforminganimmuneanti-D.Occasionallyamother'sscreensmaybe !/** positiveduetotheante_partum_Ԁadministrationofthe_RhIg_.Inthesecasesthe ) antibodyscreenisvery,veryweakandonceidentifiedasbeingdueto_RhIg_ # administration,shemuststillgetapost_partum_Ԁdose.Ifithasbeendeterminedthat  theanti-Disimmune,sheisnotan_RhIg_Ԁcandidate.Itiscriticalthatherhistorybe  obtained,specificallywhenherdoseofante_partum_Ԁ_RhIg_Ԁwasadministered.The  termusedfortheantiDdetectedafteradministrationof_RhIg_Ԁis passivelyacquired   antiD.  T$ T$ 3.0 ThethirdpartoftheRhimmuneglobulin_workup_Ԁistheerythrocyte_rosetting_Ԁtest.   Thebrandnameofthekitusedinlabis_FETALSCREEN_.Thistestisperformed    toscreenforanabnormallylarge_feto_Ԅmaternalhemorrhagewhichwouldindicate   theneedformorethan1vialof_RhIg_.  T$ T$ bLv XbXY PrincipleoftheRosetteTest #bXYX bLv&#   AsuspensionofredcellsfromtheDnegativemotherismixedwith_FETALSCREEN_  AntibodyReagent(antiD),incubated,andwashedtoremoveunboundantibody.During  theincubationperiod,anyDpositivefetalredcellspresentwillbecomesensitizedwith  anti-D.Oneantigenbindingsiteofeachantibodymolecule(Fabpiece)attachestoafetal  cellleavingtheotherantibodysitefreetoattachtoaDantigenofthe_FETALSCREEN_  IndicatorCells(Dpositivecells)whichareaddedsubsequently.Thissuspensionoftestcells  andindicatorcellsiscentrifugedbriefly,transferredtoamicroscopeslide,orreadthetube  onthetubeholderandexaminedforclumpsofagglutinatedredcells,usinglowpower | magnification. v Theresultisanappearanceofrosettesormixed-fieldagglutinatesinwhichtheagglutinates j consistofclumpsofDpositiveindicatorcellsclusteredaboutthesensitizedfetalcells.Each d clumpseenrepresents one fetalcellsurroundedbytheindicatorcells.Ifaclumpofcellsis ^ seeninthemicroDu,eachcellintheclumpisafetalcell.Therosettetestissosensitiveand X specificthattheremustbeacertainnumberofclumpsseenbeforeitiscalledpositive,while { R inthemicroDuthepresenceofevenoneclumpissignificant.Whenthetestsamplecontains u!L fewornoDpositivefetalcells,_rosetting_Ԁisnotobserved.Becausethevastmajorityof o"F samplesscreenedwillcontainveryfewDpositivefetalredcells,observingmeasurable i#@  numbersofrosettesinatestshouldalertthetechnologisttothepossibilitythatalargerthan c$: ! expectedfetal-maternalhemorrhagemayhaveoccurred.Inthissituation,aquantitativetest ]%4!" mustbeusedtodeterminetheamountoffetal-maternalhemorrhageandthedosageofRh W&."# immuneglobulinrequired. Q'(#$ WeakDpositiveredcellsmaynotreactaswellasDpositiveredcellsin_rosetting_ E)%& procedures,presumablybecausetheyhavefewerDantigensites. Ifthenewborntypes ?*&' asRhweakDpositive,aKleihauerBetkeacidelutiontestshouldbedone 9+'( routinely.  3, () TheRosetteprocedureismuchmoresensitivethanthemicroDuindetectingexcessive '.)+ _feto_-maternalhemorrhages. !/*, ЇApositiveDuand/orrosetteprocedureindicatesthatanexcessivefetal-maternal ) hemorrhagehasoccurred.TheDuandrosettearequalitativetests.Theycandetermine # thatanexcessivebleedhasoccurred,butnothowmuch.  Themethodusedto_quantitate_Ԁthebleedisthe Kleihauer-Betkeacidelutionstain .This  methodisbasedonthefactthatfetalhemoglobin(hemoglobinF)isresistanttoacidelution,   whereasadulthemoglobinisnot.Whenathinbloodsmearisexposedtoanacidbuffer,the   adultredbloodcellslosetheirhemoglobinintothebuffersothatonlystromaremains.   Normaladultcellsappearasverypaleghosts.Fetalredcellsareunaffectedandretaintheir   hemoglobin.Fetalcellsappearasbrightpink_refractile_Ԁbodies.Thevolumeoffetalcellsis    determinedbyrecordingthenumberoffetalcellsobservedin2000adultcellsandconverting   ittopercentageusingthefollowingformula:      1,^,^ HH1    P DFEN>:z X  0 @ H@EP P    Thendeterminethevolumeof_feto_Ԅmaternalhemorrhagein_ml_Ԁofwholebloodbytakingthe  percentfetalcellsx50.   P %fetalcellsx50=volumeof_feto_Ԅmaternalhemorrhage    rDTU:*&b|2N @E( N ` rOnevialof_RhIg_Ԁwillcovera30_ml_Ԁwholebloodbleed.Ifitisdeterminedthatthebleed  exceedsthisamount,thevolumeoffetalbleedisdividedby30todeterminethenumberof  dosesof_RhIg_Ԁrequired.       { Reagents  )   { 1.0 Seepage1) T$ T$ 2.0 Rosettekit(fetalbleedscreen) # T$ T$  1,^,^`HH1Procedure   1.0 PerformDATon_cordbloods_ԀasinDATexercise. T$ T$ 2.0 PerformABO/Dtypingonthe_cordbloods_ԀofallDnegativemothers. T$ T$ 3.0 IfmotherisDnegativeandbabyisDpositive,obtainmaternalspecimenfrom   instructorfor_RhIg_Ԁworkup.  T$ T$ 4.0 Placematernalseruminappropriatelylabeledtubeandpreparea4-6%patientcell   suspension(mother'scells).  T$ T$ 5.0 CorrectlylabeltubesforTypeandScreen,remembertosetupRhctrltube.  T$ T$ 6.0 Labelthree(3)additionaltubesforrosettetestasfollows:patientinitialsROS,    ROS+(positivecontrol)and ROS=(negativecontrol.  T$ T$ 7.0 a.0 T$ T$Addreagentserumandcells,andpatientserumandcellstothe   appropriatetypeandscreentubes. T$T$ 0 P 0 P T$P T$b.0 T$ T$Add:onedroppatientcellstopatientROStube;onedropofrosettepos   controlcellsto+ROStube;andonedropofrosettenegcontrolcellsto   =ROStube.T$T$ 8.0 Addonedropof_Fetalscreen_ԀAntibodyreagenttothethree(3)rosettetesttubes,  mixwellandimmediatelyplacein37$Cwaterbath. T$ T$ 9.0 SpinTypeandScreentubes.Readandrecordreactionsimmediately.(SalineIS  phase) T$ T$ 10.0 Addtwo(2)dropsofalbumintotheantibodyscreen.Mixwellandplacethose  tubesplusthepatient'snegativeDandRhctrltubeinthe37$Cfor20minutes.(If | thepatientisDpositive,seeinstructor.)v T$ T$ 0 P HELPFULHINT: Atthistime,youshouldhaveeighttubesincubatingat37$C.Ifyou p don't,seeinstructor.jP T$P T$ 11.0 Afterincubation,spinthethree(3)antibodyscreentubesfor20seconds,readand d recordreactionsimmediately.(Albumin,37$Cphase)^ T$ T$ 12.0 RemovetheDtube,Rhctrland3ROStubesfrom_waterbath_Ԁandwashalleight X (8)tubeswithsalinethree(3)times,blottingendsoftubeswithgauzeafterlast { R wash.u!L T$ T$ &  ReadthefollowingstepsCAREFULLY.  o"F 'o"H13.0 a.0 T$ T$Addtwo(2)dropsofanti-humanglobulinserumtothe screentubes , i#@  antiD tubes,andRhctrlTubec$: T$T$ 0 P 0 P T$P T$b.0 T$ T$Addonedropof_Fetalscreen_ԀIndicatorcellstoallthree(3)rosettetubes.]%4! T$T$ 0 P 0 P T$P T$c.0 T$ T$Addone(1)dropof_Fetalscreen_ԀEnhancementReagenttothethree(3) W&."! rosettetubes.Q'(#"T$T$ 14.0 Mixalleight(8)tubeswellandspinfor20seconds.K("$# T$ T$ 15.0 Readalltubesmacroscopicallyandmicroscopicallyandrecordreactions. E)%$ T$ T$ 1,^,^`HH1 ?*&$ 16.0 UsecheckcellstoconfirmAHGreagentactivityinallappropriatetubes(negative ?*&$ Dandscreens). DONOT usecheckcellsinthethreerosettetubes.9+'% T$ T$ 17.0 Recordresultsofthefetalbleedscreenintheboxmarked _FBS_onthepatient 3, (& form.--)' T$ T$  !/*) 1` ,,^`HH1  9% ,X<66 X9InterpretationofResults  )   Antibodyscreen !Refertopreviousprocedure. )  # (` ,@H H (bXbXYGb*IJddd Xdd Xdd XH$H$,00 ,@0 ,H@0 ,@@ +  5+ 05RhandRhControl/MicroscopicDu M$  B8 /" 0   @B ?H*Q(" d?ant Q( iD XHC+ "Hd dXDu ?0+Q("Hd ? E;#Q( @   @E ,#  " ,O ;,!#  " ;O ?,!#  " ?Rhnegative E;##   @  @E* / ,  " /O >/!, " >3+ 9&!, " 9WeakDpositive E;#,  @  @E ,5 " ,O ;,!5 " ;MF ?,!5 " ?possibleexcessive_feto_Ԅmaternalhemorrhage!perform 5  _Kleihauer_ E;#  @   @E* . " .O =,! " =+ ?,! " ?testinvalidperform_Kleihauer_3)'  @    3GXYXGKXYXXGXY0    *PerformDATonpatient.Ifitisnegative,patientisaweakDpositive.Ifitispositive,additional0@#$$work ;  wouldneedtobedone.5 $$ KXKXYLK*MNdd00 @0 H@0 H@@ IJH$H$,D@0 ,@0 ,@0 ,@@ +  5+# # 05FetalScreen/RosetteTest WHB S*!" 0   @dWPatient UH@+uL""Hd dUPositive uL# Control UH@+>$"Hd dUNegative uL% Control E6+>&"Hd E UD,uL' @   @UO/+(lessthan7clumpsin5 G( fields =,!)" =+ =,!G*" =O 6#!G+" 6excessivebleedhasnot G, occurred M>#- @   @M+(greaterthan7clumpsin5 . fields >/!/" >+ >/!0" >O 9&!1" 9excessivebleedhasoccurred, 2 perform_Kleihauer_ J;#3 @   @JO ;,!4" ;+ ;,!5" ;+ ?,!6" ?invalid,repeattest M>#7 @  @M+ >/!8" >+ >/!9" >+ 9&!:" 9invalid,repeattest L;#; @  @LO =,!<" =O =,!=" =O ?,!>" ?invalid,repeattest3)'? @    3  ? LXYXLKXYXXLXY@  $ CordbloodFlowChart ) @ DirectAntiglobulinTest!DAT  {R *OP ddD@0 D@0 @0 @@ MNH$H$, , , , ,/ ,8 , , , +  <+ )0< DATNegative 9/$" 9 2!" 2 DATPositive UK/" 0 )  0U .$+ " . * +  " * +!+  " + F< +  " 0   0FMomDpos .$U , " .MomDNeg * U , " * +!U ," +ABO/Dtypecordcells F< U ," 0   0F .$ V" . *  V" * +! V" + F<  V" 0   )0FNothingmore 5$ " 5ABO/Dtypecordcells 9/$ " 9 2! " 2TypeandScreenMom QG/ " 0 )  0Q ' " ' ' " ' ' " ' ' " ' ' " ' ' " ' ' " ' ' " ' J9 " 0  0J C2#  !"dd C C2#  ""dd C 8.#  #"dd 8Dnegbaby '  $" ' '  %" 'Dposbaby 2!  &" 2 C2#  '"dd CScreenNegative   ( andMomisGroup  ) OandbabyisAor  * B +  8.#," 8ScreenPositive :0  -" 0  0:  e -   e -  ! e - ! ' ." ' ' /" ' " 0" "  e 0  ! e 0 ! :0 1" 0  0:  ?1   ?1  ! ?1 !No_RhIg_ 'oF2" ' 'oF3" '_RhIg_Ԁneeded oF4 forMom "i@5" "  ?5  ! ?5 !Panelonmom oF6  ?5i@7" 0  0? 'j8" ' 'j9" ' 'j:" ' 'j;" ' 'j<" ' 'j=" ' 'j>" '_Lui_ԀFreezeelution 'j?" 'Identifyantibodyin j@ mom'sserum ?5dA" 0  0? 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'/^" ' '/_" ' '/`" ' '/a" ' '/b" ' '/c" ' '/d" ' '/e" 'Identifyantibodyin /f cordeluate-#!)g" 0  -i:X<0f>t ,X<66iForDnegativemothersinwhichthebabyhasapositiveDAT,_RhIg_Ԁcandidacyisdeterminedbyidentificationofthe  "k antibodycoatingthebaby'scells. #l `1,X` <66 X<66`0  0X$$IfitisduetoimmuneantiD(determinedbymother'shistory)sheisnotan_RhIg_Ԁcandidate.$ nX$X$ 0  0X$$IfitisduetopassivelyacquiredantiDfromherantenataldoseof_RhIg_Ԁ(determinedbymother'shistory)she %!o  is an_RhIg_Ԁcandidate.&"pX$X$ 0  0X$$Ifitisduetoanyotherimmuneantibody(i.e.,K,_Fy_,Aetc.)sheisan_RhIg_Ԁcandidate.'#qX$X$   )%s 0$Name_________________________________ ) @@0$Date_________________________________   Exercise10 @( CordbloodDAT c : @XX&RecordingResults    _S_TD@zx! p @ H@E!!!_ HIHIH$H$ HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI HIHIHIHI H$H$HIHI  e&<"" K1EXKXYZ1EK1EZ XT8| p,X` <66Z0$ZXYXZ1EName_________________________________ ) #Z1EXZXYc# K1E*Z1EExercise10 #Z1EK1E#Ԁ RhImmuneGlobulin(_RhIg_)Work V- - HXXT8DpD-0  0$$0P $$0 P $P $StudyQuestions f $ $ ZXYXZ1E1.0  DescribehowtheDnegativemotherisexposedtotheDantigenduringthebirthprocess.(1point) h$$ 2.0  Define kernicterus.(1point)[2$$ 3.0  Describetheproduct RhImmuneGlobulin(_RhIg_).(1point)7$$ 4.0  Statehowadministrationof_RhIg_ԀpreventssensitizationofthemothertotheDantigen and withinwhattime ! frameitmustbeadministered.(2points) "$$ 5.0  Statethewholebloodandpackedcellvolumesthat1vialof_RhIg_Ԁwillcover.(1point)*&'$$   -)* 6.0  Statethereasonforadministrationofante_partum_Ԁadministrationof_RhIg_Ԁ and whenduringthepregnancy )  thisisadministered.(1point)#$$ 7.0  Listthree(3)groupsofwomenwhoare NOT candidatesfor_RhIg_?(1.5points) $$ 8.0  Listseven(7)circumstanceswhenanRhnegativewomanshouldreceive_RhIg_?(3.5points)$$   c$: ! c iBV  iBVmc9  .0    Whatgroupoftestsconstitutean_RhIg_Ԁ_workup_Ԁandbrieflystatethepurposeofeachtestperformed.(3 ) points)iBVmc ی#$$ Ќ  iBV  iBVc10  .0    WhatisthetermusedforantiDpresentinthematernalserumduetoadministrationof_RhIg_?Whatisthe  termusedforanantiDpresentinaDnegativepersonwhohasbeensensitizedtotheDantigen?(1point)iBVc ی$$ Ќ  11.  Briefly describetheprincipleoftheRosettetest?(2_pts_) v 12.  Briefly describetheprincipleoftheKleihauerBetkeacidelutiontest?(2_pts_) u!L 13.  WhyistherosettetestmoresensitiveandspecificthanthemicroDu?(1point) K("$%   !/*, c iBV  iBVc14  .0    AKleihauerBetkeacidelutiontestwasdone.Theresultsare50fetalcellsin2000adultcellsseen ) Calculatethedoseof_RhIg_Ԁneeded.Showyourwork.(1point)iBVȏcی#$$ Ќ  iBV  iBVIc15  .0    HowisitdeterminedwhethertheantiDdetectedinthematernalsampleisimmuneorpassively $    acquired?(1point)iBVIdcی $$ Ќ  16.  ForeachofthefollowingdeterminewhetherornottheMotherisan_RhIg_Ԁcandidate.(3Points)  *tud d    / /8 8   OPH$H$,dd ,A dd ,rdd ,dd ,dd +  /X /Maternal  ABO/D AX,! "X AMaternalAntibodyScreen AX,!"X AInfantABO/D AX,!"X ADAT AX,!"X A_RhIg_  YesorNo -#! "X -a.  0Neg  n Neg  n 0Neg 'n" 'Neg n "   n! b.  APos  %" Neg  %# 0Neg '%$" 'Neg %%"   %& c.  ANeg  ' antiC+K  ( APos ')" 'Pos *"   + d.  0Neg  A , Neg  A - BPos 'A ." 'Pos A /"   A 0 e.  ANeg  !1 passivelyacquiredantiD  !2 0Pos '!3" 'Neg !4"   !5 f.  ABNeg  ]#46 antiDduetosensitization  ]#47 APos ']#48" 'Pos ]#49"  ]#4: