RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018
Obstetrics & Gynaecology
Medium
An 'Rh-negative' mother delivered a baby, which among the following list is more likely to be ordered for the baby?
Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018
Explanation
- The Direct Coombs test, also known as the Direct Antiglobulin Test (DAT), is performed specifically on the newborn's blood.
- It is designed to detect maternal IgG antibodies that have crossed the placenta and are attached directly to the surface of the baby's red blood cells (RBCs).
- A positive result confirms that an immune process is causing the destruction of the baby's RBCs (hemolysis), which is the underlying mechanism of Hemolytic Disease of the Newborn (HDN).
- This test is the definitive diagnostic tool for confirming isoimmune hemolysis in the neonate.
Why Other Options Were Wrong
- Option A: A blood culture is used to diagnose bacterial or fungal infections (sepsis) by checking for the growth of microorganisms in a blood sample. It has no role in diagnosing antibody-mediated hemolysis.
- Option C: The Indirect Coombs test is performed on the mother's serum, not the baby's blood. It detects free-circulating antibodies in the mother's plasma that have the potential to cross the placenta.
- Option D: A platelet count is a component of a complete blood count (CBC) that measures the number of platelets. It is not a primary diagnostic test for Rh incompatibility.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnostic testing for Rh incompatibility and Hemolytic Disease of the Newborn (HDN) as background academic context rather than a clinical decision trigger.
- Nurses are responsible for correctly collecting cord blood at delivery for at-risk infants and ensuring it is sent for a Direct Coombs test, blood type, and Rh factor determination.
- A positive Direct Coombs test is a critical finding that requires the nurse to increase surveillance of the newborn for jaundice and signs of anemia (pallor, tachycardia).
- Early identification of hemolysis allows for prompt intervention, such as phototherapy to treat jaundice or, in severe cases, an exchange transfusion to prevent kernicterus (bilirubin-induced brain damage).
How to Approach the Question
- First, identify the key elements of the clinical scenario: an 'Rh-negative' mother and her newborn baby.
- Recognize that this situation presents a classic risk for Hemolytic Disease of the Newborn (HDN) due to Rh incompatibility.
- The question asks for a test ordered specifically for the 'baby'. This is a crucial detail that helps differentiate between the options.
- Evaluate the Coombs tests: Recall that the 'Direct' Coombs test is done directly on the baby's red blood cells, while the 'Indirect' Coombs test is done on the mother's serum.
- Based on the question's focus on the baby, select the Direct Coombs test as the most logical diagnostic tool.
- Rule out the other options: A blood culture is for infection, and a platelet count is a non-specific hematology test, making them less likely primary tests for this specific condition.
Concept Tested & Keywords
- Concept Tested: Diagnostic testing for Rh incompatibility and Hemolytic Disease of the Newborn (HDN).
- Stem keywords: Rh-negative mother, baby, ordered for the baby
- Lead-in keywords: more likely
- Clinical cues: The scenario of an Rh-negative mother and her newborn is a classic indication for investigating potential Rh incompatibility.
Question ID
Q6dYkPO-6uArsQIynvRAPb
Reference Book
E6 Medicine Davidson Principles Practice 24e p. 969-971
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1117-1119
E6 Medicine Harrison 22e Part 1 p. 951-953
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