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Association of Blood Banks also recommends repeated antibody screening before administration of anti-D immune globulin at 28 weeks of gestation, postpartum, and at the time of any event in pregnancy What test is the most sensitive test for determining antibody titers and diagnosing Rh(D) alloimmunization How does it work Indirect Coomb s test. Incubation of a known specimen of Rh(D+) RBCs with maternal serum is the first step in the indirect Coomb s test. Maternal anti-Rh(D) antibodies, if present, will adhere to the RBCs. The RBCs are then washed and suspended in serum containing antihuman globulin (Coomb s serum). Red cells coated with maternal anti-Rh(D) will be agglutinated by the antihuman globulin, which is referred to as a positive indirect Coomb s test Critical titers may vary from laboratory to laboratory. In general, the critical titer that poses a significant risk for erythroblastosis fetalis and hydrops is 1:16 to 1:32 It is similar to the indirect Coomb s test and is done after birth to detect the presence of maternal antibody on the neonate s RBCs. It is performed by placing the infant s RBCs in Coomb s serum; maternal antibody is present if the cells are agglutinated It is not effective once alloimmunization to the Rh(D) antigen has occurred. Therefore, it is essential that it be given to an Rh(D-) woman whose fetus is or may be Rh(D+) whenever there is a risk of fetomaternal hemorrhage It is an IgG that will attach to the Rh antigen and prevent an immune response by the mother (see Fig. 9-6) There are three options once the gravida reaches the critical titer: 1. MCA doppler can be performed weekly. MCA doppler is sensitive in diagnosing moderate to severe

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The earlier used SI&A sheet for eld data input about each element of a bridge has now been replaced by a Pontis-based data input sheet. In many states, PONTIS data sheets are being used to help with input in a computer program. Otherwise the objectives of the method are the same. Old structural inventory and appraisal (SI&A) sheets and new PONTIS sheets: 1. SI&A sheets outline the inspected condition of a bridge, the ratings, and proposed improvements. 2. Based on these sheets, a rehabilitation report is prepared. 3. Many of the existing inspection reports are based on SI&A sheets, which had extensive data in a condensed format on a single page. SI&A sheets include the following inspection related data: 1. 2. 3. 4. 5. 6. 7. Bridge name and location. Identi cation. Classi cation. Structure data for load posting, type of service, structure type for main and approach spans, minimum vertical and lateral clearances, etc. Proposed improvement costs in thousands and future ADT. Inspection data and other inspection dates. Condition ratings for deck, superstructure and substructure, channel and channel protection, culvert and approach condition, critical features such as fracture critical, underwater, or special inspections. Inventory and operating rating. Appraisal ratings, structural evaluation, deck geometry, vertical and lateral underclearance, bridge posting, and waterway adequacy. Railroad items. Programming. Remarks.