Abstract
Aim: This study was aimed to review and establish the practice of exchange transfusion (ET) with whole blood reconstituted (WBR) in hemolytic disease of newborn (HDN). Objectives: To observe fall in indirect serum bilirubin, correction of anemia and comparison with related studies. Background: Hemolytic disease of the Newborn is characterized by presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia. Exchange transfusion with or without phototherapy is the method of choice for treating the newborn with on going hemolysis Methods/Materials: Sample size consisted of 110 neonates in whom 119 exchange transfusions were carried out with WBR. WBR was prepared by suspending O Rhesus-D (RhD) positive/negative cells (compatible with neonate’s/ mother’s serum) in AB plasma. Double volume exchange transfusion(s) were carried out through umbilical vein by push-pull technique. Results: Out of 110 cases, 61 (55.5%) were of RhD HDN whereas ABO and other group HDN cases were 30 (27.3%) and 19 (17.3%) respectively. An average post-ET fall in indirect serum bilirubin by 54.6% and correction of anemia by3.7 gm/dl were reported in the study. Conclusion: An average post-ET fall in indirect serum bilirubin and correction of anemia was found to be more significant when compared to other studies. Hence we recommend exchange transfusion in HDN with WBR to obtain reasonable fall in indirect serum bilirubin and high average rate of correction of anemia.
Highlights
Hemolytic disease of the Newborn is characterized by presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia
Present study was conducted on 110 cases of Hemolytic Disease of New Born (HDN) in whom 119 exchange transfusions were performed by whole blood reconstituted (WBR)
Out of these 110 cases, in 101 cases (91.8%) exchange transfusion (ET) was performed once while in 9 cases (8.2%) where pre-ET indirect serum bilirubin was above 40 mg/dl ET was performed twice. Out of these nine cases, 8 cases belonged to RhD HDN (88.8%) and one case was of other blood group HDN (11.2%)
Summary
Hemolytic disease of the Newborn (HDN) is characterized by presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia [1]. Detection and treatment of neonatal hyperbilirubinemia is important in prevention of bilirubin-induced encephalopathy [2]. It is classified as RhD HDN, ABO HDN and HDN due to other blood group antibodies (non-ABO, non-RhD) according to the specificity of causative IgG antibodies. Exchange transfusion (ET) removes indirect serum bilirubin, circulating mother’s antibodies and antibody-coated neonate’s red blood cells (RBCs) from the circulation and provides RBCs compatible with neonate’s serum and albumin with new bilirubin binding sites [4]. The objecttive of this study is to establish the role of practicing whole blood reconstituted (WBR) for exchange transfusion (ET) in hemolytic disease of newborn (HDN)
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