BLOOD BANKING INTERNSHIP

ACTIVITY 4

PROGRAM OUTCOME/S ADDRESSED (CHED CMO #13-S-2017)

A. Demonstrate technical competence in the performance of clinical laboratory tests
in aid of diagnosis, treatment, and management of diseases vis-à-vis biosafety and
waste management.
Indicator/s
 perform laboratory testing accurately through the use of
appropriate techniques, skills and technology
 analyze and interpret laboratory test data
 monitor testing procedures, equipment, and professional/ technical
competency using quality assurance methodologies
 operate instruments properly and perform appropriate preventive and
corrective maintenance
 adhere to all laboratory safety rules and regulations

B. Demonstrate analytical and critical thinking skills in the workplace.

Indicator/s
 demonstrate skills in quality assurance and continuous quality improvement
 evaluate the validity of the generated data and assure its reliability
before reporting
 recognize errors/problems and perform root cause analysis to establish
a course of action

C. Apply research skills in relevant areas of Medical Technology/Medical

Laboratory Science practice

D. Engage in life-long learning activities

E. Demonstrate effective teaching and communication skills

MOTHER / INFANT PRE-TRANSFUSION TESTING PROCESS (HDFN)

INTRODUCTION

All people have a blood type (A, B, AB, or O). Everyone also has an Rh factor (positive or negative). There
can be a problem if a mother and baby have a different blood type and Rh factor.
HDN happens most often when a Rh-negative mother has a baby with a Rh-positive father. If the baby's Rh
factor is positive, like their father's, this can be an issue if the baby's red blood cells cross to the Rh-
negative mother.

42
This often happens at birth when the placenta breaks away. But it may also happen any time the mother’s
and baby's blood cells mix. This can occur during a miscarriage or fall. It may also happen during a prenatal
test. These can include amniocentesis or chorionic villus sampling. These tests use a needle to take a
sample of tissue. They may cause bleeding.
The Rh-negative mother’s immune system sees the baby's Rh positive red blood cells as foreign. Your
immune system responds by making antibodies to fight and destroy these foreign cells. Your immune
system stores these antibodies in case these foreign cells come back again. This can happen in a future
pregnancy. You are now Rh sensitized.
Rh sensitization normally isn’t a problem with a first pregnancy. Most problems occur in future pregnancies
with another Rh-positive baby. During that pregnancy, the mother's antibodies cross the placenta to fight
the Rh-positive cells in the baby's body. As the antibodies destroy the cells, the baby gets sick. This is
called erythroblastosis fetalis during pregnancy. Once the baby is born, it’s called HDN.

BABIES AT RISK FOR HDN

The following can raise your risk for having a baby with HDN:
Rh negative mother and have a Rh-positive baby but haven’t received treatment.
Rh negative mother and have been sensitized. This can happen in a past pregnancy with a Rh-positive baby.
Due to an injury or test in this pregnancy with a Rh-positive baby.
HDN is about 3 times more common in white babies than in African-American babies.

SYMPTOMS OF HDN IN A NEWBORN

Symptoms can occur a bit differently in each pregnancy and child.

During pregnancy, symptoms are not detected but may manifest during a prenatal test. A yellow coloring of
amniotic fluid. This color may be because of bilirubin. This is a substance that forms as blood cells break
down.
 The baby may have a big liver, spleen, or heart. There may also be extra fluid in their stomach,
lungs, or scalp. These are signs of hydrops fetalis. This condition causes severe swelling (edema).
After birth, symptoms may include:
 Pale-looking skin. This is from having too few red blood cells (anemia).
 Yellow coloring of the baby’s umbilical cord, skin, and the whites of their eyes (jaundice). The baby
may not look yellow right after birth. But jaundice can come on quickly. It often starts in 24 to 36
hours.
 The newborn may have a big liver and spleen.
 A newborn with hydrops fetalis may have severe swelling of their entire body. They may also be
very pale and have trouble breathing.

HDN DIAGNOSIS IN A NEWBORN

HDN can cause symptoms similar to those caused by other conditions. To make a diagnosis, the child’s
healthcare provider will look for blood types that cannot work together. Sometimes this diagnosis is made
during pregnancy. It will be based on results from the following tests:
 Blood test. Testing is done to look for Rh positive antibodies in your blood.
 Ultrasound. This test can show enlarged organs or fluid buildup in your baby.
 Amniocentesis. This test is done to check the amount of bilirubin in the amniotic fluid. In this test, a
needle is put into your abdominal and uterine wall. It goes through to the amniotic sac. The needle
takes a sample of amniotic fluid.
 Percutaneous umbilical cord blood sampling. This test is also called fetal blood sampling. In this
test, a blood sample is taken from your baby’s umbilical cord. The child’s healthcare provider will
check this blood for antibodies, bilirubin, and anemia.

TESTS USED TO DIAGNOSE HDN AFTER THE BABY IS BORN

43
  Testing of your baby's umbilical cord. This can show your baby’s blood group, Rh factor, red blood
cell count, and antibodies.
 Testing of the baby's blood for bilirubin levels.

HDN TREATMENT IN A NEWBORN

During pregnancy, treatment for HDN may include the following.

MONITORING

A healthcare provider will check your baby’s blood flow with an ultrasound.

INTRAUTERINE BLOOD TRANSFUSION

This test puts red blood cells into the baby's circulation. In this test, a needle is placed through the uterus. It
goes into the baby’s abdominal cavity to a vein in the umbilical cord. The baby may need sedative medicine
to keep him or her from moving. There may need to have more than 1 transfusion.

Early delivery

If the baby gets certain complications, they may need to be born early. They may induce labor may once
the baby has mature lungs. This can keep HDN from getting worse.

HDN TREATMENT AFTER BIRTH

BLOOD TRANSFUSIONS

This may be done if your baby has severe anemia.

INTRAVENOUS FLUID INFUSION

This may be done if the baby has low blood pressure.

PHOTOTHERAPY

In this test, the baby is put under a special light. This helps your baby get rid of extra bilirubin.

EXCHANGE TRANSFUSION

This test removes the baby’s blood that has a high bilirubin level. It replaces it with fresh blood that has a
normal bilirubin level. This raises the baby’s red blood cell count. It also lowers their bilirubin level. In this
test, the baby will alternate giving and getting small amounts of blood. This will be done through a vein or
artery. The baby may need to have this procedure again if their bilirubin levels stay high.

INTRAVENOUS IMMUNOGLOBULIN (IVIG)

IVIG is a solution made from blood plasma. It contains antibodies to help the baby's immune system. IVIG
reduces the baby’s breakdown of red blood cells. It may also lower their bilirubin levels.

PREVENTION OF HDN

HDN can be prevented. Almost all women will have a blood test to learn their blood type early in pregnancy.
If you’re Rh negative and have not been sensitized, you’ll get a medicine called Rh immunoglobulin
(RhoGAM). This medicine can stop your antibodies from reacting to your baby’s Rh-positive cells. Many
women get RhoGAM around week 28 of pregnancy.

44
If your baby is Rh positive, you’ll get a second dose of medicine within 72 hours of giving birth. If your baby
is Rh negative, you won’t need a second dose

Source:
1. Metcalf RA, Khan J, Andrews J, Mayock D, Billimoria Z, Pagano MB. Severe ABO Hemolytic Disease of
the Newborn Requiring Exchange Transfusion. J Pediatric Hematology Oncol. 2019 Nov;41(8):632-
634. [PubMed]
2. Noronha SA. Acquired and Congenital Hemolytic Anemia. Pediatric Rev. 2016 Jun;37(6):235-46. [PubMed]
3. Naiman JL. On Dr. Louis K. Diamond's 1932 article and subsequent contributions to erythroblastosis fetalis.
J Pediatric Hematology Oncol. 2001 Nov;23(8):550-3. [PubMed]
4. ACOG Practice Bulletin No. 192: Management of Alloimmunization During Pregnancy. Obstetric
Gynecol. 2018 Mar;131(3): e82-e90. [PubMed]
5. Murray NA, Roberts IA. Haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed.
2007 Mar;92(2): F83- [PMC free article] [PubMed]
6. Delaney M, Matthews DC. Hemolytic disease of the fetus and newborn: managing the mother, fetus, and
newborn. Hematology Am Soc Hematol Educ Program. 51. [PubMed]
7. Practice Bulletin No. 181: Prevention of Rh D Alloimmunization. Obstet Gynecol. 2017 Aug;130(2):
e57- e70. [PubMed]

LEARNING OUTCOMES:
At the end of activity 4, the student intern must be able to:

Cognitive

1. Describe the etiology and epidemiology of hemolytic disease of the fetus and newborn.
2. Identify the laboratory tests involved in the diagnosis of HDFN during pregnancy.
3. Discuss the different causes and classify the levels of HDFN
4. Discuss the management of hemolytic disease of the fetus and newborn including RhIG
administration
5. Discuss the history of Rh immune globulin and identify its clinical utility, mechanism of action, how it
is used, when it should be given to women at risk of HDFN due to anti-D.

Cognitive Application

1. Create a reference guide on the etiology and epidemiology of hemolytic disease of the fetus and
newborn.
2. Create a flip chart of the laboratory tests for easy reference involved in the diagnosis of HDFN
during pregnancy.
3. Create a worksheet that illustrate the different causes and levels of HDFN
4. Create a decision table in managing hemolytic disease of the fetus and newborn including RhIG
administration.
5. Create a worksheet that enumerate the history of Rh immune globulin and identify its clinical utility,
mechanism of action, how it is used, when it should be given to women at risk of HDFN due to anti-
D.

Psychomotor Application

1. Perform the mother and Infant testing procedures in the correct sequence
2. Perform titration and describe the results titer of anti-D as it pertains to HDFN.

45
LEARNING GUIDE:

Learning Steps Equivalent

Resources
Duty Hours
1. Read Information on MOTHER /INFANT
PRETRANSFUSION TESTING PROCESS (HDFN) and prepare 8 hours Printed
your “Learner’s Notes” on the following learning outcomes. Textbooks/Refe
(Use provided template “Job Sheet”) rence Books’,
Online Text
1. Describe the etiology and epidemiology of hemolytic References,
disease of the fetus and newborn. Online Videos,
2. Identify the laboratory tests involved in the diagnosis of Online
HDFN during pregnancy. audio/visual
3. Categorize the different causes and classify the levels of presentations,
HDFN Job Sheet
4. Discuss the management of hemolytic disease of the Template, etc.
fetus and newborn including RhIG administration
5. Discuss the history of Rh immune globulin and identify its
clinical utility, mechanism of action, how it is used, when
it
should be given to women at risk of HDFN due to anti-D.
2. Suggested Follow-Up/Alternate Self-Directed Learning LMS
Activities: Instructor
Trainer,
Attend online/face to face lecture session, or watch videos on Speaker,
on MOTHER /INFANT PRETRANSFUSION TESTING Internet
PROCESS (HDFN
Accomplished
3. Submit Student Job Sheet - Learner’s Notes
Job Sheet
4. Perform/Answer on-the-job task/s.

Note: If the task is a hands-on procedure that requires manual Online video-on
dexterity, this shall be performed in the clinical site when face-to- demand (you
face session is allowed, however if a face-to-face session is not tube, etc.)
(yet) feasible, as alternative, watch related valid online videos for
procedure familiarization.
Summative
5. Take the summative examination for Activity-3 on the
Examination
scheduled dates.
Questionnaires
6. Take the oral examination on the assigned “On the Job”
task
Comprehensive
7. Take the comprehensive (shifting) examination on
Examination
Activity-3 on the assigned on the scheduled dates
Questionnaires
Summative
8. Report and consult with your clinical instructor for your
Examination
examination results.
results

9. Proceed to Activity 4. Activity 4

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 Activity 4

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

STUDENT JOB SHEET: LEARNER’S NOTES

Name: Date: April 30, 2024

INSTRUCTION: Search from PRINTED OR ONLINE, OR VIDEO RECORDED valid references

information that would help in the achievement of the following learning outcomes. Follow this
template (cut this page or copy paste) for your answers and submit it according to the instruction
of your instructor. Use additional page if needed. PLEASE INDICATE THE SOURCE/S OF YOUR
ANSWERS.

LEARNING OUTCOMES ANSWERS

1. Describe the etiology

and epidemiology of There are two main mechanisms in which maternal antibodies target
hemolytic disease of the fetal or newborn RBC antigens:
fetus and newborn.
 ABO incompatibility
 Fetomaternal hemorrhage

ABO incompatibility is a congenital, inherent mismatch between

maternal and fetal blood types. Conversely, alloimmunization due to
fetomaternal hemorrhage is an acquired immune-mediated mechanism
that typically affects subsequent pregnancies rather than the pregnancy
in which the FMH happens.

Rh incompatibility varies by race, ethnicity, and risk factors.

The Rh-negative blood type is most predominant in white races
(15%) compared to African Americans
(5% to 8%) or Asians and Native Americans
(1% to 2%).

Among white women, an Rh-negative woman has an 85% chance of

mating with an Rh-positive man.

Source: Ree IMC, Smits-Wintjens VEHJ, van der Bom JG, van Klink JMM,
Oepkes D, Lopriore E. Neonatal management and outcome in alloimmune
hemolytic disease. Expert Rev Hematol. 2017 Jul;10(7):607-616.

Basu S, Kaur R, Kaur G. Hemolytic disease of the fetus and newborn: Current
trends and perspectives. Asian J Transfus Sci. 2011 Jan;5(1):3-7. [PMC free
article]

de Haas M, Thurik FF, Koelewijn JM, van der Schoot CE. Haemolytic disease of
the fetus and newborn. Vox Sang. 2015 Aug;109(2):99-113.
2. Identify the laboratory
tests involved in the ABO/Rh typing and an antibody screen are recommended for all
diagnosis of HDFN pregnant women to assess the risk of HDFN development, identify
during pregnancy. alloantibodies, and determine the need for anti-D immune globulin
prophylaxis

Percutaneous umbilical cord blood sampling. This test is also called

fetal blood sampling. In this test, a blood sample is taken from the
baby’s umbilical cord to check for antibodies, bilirubin levels and
anemia.

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 Activity 4

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

Source:

Christensen RD, Agarwal AM, George TI, et al. Acute neonatal bilirubin
encephalopathy in the State of Utah 2009-2018. Blood Cells Mol Dis. 2018;72:10-
13.

ACOG practice bulletin no. 192: Management of alloimmunization during

pregnancy. Obstet Gynecol. 2018;131(3):e82-e90.
3. Categorize the different
causes and classify the HDN happens most often when a Rh-negative mother has a baby with a
levels of HDFN Rh-positive father. If the baby's Rh factor is positive, like his or her
father's, this can be an issue if the baby's red blood cells cross to the
Rh-negative mother.

The rate of hemolysis determines whether the nature of HDN is mild,

moderate, or severe. In mild cases, the small increase in the rate of
hemolysis is tolerated by the fetus. At birth and during the newborn
period, symptoms include a mild anemia and jaundice, both of which
may resolve without treatment.

In cases where there is a greater increase in the rate of hemolysis, the

level of bilirubin may still remain low during the pregnancy because of
the ability of the placenta to remove bilirubin from the fetal circulation.
However, after birth the neonate's immature liver is unable to metabolize
the increased amount of bilirubin that instead accumulates in his or her
blood.

An even greater rapid and prolonged destruction of RBCs leads to

severe anemia in the fetus. The liver, spleen, and other organs increase
their production of RBCs to compensate for their loss. The drive to
produce RBCs causes the liver and spleen to increase in size
(hepatosplenomegaly), and liver dysfunction can occur. Immature RBCs
(erythroblasts) spill into the circulation, giving rise to the alternative
name of this disease, erythroblastosis fetalis.

Source:
Urbaniak SJ , Greiss MA . RhD haemolytic disease of the fetus and the newborn.
Blood Rev. 2000;14:44–61.
Garratty G , Glynn SA , McEntire R . ABO and Rh(D) phenotype frequencies of
different racial/ethnic groups in the United States. Transfusion. 2004;44:703–6.

4. Discuss the
management of Management of Hemolytic disease of the newborn includes:
hemolytic disease of the  Phototherapy using blue lights to convert bilirubin to a form
fetus and newborn which makes the body get easier to get rid of
 Exchange transfusion removes circulating bilirubin and
including RhIG antibody-coated RBCs, replacing them with RBCs compatible
administration with maternal serum and providing albumin with new bilirubin
binding sites.
 RhIg which includes intravenous immunoglobulin
administration to help protect the baby’s red blood cells from
getting destroyed.

Source: Josephson CD, Sloan SR. Pediatric transfusion medicine. In: Hoffman
R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and
Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 121.

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MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

Niss O, Ware RE. Blood disorders. In: Kliegman RM, St. Geme JW, Blum NJ,
Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed.
Philadelphia, PA: Elsevier; 2020: chap 124.
Bowman JM. Hemolytic disease (erythroblastosis fetalis). Creasy RK, Resnik R.
Maternal-fetal medicine. 4th edition. Philadelphia: WB Saunders; 1999. 736-767.
5. Discuss the history of
Rh immune globulin and RhD immune globulin (also known as RhIG) is a commercial biological
identify its clinical utility, antibody derived from human plasma that targets red blood cells
positive for the RhD antigen.
mechanism of action,
how it is used, when it RhIG is known for its use in preventing hemolytic disease of the fetus
should be given to and neonate, which is the result of transplacental passage of anti-D
women at risk of HDFN antibodies due to previous exposure to an incompatible Rh blood type
due to anti-D. of either a previous pregnancy or received blood products.

Intravenous infusion of anti-D into an Rh-positive recipient leads to

antibody coating of the circulating erythrocytes, which are eventually
cleared primarily by the spleen. Clearance of sensitized erythrocytes by
the RES results in increased platelet counts and reduced bleeding.

If you're Rh negative and have not been sensitized, you'll get a medicine
called Rh immunoglobulin (RhoGAM). This medicine can stop your
antibodies from reacting to your baby's Rh-positive cells. Many women
are given RhoGAM around the 28th week of pregnancy.

Source: Kim YA, Makar RS. Detection of fetomaternal hemorrhage. Am J

Hematol. 2012 Apr;87(4):417-23.

Bowman JM. The prevention of rh-immunization. Can Fam Physician. 1977

Dec;23:60-8.

Crowther C, Middleton P. Anti-D administration after childbirth for preventing

Rhesus alloimmunisation. Cochrane Database Syst Rev. 2000;(2):CD000021.

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 Activity 4

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

ON THE JOB TASK SHEET: COGNITIVE APPLICATION

Name: Date: April 30, 2024

INSTRUCTION: Read and analyze each case carefully and answer the given questions. Search from
PRINTED OR ONLINE valid related cases to back-up your answers. Follow this template (cut this
page or copy paste) for your answers and submit it according to the instruction of your instructor.
Use additional page if needed. PLEASE INDICATE THE REFERENCE/S USED FOR YOUR ANSWERS.

LEARNING OUTCOMES ANSWERS

1. A patient has just

reported to the RhoGAM is the injection used to treat Rh incompatibility during
laboratory for a pre- pregnancy. The shot contains antibodies (collected from plasma donors)
natal blood work. that stop your immune system from reacting to your baby’s Rh positive
blood cells.
Results were: ABO/Rh
type – O Rh Negative. Getting a RhoGAM shot is the best way to prevent any possible
What would be the next complications from Rh incompatibility. It protects your baby’s red blood
step to help this young cells from attack if her blood comes into contact with yours during labor
mother to avoid HDFN? and delivery and helps prevent Rh-related complications from
happening in later pregnancies.

Reference:
Kaplan M, Wong RJ, Burgis JC, Sibley E, Stevenson DK. Neonatal jaundice and
liver diseases. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's
Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 91.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Blood
disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson
KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier;
2020:chap 124.
2. The antibody screen is
positive. What is the Diagnosis for HDFN
next plan of action to  Anatomy ultrasound - a high-resolution ultrasound to assess
organs for any enlargement. When a fetus is anemic the organs
help diagnose an
can be enlarged.
impending HDFN?  Amniocentesis - a medical procedure in which a small amount
of amniotic fluid is extracted and then studied in the lab to
screen for genetic abnormalities

Reference: Hemolytic disease of the fetus & newborn (HDFN): Diagnosis &
treatment. (n.d.). Nationwide Children's Hospital.
3. A one-day old baby with
severe jaundice is Babies with jaundice have a yellow coloring of the skin and eyes. This
undergoing photo happens when there is too much bilirubin in the baby's blood.
therapy. The mother’s
Babies with jaundice will get a blood test to check bilirubin levels.
blood type is O positive Sometimes, a light machine that measures bilirubin in the skin is used.
and this baby is A But if the level is high, a blood test must confirm the result.
positive. What is the
probable cause of the Mild jaundice goes away after 1 or 2 weeks as a baby's body gets rid of
jaundice? the extra bilirubin on its own. For newborns with breastfeeding jaundice,
mothers should breastfeed the baby more often. If the baby is not
getting enough breast milk, the doctor may suggest supplementing with
formula.

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 Activity 4

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

Reference: Jaundice in newborns. (n.d.).
https://kidshealth.org/en/parents/jaundice.html
4. A patient has just
reported to the RhoGAM is the injection used to treat Rh incompatibility during
laboratory for a pre- pregnancy. The shot contains antibodies (collected from plasma donors)
that stop your immune system from reacting to your baby’s Rh positive
natal blood work.
blood cells.
Results were: O Rh
Negative. What would Getting a RhoGAM shot is the best way to prevent any possible
be the next step to help complications from Rh incompatibility. It protects your baby’s red blood
this young mother to cells from attack if her blood comes into contact with yours during labor
avoid HDFN? and delivery and helps prevent Rh-related complications from
happening in later pregnancies.

Reference:
Kaplan M, Wong RJ, Burgis JC, Sibley E, Stevenson DK. Neonatal jaundice and
liver diseases. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's
Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 91.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Blood
disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson
KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier;
2020:chap 124.
5. A patient has just
reported to the Anti-Kell is a condition in which the antibodies in a pregnant woman's
laboratory for a pre- blood cross the placenta and destroy her baby's red blood cells,
natal blood work. resulting in severe anemia.
Results were: ABO/Rh
IUT - Intrauterine Transfusion (IUT) is done either by intraperitoneal
type – O Rh positive. transfusion (IPT) or intravenous transfusion (IVT). IVT is preferred over
The antibody screen is IPT. IUTs are only done until 35 weeks. After that, the risk of an IUT is
positive and the greater than the risk from post birth transfusion.
identified antibody is
anti-K. What would be Reference:
the next step to help this P. Collinet et al., Successful treatment of extremely severe fetal anemia due to
Kell alloimmunization (Obstet Gynecol 2002)
young mother to avoid
HDFN? M.E. Caine et al., Kell sensitization in pregnancy (Am J Obstet Gynecol
1986)

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 Activity 4

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

ON THE JOB TASK SHEET: PSYCHOMOTOR APPLICATION

Name: Date: April 30, 2024

INSTRUCTION: Perform the following in the clinical site when FEASIBLE or read the procedures
from PRINTED or ONLINE references, and WATCH related VIDEOS for procedure familiarization.
Follow this template (cut this page or copy paste) for your answers and submit it according to the
instruction of your instructor. Use additional page if needed. PLEASE INDICATE THE SOURCE/S OF
YOUR ANSWERS.

LEARNING OUTCOMES ANSWERS

Perform the mother and Infant

testing procedures in the correct Newborn screening refers to a set of special tests, including blood,
sequence hearing, and heart screening, done to one- to two-day-old infants,
usually before they leave the hospital. This is to check for any serious
health disorders that do not show signs at birth.

Video Link/ Source:

https://www.youtube.com/watch?v=pn47nfIcvxU

https://www.youtube.com/watch?v=pXrGIZOLz4k

https://www.youtube.com/watch?v=vxshWngJ114

Perform titration and describe

the results titer of anti-D as it The mother's immune response to the fetal D antigen is to form
pertains to HDFN. antibodies against it (anti-D).
These antibodies are usually of the IgG type, the type that is transported
across the placenta and hence delivered to the fetal circulation. HDN can
also be caused by an incompatibility of the ABO blood group.

Video Link/ Source:

https://www.youtube.com/watch?v=UyX4QJjuleU

https://www.youtube.com/watch?v=hctji6kXD7k

https://www.youtube.com/watch?v=98zIa3Cii6I

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 Activity 4
Intern’s Performance Evaluation

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

Learner’s Notes
Date: April 30, 2024

Name of Student: Year Level/Section: 4 th year

At the end of Activity 4, the student was POINTS MAXIMUM Feedback/Remarks

able to: AWARDED POINTS
1. Describe the etiology and 4
epidemiology of hemolytic disease
of the fetus and newborn.
2. Identify the laboratory tests involved 4
in the diagnosis of HDFN during
pregnancy.
3. Discuss the different causes and 4
classify the levels of HDFN.
4. Discuss the management of 4
hemolytic disease of the fetus and
newborn including RhIG
administration.
5. Discuss the history of Rh immune 4
globulin and identify its clinical
utility, mechanism of action, how it
is used, when it should be given to
women at risk of HDFN due to anti-
D.
TOTAL POINTS 20
AVERAGE (%) 100%
Instructor’s Signature/Date

RUBRICS IN AWARDING POINTS:

4 Answer presented is complete and correct with indicated reference
3. Answer presented is incomplete and correct with indicated reference
2 Answer presented is complete and correct but with no indicated reference
1 Answer presented is incomplete and correct but with no indicated reference
0 No answer or the answer presented is incorrect.

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 Activity 4
Intern’s Performance Evaluation

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

ON-THE-JOB TASK/S: COGNITIVE APPLICATION

On-the-Job Tasks: POINTS MAXIMUM Feedback/Remarks

AWARDED POINTS
1. A patient has just reported to the 4
laboratory for a pre-natal blood
work. Results were: ABO/Rh type –
O Rh Negative. What would be the
next step to help this young mother
to avoid HDFN?
2. The antibody Screen is positive. 4
What is the next plan of action to
help diagnose an impending HDFN?
3. A one-day old baby with severe 4
jaundice is undergoing photo
therapy. The mother’s blood type is
O positive and this baby is A
positive. What is the probable cause
of the jaundice?
4. A patient has just reported to the 4
laboratory for a pre-natal blood
work. Results were: ABO/Rh type –
O Rh Negative. What would be the
next step to help this young mother
to
avoid HDFN?
5. A patient has just reported to the 4
laboratory for a pre-natal blood
work. Results were: ABO/Rh type –
O Rh positive. The antibody screen
is positive and the identified
antibody is anti-K. What would be
the next step to help this young
mother to avoid HDFN?
TOTAL POINTS 20
AVERAGE (%) 100%
Instructor’s Signature/Date

RUBRICS IN AWARDING POINTS:

4 Answer presented is complete and correct with indicated reference

3. Answer presented is incomplete and correct with indicated reference
2 Answer presented is complete and correct but with no indicated reference
1 Answer presented is incomplete and correct but with no indicated reference
0 No answer or the answer presented is incorrect.

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 Activity 4
Intern’s Performance Evaluation

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

ON-THE-JOB TASK/S: PSYCHOMOTOR APPLICATION

At the end of the activity, the student POINTS MAXIMUM Feedback/Remarks

was able to OR (watch videos on): AWARDED POINTS
1. Perform the mother and Infant 2
testing procedures in the correct
sequence
2. Perform titration and describe the 2
results titer of anti-D as it pertains to
HDFN.
TOTAL POINTS 4
AVERAGE (%) 100%
Instructor’s Signature/Date

RUBRICS IN AWARDING POINTS:

2 Perform the procedure within acceptable standards.

Watch online video on the procedure performed within acceptable standards
1 Perform the procedure with deviations from acceptable standards
Watch online video on the procedure performed with deviations from acceptable standards
0 Did not perform or watch video on the procedure

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 Activity 4
Intern’s Performance Evaluation

MOTHER / INFANT PRETRANSFUSION TESTING PROCESS

Summative Examination

Date: April 30, 2024

Name of Student: Year

Level/Section: 4th year

Note: Please submit with this form together with your summative examination.

At the end of lesson 4, the student was Total No. of No. of % Remarks
able to: Items Correct
Answers
1. Describe the etiology and
epidemiology of hemolytic disease
of the fetus and newborn.
2. Identify the laboratory tests involved
in the diagnosis of HDFN during
pregnancy.
3. Categorize the different causes and
classify the levels of HDFN.
4. Discuss the management of
hemolytic disease of the fetus and
newborn including RhIG
administration.
5. Discuss the history of Rh immune
globulin and identify its clinical
utility, mechanism of action, how it
is used, when it should be given to
women at risk of HDFN due to anti-
D.
Over-all Performance
Instructor’s Signature/Date

54