ABO incompatbility /Rh hemolysis- Part 3 - Hyperbilirubinemia. Tala Talks NICU

[@vickiewinner5739]

Thank you so much! I never understood before this why we don't worry about hemolysis when mom is A or B and baby is the opposite. Thank you!

[@TalaTalksNICU]

Oh yay Vickie! That makes us so happy- so glad it makes sense. Thanks, as always, for being here and commenting :)

[@latifamohammed9849]

I love Dr. Tala! You make learning simple.

[@TalaTalksNICU]

Oh thank YOU!!!!! What a sweet comment- makes us so happy!!

[@-fadihias4905]

Thank you a lot , thanks to you I've understood why the hemolysis happens only when the mom is O ❤

[@TalaTalksNICU]

Oh that’s fantastic!! Thanks for being here and letting us know!

[@nderitucate9338]

You are an amazing teacher. I am doing my NCK Exam in two months. Hopefully I'll pass.

[@TalaTalksNICU]

Oh thank you!! Good luck in your exams! Let us know how they go!! We’re so glad you’re here :)

[@docvaruna]

Enjoyed the concepts. Goosebumps.

[@TalaTalksNICU]

Oh yay!!!! Love those moments

[@docvaruna]

@TalaTalksNICU Thank you. All your videos, I am going through a revision. Getting additional points each time. 👏

[@mhales09]

Thanks for another great video! I’d love to see some simple segments on nursing-based skills (like the heel stick video). Maybe IV insertion tips, assisting a provider with UVC placement, head to toe assessment, proper technique for feeding an infant probe to aspiration, NG/OG insertion/placement checks, etc. Many of those skills are fairly simple and straightforward, but I know nurses newer to NICU love any extra refreshers and help they can get. :)

[@TalaTalksNICU]

Hello Laura! These are all excellent suggestions- thank you so much. We've all been texting as a team, and we have a plan of who will cover which videos. And I agree, it's the simple, every day things that really should be emphasized more than anything! So thank you!!!

[@thowpico-900]

precise and clear presentation , thank you

[@TalaTalksNICU]

Thank you so much for watching and for taking the time to write to us :)

[@thaliapaz3639]

Thank you so much for taking the time to make these videos! I absolutely love the way you simplify the information and explain it in such a way it is easily understood. I am a current NNP student and have used several of your videos in addition to my textbooks to help me understand some topics. One of my favorites is the one on PPHN. I was wondering if you would be interested in presenting some on CHDs :)

[@TalaTalksNICU]

Hi Thalia! Thank you so much for taking the time to let us know! And we are SO happy these videos are helping! I love talking about congenital cardiac disease- and we are planning on starting a series soon. We'll go through the cyanotic diseases first. Good luck in your studies- and please let us know of other suggestions you may have (or any advice with regards to these videos!) Thank you!

[@vindyathulapitiya6712]

Thank you for the great explanation!

[@TalaTalksNICU]

So glad you're here- we're about to put out the most recent hyperbili guidelines too :) Thanks for taking the time to write!

[@archanagunasekaran7723]

Thanks for the vedio It’s really helpful

[@TalaTalksNICU]

So glad it helped!! Thank you!!

[@naseembaloch1359]

Thnx Dr tala keep it up

[@TalaTalksNICU]

We will try- thank you again !

[@leahtimmermann2708]

Thank you for these incredible videos Dr. Tala! I’m in a Midwife from Canada and I find these very helpful. I was hoping you may be able to include in your videos the incidence rates for things ex. MAS, etc when you review a topic. Thanks!

[@TalaTalksNICU]

Hello Leah! Thanks so much for watching and for taking the time to give such a great suggestion. You’re right- that is definitely something we should be including. When we started we wanted it to be more about the understanding of the concepts rather than the facts (for fear of the lectures being too didactic) but you’re right! Incidence is too important not to include! Thank you!!

[@Jo-mp3qo]

Thank you! Loved it 🤩

[@TalaTalksNICU]

Thank you so much Jo! We really appreciate your support :)

[@osamaalagamawy3891]

ما شاء اللة..بارك اللة فيكى

[@TalaTalksNICU]

Thank you so much!

[@stillbreathing100]

Thanks a lot for clearing a lot of things! Great video..🤟 just a quick question. Why O blood gp makes IgG and not IgM. And why A , B and AB blood gp make IgM and not IgG.

[@TalaTalksNICU]

OOOHHH- I don't have a good answer for you. I tried looking this up, a nd looked through a heme text book. I'll need to ask an expert and get back to you. Excellent question though!

[@oceanmiss91]

Very clear explanation. I find the videos very helpful for me to understand and to have an overall picture of major issues in neonates. Could you please cover topics like neonatal seizure and hyper/hypothyroidism?

[@TalaTalksNICU]

Hello!!! Thanks for watching and for your lovely compliment. We had seizures and hypothyroidism on our running list but not hyperthyroidism which is a great topic- because it covers important aspects of maternal- fetal physiology! We have gotten a little behind so please stay patient with us! Thanks so much for being here!

[@reesejachetta289]

As always, thank you for your videos! Feel free to tell me that the answer to this is too long or complicated - but I was wondering why/how O moms make IgG and AB moms make IgM? Just curious about why they are different!

[@TalaTalksNICU]

This is an excellent question!!!! And that’s the funny thing about medicine- there’s always a deeper “why” under our explanation. I’m sure I knew answer at one point- but I don’t any more!! I’ve accepted that level of understanding to practice clinically!!! Please let me know if you go digging!!!!

[@leahr1107]

Thank you so much for your videos! I'm starting a new job as a NICU nurse in a few weeks and they are super helpful for helping me prepare! Quick question, what is the rhogam shot's purpose in all of this? If a mom recieved rhogam, are we still worried about the hemolysis? Thanks so much!

[@TalaTalksNICU]

Hello Leah! Congrats on your new job- we think you'll LOVE it! Giving mothers who are blood type NEGATIVE rhogam has been really life changing for infants. Effectively rhogam is an antibody that neutralizes the antibodies the mother is making (against her POSITIVE baby). There is still chance of the infant gets immune hemolysis, but the chances are WAY down. Does this make sense?

[@leahr1107]

@@TalaTalksNICU Yes that makes sense! Thank you so much!

[@mofeokoromadu2962]

Thank you ma for the videos. Can you do a video on cyanotic and acyanotic heart diseases

[@TalaTalksNICU]

Hello! We’re so happy you’re here. We did a couple of cardiac videos already- on the blue baby and then Tets. We have a cardiac playlist- maybe check that out? We need to get back to hearts though!

[@helenthomson8954]

Thanks for these videos. I’m a nurse/midwife working in a special care nursery in Australia. That’s care between NICU and general ward care. I love all your videos. Could you please explain why X related conditions only affect males?

[@TalaTalksNICU]

Hello Helen all the way from Australia! Thanks so much for watching the videos! Most X-linked diseases are recessive- which means for the disease to manifest there needs to be no product of the gene. All 46 chromosomes carry genes. (We have 22 chromosome pairs and then 2 sex chromosomes: XX or XY). Each gene will code for a protein that could end up being an enzyme or a structural protein or really anything! Biological men have one X chromosome (the other is a Y) Biological women have 2 X chromosomes So let's take hemophilia as an example. Hemophilia (bleeding disorder) happens when a person lacks factor 8 (a protein in the coagulation pathway that would normally help in producing a clot). The gene that codes for factor 8 is on chromosome X. So! If a man inherits a faulty gene on his X chromosome, he won't be able to make any factor 8 (therefore will be a hemophiliac) Whereas a woman would have two inherit two faulty genes -one on each X chromosome-(one from her mother and one from her father) to have the disease. More likely she will inherit one abnormal gene on her X chromosome (most likely from her mother), and then a normal gene on her other X chromosome. The normal gene on one of her X chromosomes will result in enough of the factor 8 being produced, so that she does not end up with hemophilia. Because she has one abnormal gene though, she'll be a 'carrier' for hemophilia. Sorry! That was long! Does that make sense? Do you think we should do a video on this?

[@helenthomson8954]

@@TalaTalksNICU thanks Tala. That makes total sense. I’m a great fan of all your videos and recommend your channel to students and staff who work in our nursery. Appreciate the prompt reply!

[@TalaTalksNICU]

Thank you so much Helen! Really appreciate your support!

[@jessicahirschel9300]

Hi Dr. Tala, Something I never quite understood: If I'm not mistaken, the baby's blood type is defined really early in pregnancy (5-6GW) but the alloimmune hemolytic process in the fetus starts only much later during pregnancy. What hinders antibodies to cross the placenta earlier? Thank you for your content, I'm using your channel on a regular basis at work :-)

[@TalaTalksNICU]

Yes! These are such excellent points!!! Peak transference of antibodies is in the third trimester- (kinda peak everything!) and so 28 weeks onwards really- we start worrying more about antibody mediated disease

[@zamandlanzi1661]

Thank you ❤

[@TalaTalksNICU]

Thank you for watching!!

[@laurarice5216]

This is a great explanation thank you. Out of interest, if an ‘O positive’ mum had a group blood sample sent would it show ‘anti a or anti b’antibodies or not because this is to be expected?

[@TalaTalksNICU]

Hello Laura- great question! On a regular 'antibody' test on mother- kind of like the indirect coombs- it wouldn't be picked up because it's 'self antibodies '. But if you had a specific more research-like test to check, they would be found.

[@monjidibrahim1168]

Very big big big like👍

[@TalaTalksNICU]

Ha! Thanks so much Monjid for being such a loyal viewer and for your positive comments!

[@salmamohammed8166]

Thank you ❤️❤️❤️

[@TalaTalksNICU]

Thank you so much for watching :)

[@durgaramasamy5711]

Thank u ❤

[@TalaTalksNICU]

So glad you found it helpful! Thanks for being here :)

[@duhhno]

Hi Dr Tala, thank you for the great explanation. May I ask, why does the peak hemolytic activity occur in the first week of life? Why doesn't ABO incompatibility cause fetal death in utero - since IgG is crossing freely?

[@TalaTalksNICU]

Hello Dev- this is such a good question- I should have mentioned it in the video! In utero- there could be hemolysis occurring, but the destruction is nowhere near the level of hemolysis in untreated Rh disease. So these kids may be a little anemic, but they're also REALLY good at making their own RBCs. (And they have all the constituents they need that they can easily get from their mothers). The placenta though, works as the best filtration system in the world, so it gets rid of all the indirect bilirubin, so infants are not born with elevated indirect bilirubin levels. As you know with untreated Rh disease, the hemolysis can be so great and the anemia can be so bad that these babies can develop hydrous. Does this answer the question?

[@duhhno]

@@TalaTalksNICU yes it does. Thank you for the great answer!

[@Isabel-rx1fh]

Hi! Since our bodies produce antibodies against our blood type, then can our body attack the bacteria that have those antigens that look like the A/B antigen? For example, would a blood type A create antibodies that can attack bacteria that have the B antigen? Btw you are amazing and i love your videos! Nicu nurse here

[@TalaTalksNICU]

Oh this is such a good question! I really don’t know the answer- but I’m going to guess! Those bacteria are mostly in the gut- and for the antibodies to reach them they’d probably have to be secretory type (IgA) which aren’t the usual type made )IgG and IgM are/ so I’m guessing they wouldn’t reach the bacteria?!!! I’ll see if I can find anything more scientific than my thought process!!!

[@Isabel-rx1fh]

@@TalaTalksNICU oo interesting! The human body is so smart. That makes a lot of sense! Thank you so much for your response!💗

[@naomigideons9935]

Can giving birth through cesarean section help solve the issue of ABO incompatibility because only blood of the fetus meet with the mothers during birth?

[@TalaTalksNICU]

Great question. Honestly even with a C-section birth there can be blood mixing. But- with ABO incompatibility the mothers don’t have to have a previous baby- can happen on the first pregnancy. Go check out video to understand better?

[@jenniferyackel5396]

Hi there! I’ve had a previous child with ABO incompatibility. Currently pregnant and considering delayed cord clamping. Would potential ABO incompatibility be a reason to not do delayed cord clamping?

[@TalaTalksNICU]

Hello! Congratulations! Great question! No- not a reason- it’s still the same type of blood baby has been exposed to throughout pregnancy.

[@jenniferyackel5396]

@@TalaTalksNICU Thank you so much! So it wouldn't mean more Bilirubin in their system that they would need to get rid of? I can see how DCC would help with Anemia.

[@omarkhaldoon1762]

❤

[@TalaTalksNICU]

Thank you!!

[@zayi4280]

Thank you! I am still trying to understand this, seems like my doctors don’t fully understand it either. I am O+ and husband is A+, is there a possibility that baby can be in the O blood type? Or will I keep having babies with bilirubin and staying at the hospital for a whole week? 😫 that is so frustrating.

[@TalaTalksNICU]

Hello! It depends what your husband's blood type is- it could be AA or AO. It it's AA then all your kids will be A. So frustrating mama, but thankfully treatable.

[@zayi4280]

@@TalaTalksNICU athank you so much for your response 🙏

[@arshadnadeem6388]

What if there is both Rh and ABO incompatibility.? LIKE mother is O-ve and fetus is A+??

[@TalaTalksNICU]

Hello! Then you are EVEN more concerned about hemolysis. And it's possible that you could end up with hemolysis from both the Rh as well as the ABO. These kids should be watched carefully!

[@drliaqatalishah]

If mother is o negative and completed family... Then still anti D is recommended or not..... If yes then why medam

[@TalaTalksNICU]

This is an EXCELLENT question. You're right- if the mother is Rh negative and the father is Rh negative then there is no chance (or almost no chance- there can be some weird genetics in there) of the infant being positive, and Rh disease occurring. BUT! You'd have to be very sure of paternity. In renal transplant studies, it has been estimated that 3-4% of the time, the person who is labelled the father is not the biological father. Based on this, the mother should receive rhogam. (Although I've seen OBs that haven't given it when they know the 'father' is negative). The highest chance a mother has of developing antibodies is the time of delivery. A woman often doesn't know if she'll carry another baby- so again, the safest thing to do would be to give it to her. Does this answer your question?

[@drliaqatalishah]

@@TalaTalksNICU thanks Medam

[@drliaqatalishah]

@@TalaTalksNICU thanks.. Yaeh got it

[@hajrafaisal4648]

Hello Dr Tala! Doctor I have to talk to u about my child can u please reply me so I can discuss my child condition with u

[@TalaTalksNICU]

Dear Hajra- we are so sorry your child needs extra medical help. Unfortunately we really can’t give any medical advice on this medium. We wish you strength and peace.

[@hajrafaisal4648]

Thank u so much please pray for me n my child