EBCOG PART 1 – ANTENATAL CARE – DAY 3 (EMQ)

A.No anti-D immunoglobulin required

B.250 IU anti-D immunoglobulin

C.500 IU anti-D immunoglobulin

D.1500 IU anti-D immunoglobulin

E.5000 IU anti-D immunoglobulin

F.red cell exchange transfusion

G.Kleihauer-Betke in 6 weeks

H.Kleihauer-Betke in 48 hours

I.Kleihauer-Betke in 72 hours

J.Direct antiglobulin test and 500 IU anti-D immunoglobulin

1.A 59 year old Rh-D negative non-sensitised woman who is severely thrombocytopenic and develops multiple haemorrhage sites receives 2 units of D-positive platelets

2. A 34 year old Rh-D negative non-sensitised woman who is severely thrombocytopenic and develops multiple haemorrhage sites receives 5 units of D-positive platelets

3. A 30 year old Rh-D negative non-sensitised woman is brought in following significant trauma and is transfused 4 units of D-positive blood

A.250 IU anti-D Ig

B.500 IU anti-D Ig

C.1500 IU anti-D Ig

D.Direct antiglobulin test and 250 IU anti-D Ig

E.Direct antiglobulin test and 500 IU anti-D Ig

F.125 IU IM anti-D Ig/mL fetal red cells

G.500 IU IM anti-D Ig/mL fetal red cells

H.No anti-D Ig required

I.Kleihauer-Betke in 6 weeks

J.Kleihauer-Betke in 7 days

What is the most appropriate action in the following scenarios?

4. Mrs, Denver A 20 year old who is 26 weeks pregnant and Rh-D negative attends clinic asshe has noticed no fetal movements. Doppler fails to detect a fetal pulse and ultrasound later confirms fetal death.

5. MsTina A 23 year old Rh-D negative patient attends EPU after 2 hours of light menstrual bleeding that has now resolved. Ultrasound

6.A 26 year old Rh-D negative patient presents with PV bleeding at 22 weeks gestation and miscarriage is diagnosed. Kleihauer-Betke test shows feto-maternal haemorrhage volume at 2.5ml.

A.Anti D 250IU

B.Refer to tertiary Fetal medicine unit

C.Measure antibodies every 2 weeks

D.Measure antibodies every 4 weeks

E.Measure antibodies every week

F.Anti D 1500iu

G.Reassurance no monitoring required

H.Do kleihauer betke test only

I,AntiD 500IU

J,Monitor MCA PSV weekly

K.No anti D required

7. You have been asked to review the mrs. Agastya ,24 year-old nulliparous woman who is now 12 weeks pregnant. She is fit and healthy with a BMI of 24. In the past she had surgical management for a missed miscarriage at 10 weeks of gestation. The results of her booking bloods have been phoned through to the clinic and are as follows:
blood group: A Rhesus negative
antibody screen: anti-D antibodies present at 2.5 IU/ml.

8.A 23-year-old multiparous woman at 29 weeks of gestation is referred to the antenatal clinic measuring large for dates (symphysio–fundal height = 34 cm). In her previous pregnancy, she had recurrent antepartum haemorrhage and had a normal delivery at 37 weeks of gestation of a baby girl weighing 2.9 kg. So far, this pregnancy has progressed as expected with dating and anomaly scans both reporting no anomalies. However, at booking she was noted to have elevated anti-D levels (blood group = AB Rhesus negative). At 16 weeks of gestation, anti-D was 3 IU/ml and at 20 weeks of gestation it was 4 IU/ml. She missed her 24-week blood test due to a family holiday.She had an ultrasound scan that showed this.

A serum antibody screen performed last week shows anti-D levels of 22IU/ml.

9.A 22-year-old primiparous woman who is 34 weeks pregnant presents at the antenatal clinic.Late booker She is RhD negative with a RhD-positive fetus on cell-free fetal DNA.she has antibody screen: anti-D antibodies present at 2.5 IU/ml.and The anti-c level is reported as 5 IU/ml.

 10. A 34-year-old RhD-negative women is at 22 weeks of gestation in her second pregnancy and just completed an intrauterine platelet transfusion for alloimmunization to platelets

11.A 31-year-old nulliparous woman who is 16 weeks pregnant. At her booking bloods she was found to be O RhD negative with anti-k antibodies. The anti-k level is reported as 12IU/ml.