Hematological Characterization of Neonatal Hyperbilirubinemia during Hemolytic Disease of Newborn (HDN): An Approach to Management of Hyperbilirubinemia

Abstract

Hemolytic disease of newborn (HDN) consequences lead to considerable morbidity and mortality, and so immediate diagnosis and treatment to prevent serious repercussions are crucial. Since investigative and preventative measures of hemolytic disease of the fetus and newborn (HDFN) in Sudan lack adherence to standard international protocols (due to a lack of adequate antenatal care), this study may be useful in improving quality of life. The present study aimed to determine different hematological parameters (Hb, HCT, RBC, and erythroblast values) and maternal–fetal ABO blood type incompatibility among Sudanese jaundiced neonates with HDN. A descriptive cross-sectional study was carried out on 305 mothers and their fetuses admitted to Omdurman Maternity Hospital, Sudan. ABO and rhesus (RhD) blood groups, direct antiglobulin test (DAT), CBC, and a comment on blood smear were determined for the jaundiced newborns and used for data analysis. The history of total bilirubin, direct bilirubin level, mother’s age, gestational age, weight, gender, phototherapy, blood exchange, and presence of fever of neonates were recorded during the study. Statistical data analysis was performed using SPSS Software Version 16. The overall frequency of HDN with positive DAT was 57 (18.9%). RhD, ABO, and other blood group system incompatibility in HDN were 4 (1.3%), 18 (5.9%), and 35 (11.4%), respectively. There was statistical significance in total and direct bilirubin, gestational age, transfusion history, and phototherapy. There was a highly significant association between a positive Coomb’s test and the presence of abnormal peripheral cells (spherocyte, NRBCs, polychromasia, and target). This study revealed that the prevalence of HDFN with hyperbilirubinemia was 57 (18.9%), which remains a challenge due to the lack of standard protocols in Sudan. RhD remains the most significant antigen contributing to HDFN, although prophylactic anti-D was used. There was a significant association between DAT and abnormal blood cells.