038: HDFN with Greg Denomme

Hemolytic Disease of the Fetus and Newborn (HDFN) is not just a diagnosis from the history books! It still happens, and all involved must respond quickly. Dr. Greg Denomme guides us to better HDFN understanding and management.

Dr. Greg Denomme

In the distant past, far too many babies died because we did not understand the basic principles of what we now call “hemolytic disease of the fetus and newborn” (“HDFN” for short). Once researchers outlined the most common mechanism (anti-D formation in an Rh-negative mother impacting future D-positive babies) and the intervention to prevent its occurrence (injection of Rh Immune Globulin to prevent anti-D formation in the mother), the incidence of fatal HDFN dropped dramatically. However, we are not out of the woods yet!

Call in the Expert!

Dr. Greg Denomme, winner of the 2017 AABB Sally Frank Memorial Award, has studied HDFN and worked in maternal-fetal transfusion for decades, and he is my guest to help us understand why HDFN is still a problem. He will outline clinical and laboratory aspects of HDFN prevention and monitoring, and discuss several cases that illustrate some pitfalls for all involved in these potentially heartbreaking cases.

About My Guest:

Greg Denomme, PhD, FCSMLS(D) (@GregDenomme) is the Senior Director of Immunohematology and Innovation at the BloodCenter of Wisconsin and a Senior Investigator with the Blood Research Institute. He is a clinical and academic trained scientist, and has worked in transfusion medicine his entire career. Dr Denomme obtained his med tech credentials along with an ART and then a doctorate in Microbiology & Immunology, followed by two postdoctoral fellowships (Pathology & Molecular Medicine at McMaster University and platelet immunology with the Canadian Red Cross Society). He received a 5-year Medical Research Council/Canadian Blood Services Scholarship while at the University of Toronto, and his work focused on platelet antigen and blood group genetics and maternal-fetal transfusion medicine. Since moving to the BloodCenter of Wisconsin, Greg has been leading the Immunohematology Reference Lab’s foray into molecular blood group genetics. With his team, he’s developed a donor red cell genotyping program and has expanded patient testing in molecular immunohematology.

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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Denomme nor I have any relevant financial disclosures.

The images below are generously provided by Dr. Denomme.

Denomme Slide 2 - History of HDFN Treatment

Denomme Slide 4 - Antibodies and antigens involved in HDFN

Denomme Slide 5 - Example of RhD zygosity differences

Denomme Slide 6 - Paternal RhD zygosity testing examples

Denomme Slide 8 - HDFN hemolysis pathophysiology

Denomme Slide 9 - RBC maturation (K is earlier than RhD)

Take the Quiz:

15 Comments

Malcolm Needs on September 5, 2017 at 8:54 am

BRILLIANT, BRILLIANT, BRILLIANT! I was purring as I listened to this Podcast discussion between two of my favourite speakers! To be pedantic (as I ALWAYS seem to be) blood group antigens are not inherited, but the genes governing their expression are inherited! I was a little surprised that Greg did not mention the use of cell free foetal DNA harvested from the maternal circulation to allow foetal genotyping in a non-invasive fashion, but, as you so correctly said at the end yourself Joe (concerning anti-G), you couldn’t include everything. I repeat, a brilliant Podcast.

Joe Chaffin on September 5, 2017 at 9:49 am

I’m very honored, Malcolm! I completely agree that Greg is fantastic! As for your “pedantic” note, you are of course correct. For the cell-free DNA issue, that issue is a little bit “dicey” in the US (patent issues and other confusing questions abound, unlike in Europe; I discussed this with Meghan Delaney in Episode 029 at around the 49 minute mark), so I elected to avoid the question (maybe not the best call in retrospect!). I would refer interested folks to the episode linked above for Meghan’s discussion.
-Joe
Reply
- Malcolm NEEDS on September 6, 2017 at 1:34 am
  
  Thanks Joe. I’ll try to do that.
  Reply
Greg Denomme on September 8, 2017 at 6:04 am

Thanks Malcolm! Maternal-fetal transfusion medicine remains my favourite discipline. So many examples of serologic and molecular immunohematology working together.
Reply

Adrian Beig on September 5, 2017 at 9:12 pm

Great talk, I just loved it THANK YOU!

Sandra Bakker on September 6, 2017 at 3:15 am

Excellent podcast! Love the quiz at the end too :$@)

Joe Chaffin on September 7, 2017 at 12:32 am

Thanks, Sandra! I’m very glad it was helpful (and that you liked the quiz!).
-Joe
Reply

Ergelen Calixto on September 29, 2017 at 7:05 pm

A really great podcast…it’s very informative. I’ve learned a lot and it enlightened me..it’s very helpful especially for someone like me assigned in bloodbank transfusion medicine…thank you so much …

Joe Chaffin on September 29, 2017 at 10:50 pm

I’m very glad it was helpful!
-Joe
Reply

Eileen on October 8, 2017 at 3:45 pm

The quiz is really cool Dr. Chaffin! ?? Thank you!

Joe Chaffin on October 8, 2017 at 5:52 pm

Glad you like it, Eileen!
-Joe
Reply

kelsie on October 10, 2017 at 11:41 am

Had a question come up about this topic today and remembered this podcast! A mom’s prenatal work showed a negative screen, upon delivery she tested positive for Fya, baby antigen typed negative for Fya and mom is insistent she did not receive any transfusions. Any idea how she gained the antibody?