2. ERYTHROBLASTOSIS FETALIS SUPRIYA SARASWATI A potentially life threatening blood disorder in a foetus or a newborn, arising due to incompatibility with mother’s blood.‏ EFFECTS OF THE DISEASE

3. Master layout or diagram Make a schematic diagram of the concept Explain the animator about the beginning and ending of the process. Draw image big enough for explaining. In above image, identify and label different components of the process/phenomenon. (These are like characters in a film)‏ Illustrate the basic flow of action by using arrows. Use BOLD lines in the diagram, (minimum 2pts.)‏ In the slide after that, provide the definitions of ALL the labels used in the diagram 5 3 2 4 1 INSTRUCTIONS SLIDE

4. © 2008 Nucleus Medical Art, Inc. Anaemic, Jaundice Baby MASTER LAYOUT Part Two: EFFECTS OF EF

5. Definitions of the components: 5 3 2 4 1 1. Anaemia: A condition resulting from quantitative and qualitative loss of red blood cells. 2. Jaundice: Yellowish discoloration of skin due to increased levels of yellow colored pigment called bilirubin, in the body. Bilirubin is the breakdown product of RBCs. 3. Kernicterus: A condition where very high levels of bilirubin in blood get deposited in the brain tissue causing irreversible damage to the brain.

6. Explain the process 1 5 3 2 4 In this step, use an example to explain the concept. It can be an analogy, a scenario, or an action which explains this concept/process/topic Try to use examples from day-to-day life to make it more clear You have to describe what steps the animator should take to make your concept come alive as a series of moving images. Keep the examples simple to understand, and also to illustrate/animate.

7. Analogy / Scenario / Action 1 5 3 2 4 The immune system of the body is well developed to fight infections and keep the body healthy. Any foreign substance (antigen) entering the body makes the immune system produce molecules called antibodies that destroy the antigen. Blood transfusions are procedures of transferring blood or blood based products from one circulatory system into another. For this the blood of the donor should be compatible with that of the recipient’s blood, which means the blood types should match. Or else any component not matching the recipient’s blood type will lead to production of antibodies in his body against the donor’s blood cells. These antibodies will attack the newly received blood and kill the blood cells. Erythroblastosis fetalis is a diseased condition arising from incompatibility of fetal blood with that of the maternal blood. It usually happens in Rh- women carrying Rh+ fetus. Maternal antibodies attack the fetal blood cells and destroy them.

8. Stepwise description of process The goal of the IDD is to provide instructions to an animator who is not a expert. You have to describe what steps the animator should take to make your concept come alive as a moving visualization. Use one slide per step. This will ensure clarity of the explanation. Add a image of the step in the box, and the details in the table below the box. You can use any images for reference, but mention about it's copyright status The animator will have to re-draw / re-create the drawings Add more slides as per the requirement of the animation 1 5 3 2 4

9. Step 13: ActionAudio Narration 1 5 3 2 4 Description of the action Show attack of IgG antibodies The IgG antibodies attack the fetal RBCs and destroy them. Once the IgG antibodies reach the fetus, they destroy the fetal RBCs since they bear the Rh antigen, recognized as foreign by the mother’s immune system. Destroyed fetal RBCs

10. Step 14: ActionAudio Narration 1 5 3 2 4 Description of the action Show develop- ment of anemia in newborn. Show destruction of RBCs leads to less number of RBCs in newborn. Destruction of the fetal RBCs by the mother’s antibodies leads the newborn into developing anemia.

11. Step 15: ActionAudio Narration 1 5 3 2 4 Description of the action Show immature RBCs in baby’s circulation Show increased number of immature RBCs and decreased number of mature RBCs in the baby. In an attempt to compensate for the loss of RBCs, the baby ends up releasing more amounts of immature RBCs- erythroblasts in circulation. This condition is hence called erythroblastosis fetalis. Immature erythrocytes called erythroblasts are released in fetal circulation

12. Step 16: ActionAudio Narration 1 5 3 2 4 Description of the action Show circulati on of erythrobl asts in baby. Show presence of numerous erythroblasts in the baby’s circulation. Hematopoietic tissues of infant attempt to replace the hemolyzed RBCs. Because of rapid production of red cells, many early forms of RBC are thus passed into the baby’s circulation. These forms include early blastic red cells, hence the name of the disease.

13. Step 17: ActionAudio Narration 1 5 3 2 4 Description of the action Show development of jaundice in the baby Show presence of yellow colored pigment bilirubin in the baby’s circulation. Show that this will make baby’s skin and the white of eye appear yellow. There is an increased destruction of the red blood cells of the newborn due to the attack by the mother’s antibody. Due to the breakdown of these red cells, a yellow colored pigment is formed, called bilirubin. This presents itself as jaundice, making the skin and sclera of the baby yellow. Bilirubin

14. Step 18: ActionAudio Narration 1 5 3 2 4 Description of the action Show kernicterus develops in the baby. Show movement of some bilirubin from the circulation into the brain of the baby. Show that some bilirubin gets deposited into the brain. Very high levels of bilirubin in blood, crosses the blood brain barrier and reaches the brain to get deposited there. This causes damage to cerebral tissues, a condition called Kernicterus. Bilirubin reaches brain

15. Step 19: ActionAudio Narration 1 5 3 2 4 Description of the action Show all the three conditions in the baby together Show continual destruction of RBCs in the baby & show a bubble with anemia written in it. Show increased breakdown of RBCs into bilirubin with pale skin of baby & show a bubble with jaundice written in it. Show movement and deposition of bilirubin from blood to brain & show a bubble with kernicterus written in it. Recall the conditions developed in the baby and the reasons for the same. Anemia JaundiceJaundice Jaundice Kernicterus

16. Step 20: ActionAudio Narration 1 5 3 2 4 Description of the action Show erythroblast otic baby Show along with the previously described conditions, presence of nucleated blast cells in the baby. Show a bubble with erythroblastosis fetalis written in it. This is the erythroblastotic baby. Anemic, jaundiced, and with kernicterus. Anemia Jaundice Kernicterus Erythroblastosis fetalis

17. Animation design Please see the design template provided in the next slide. This is a sample template, and you are free to change as per your design requirements. Try and recreate the sections/subsections as shown in the template. 1 5 2 4 3

19. Interactivity and Boundary limits In this section, you will add the ‘Interactivity’ options to the animation. Use the template in the next slide to give the details. Insert the image of the step/s (explained earlier in the Section 3) in the box, and provide the details in the table below. The details of Interactivity could be: Types: Drop down, Slider bar, Data inputs etc. Options: Select one, Multiple selections etc Boundary Limits: Values of the parameters, which won’t show results after a particular point Results: Explain the effect of the interaction in this column Add more slides if necessary 1 2 5 3 4

20. Interactivity option 1:Step No: Boundary/limits Interacativity Type Options Results 1 2 5 3 4 Why is the disease erythroblastosis fetalis called so? Choosing the correct option box The correct answer box turns green on clicking. The incorrect answer box turns red on clicking. Box D has the correct answer. Boxes A, B and C have incorrect answers. D. Presence of immature RBCs called erythroblasts in the fetus. C. Development of anemia in the fetus. A. Development of kernicterus in the fetus. B. Development of antibodies in the mother against fetal erythrocytes.

21. Interactivity option 2:Step No: Boundary/limits Interacativity Type Options Results 1 2 5 3 4 All of these are signs of erythroblastosis fetalis except- Choosing the correct option box The correct answer box turns green on clicking. The incorrect answer box turns red on clicking. Box C has the correct answer. Boxes A, B and D have incorrect answers. D. Kernicterus. C. Exophthalmia. A. Jaundice. B. Anemia.

22. Interactivity option 3:Step No: Boundary/limits Interacativity Type Options Results 1 2 5 3 4 A clinical condition where bilirubin crosses blood-brain-barrier is- Choosing the correct option box The correct answer box turns green on clicking. The incorrect answer box turns red on clicking. Box B has the correct answer. Boxes A, C and D have incorrect answers. D. Gastritis C. Alkaptonuria A. Megaloblastic anemia B. Kernicterus.

23. Links for further reading Reference websites: www.nlm.nih.gov http://en.wikipedia.org www.marchofdimes.com www.mercksource.com Books: Textbook of Immunology, Kuby Textbook of Medical Physiology, Guyton Research papers: