ABO Hemolytic Disease Research Articles

Evaluation of clinical effects of two elution test methods for neonatal ABO hemolytic disease detection

Objective To compare the clinical application efficacy of frozen elution test and improved thermal elution test (papain-treated erythrocyte micro-column gel-card method) for neonatal ABO hemolytic disease detection, in order to select a laboratory diagnostic method with the best sensitivity and specificity in neonatal ABO hemolytic disease detection. Methods From October to December 2015, a total of 194 whole blood samples for neonatal ABO hemolytic disease detection were collected in this study. Frozen elution test and improved thermal elution test were used to detect all the samples for neonatal ABO hemolytic disease detection, respectively. The positive detection rate, specificity and sensitivity of these 2 methods for neonatal ABO hemolytic disease detection were calculated, and the positive detection rate of the 2 methods for neonatal ABO hemolytic disease detection was compared by Chi-square test. Results The positive detection rate of frozen elution test for neonatal ABO hemolytic disease detection was 57.7% (112/194), which was higher than that of 45.9% (89/194) of improved thermal elution test, and the difference of positive detection rates in these 2 methods was statistically significant (χ2=5.46, P<0.05). The sensitivity of the frozen elution test for neonatal ABO hemolytic disease detection was 92.3% (72/78), which was higher than that of 76.9% (60/78) of improved thermal elution test. The specificity of the 2 methods was both 98.3% (57/58). Conclusions Frozen elution test and improved thermal elution test were both with high specificity for neonatal ABO hemolytic disease detection. However, the sensitivity of frozen elution test is higher and more suitable for the clinical application of this project. Key words: Infant, newborn; Erythroblastosis, fetal; ABO blood-group system; Elution test

Audit of Pediatric Transfusion Practices in a Tertiary Care Hospital: Expert's Opinion.

To the Editor: Bahadur et al. reported a retrospective audit of pediatric transfusion practices over a period of 3 mo at Lady HardingeMedical College, NewDelhi in the April, 2015 issue of this journal [1]. The authors observed an appropriate usage of blood components in 59.65 % requests, of 2,145 units issued. Appropriate requests were considered as those which conformed to the guidelines of transfusion practices. They have considered the utility of whole blood for neonatal exchange transfusion (ET) as ‘appropriate’ and observed that whole blood was appropriately (100 %) utilized for ET. In a correspondence, Aydin et al. from Turkey, have deliberated the subject of reconstituted packed red blood cells (PRBCs) vs. whole blood for neonatal ET [2]. They have commented that whole blood is generally an inappropriate choice for transfusions, particularly in pediatrics-neonatology. The argument favoring PRBCs reconstituted with plasma for ET is to minimize the anti-A and anti-B titers, in the appropriate setting. In ABO hemolytic disease, when ET is planned with O Rh-negative blood, O Rh-negative PRBCs suspended in AB plasma is ideal to minimize the anti-A and anti-B titers [3, 4]. For non-group O neonates, RBC units for ET (group O) are best resuspended in AB plasma or plasma of the baby’s blood group due to concerns over possible risks of hemolysis from the residual group O plasma [5]. Whole blood is rarely used for ET in the western world [5]. Whole blood is not readily available in most areas of the United States [6]. However, several centers prefer to reconstitute PRBCs for ET with plasma from the same donation where possible [5]; this practice, intended to reduce donor exposure, effectively renders the unit as a ‘whole blood’ from a single donor. As stated in British Transfusion Guidelines-2004, while there is no consensus, plasma-reduced red cells with a hematocrit of 0.50–0.60 should be suitable for ET [7]. Whole blood, with a hematocrit of 0.35–0.45 may result in a postexchange Hb of <12 g/dl in a severely anemic baby and thus increase subsequent donor exposure [7]. Surprisingly, there is a dearth of clinical evidence favoring the use of reconstituted PRBCs over whole blood for ET. In a study of 381 neonates by Yigit et al. fromTurkey, the reexchange rate was higher in the whole blood group, compared with the reconstituted PRBC for ABO hemolytic disease [3]. However, the study was retrospective. In addition, the two groups were significantly varied in gestational age, birth weight, as well as pre-ET bilirubin [3]. In contrast to the developed countries, whole blood is still available in majority of blood banks in India. Whole blood continues to be used for ET at several centers in India, plausibly for reasons of easy availability of whole blood and an unquestioned continuation of ‘conventional’ practice. With increasing availability of blood components and trained personnel in transfusion medicine and neonatology, this practice is likely to change with time. The note of caution is that the reconstitution of PRBCs should be conducted in the blood bank and ideally performed with a closed system [4]. This may not be available round the clock at all centers. A reconstitution performed at bedside with a three-way stop cock may result in a greater risk for error in appropriate dilution. The use of reconstituted PRBCs has gained favor over whole blood for ET for the above stated reasons. The clinical * Deepak Bansal deepakbansaldr@gmail.com

Neonatal BO Incompatibility Is Associated With a Positive Cord Blood Direct Antiglobulin Test in Infants of Black Ethnicity.

ABO hemolytic disease of the newborn occurs almost exclusively in infants of blood group A and B who are born to group O mothers. Positive Direct Antiglobulin Test (DAT) can identify those infants who are at risk of developing the ABO hemolytic disease. Earlier studies have suggested that BO incompatibility is associated with a positive DAT in black infants. In this study we sought to determine whether ABO incompatibility type could be associated with a higher rate of DAT positivity or clinical hemolytic disease. We reviewed the electronic medical records of all ABO-incompatible births over a 2-year period. There were 1537 ABO-incompatible births during the study period. DAT was more commonly positive among BO incompatible (21.5% in BO vs. 14.8% in AO, P=0.001) and black (18.8% in blacks vs. 10.8% in nonblacks, P=0.003) infants. DAT positivity was significantly associated with both severe hyperbilirubinemia (P=0.028) and hemolytic anemia (P<0.001). BO incompatibility was significantly associated with hemolytic anemia, but not severe hyperbilirubinemia, in the infants tested.

Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis

Background: End-tidal breath carbon monoxide (ETCOc) levels correlate with catabolism of heme, but until recently, this measurement was not readily available for application to neonatology practice. Objectives: We performed a prospective, multihospital, test-of-concept study where ETCOc was measured during the birth hospitalization of neonates with a total bilirubin (TB) value >75th percentile on the Bhutani bilirubin nomogram. This was done to test the feasibility and ease of use of this new device. Methods: Neonates with an elevated ETCOc (with a >95th percentile reference interval previously established) were labeled as having ‘hemolytic jaundice'. We recommended a follow-up TB check <24 h after hospital discharge to these families. Results: One hundred and fifteen neonates were eligible for the study, the parents of 103 provided consent, and measurements were obtained for 100. Sixty-three had normal and 37 had elevated ETCOc values. By means of a direct antiglobulin test (DAT; Coombs), 11 of these 37 were found positive for ABO hemolytic disease; the remaining 26 had other etiologies. Thirty-six of the 37 with an elevated ETCOc had repeat TB monitoring <24 h after discharge home. None of the 100 were rehospitalized for jaundice treatment compared with a rate of 2.99 rehospitalizations per 100 control neonates who had a TB value >75th percentile (p = 0.079). Conclusion: ETCOc measurement is a feasible means of assessing hemolysis in jaundiced neonates during the birth hospitalization. When hemolysis is identified, parents are likely to comply with instructions to bring the infant for a TB checkup <24 h after discharge home.

Estimating the Risk of ABO Hemolytic Disease of the Newborn in Lagos.

Background. ABO hemolytic disease of the newborn is the most common hemolytic consequence of maternofetal blood group incompatibility restricted mostly to non-group-O babies of group O mothers with immune anti-A or anti-B antibodies. Aim. We estimated the risk of ABO HDN with view to determining need for routine screening for ABO incompatibility between mother and fetus. Materials and Methods. Prevalence of ABO blood group phenotypes in blood donors at the donor clinic of the Lagos University Teaching Hospital and arithmetic methods were used to determine population prevalence of ABO genes. We then estimated proportion of pregnancies of group O mothers carrying a non-group-O baby and the risk that maternofetal ABO incompatibility will cause clinical ABO HDN. Results. Blood from 9138 donors was ABO typed. 54.3%, 23%, 19.4%, and 3.3% were blood groups O, A, B, and AB, respectively. Calculated gene frequencies were 0.1416, 0.1209, and 0.7375 for A, B, and O genes, respectively. It was estimated that 14.3% of deliveries will result in a blood group O woman giving birth to a child who is non-group-O. Approximately 4.3% of deliveries are likely to suffer ABO HDN with 2.7% prone to suffer from moderately severe to severe hemolysis.

Maternal IgG Anti-A and Anti-B Titer Levels Screening in Predicting ABO Hemolytic Disease of the Newborn: A Meta-Analysis

Maternal IgG anti-A/B titers have been considered as a susceptible factor to the risk of ABO hemolytic disease in newborn (ABO-HDN). However, the results remain controversial. This meta-analysis aimed to estimate the association between maternal IgG anti-A/B titers and the risk of ABO-HDN. Methods: Trials on the relationship between maternal IgG anti-A/B titers and the risk of ABO-HDN were collected by searching Embase, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases. The inclusion criteria were maternal IgG anti-A/B titers screening and the evaluation of clinical outcomes in relation to ABO-HDN. Stata 12.0 was used to analyze the data. Results: A total of 23 trials were eligible for inclusion, of which four trials with 5,246 participants were suitable for this meta-analysis. Meta-analysis results suggested that maternal IgG anti-A/B titers were significantly associated with the risk of ABO-HDN [OR = 2.86, 95% CI = 2.50–3.28; OR = 4.67, 95% CI = 3.92–5.55; OR = 1.61, 95% CI = 1.36–1.91 in titers (128 to 256) vs. titers (64 or lower), titers (512 or higher) vs. titers (64 or lower), and titers (512 or higher) vs. titers (128–256), respectively]. Conclusions: Our meta-analysis suggests that maternal IgG anti-A/B titers are significantly associated with the risk of ABO-HDN. They contribute to the prediction of risk of ABO-HDN, in addition to the need for invasive treatment for antibody titers ≥512.

A pediatrician's practical guide to diagnosing and treating hereditary spherocytosis in neonates.

Newborn infants who have hereditary spherocytosis (HS) can develop anemia and hyperbilirubinemia. Bilirubin-induced neurologic dysfunction is less likely in these neonates if the diagnosis of HS is recognized and appropriate treatment provided. Among neonates listed in the USA Kernicterus Registry, HS was the third most common underlying hemolytic condition after glucose-6-phosphate dehydrogenase deficiency and ABO hemolytic disease. HS is the leading cause of direct antiglobulin test (direct Coombs) negative hemolytic anemia requiring erythrocyte transfusion in the first months of life. We anticipate that as physicians become more familiar with diagnosing HS in the newborn period, fewer neonates with HS will develop hazardous hyperbilirubinemia or present to emergency departments with unanticipated symptomatic anemia. We predict that early suspicion, prompt diagnosis and treatment, and anticipatory guidance will prevent adverse outcomes in neonates with HS. The purpose of this article was to review the neonatal presentation of HS and to provide practical and up-to-date means of diagnosing and treating HS in neonates.

Analysis of Etiology, Diagnosis and Treatment of Neonatal Pathological Jaundice

&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the causes of neonatal pathological jaundice and provide the basis for clinical diagnosis and treatment. &lt;strong&gt;Method: &lt;/strong&gt;The clinical data of 120 cases of neonatal jaundice were analyzed retrospectively. &lt;strong&gt;Results: &lt;/strong&gt;In the cause of the disease, 22 cases of neonatal asphyxia, accounting for 21, 17.50% cases of breast feeding, accounting for 13, 10.83% cases of ABO hemolytic disease, accounting for 24.17%, 8 cases of cesarean section, accounting for 6.67%, 5 cases of premature delivery, accounting for 4.17%, 6 cases of intracranial hematoma, accounting for 5%. Infection, breast feeding, neonatal asphyxia, ABO blood group incompatibility is an independent factor. 120 cases were cured and discharged. No serious sequelae and dysfunction occurred. &lt;strong&gt;Conclusion: &lt;/strong&gt;To strengthen the perinatal health care, and pay attention to the prevention and treatment of risk factors, such as infection, neonatal asphyxia, and the use of appropriate breast feeding, can effectively reduce the incidence of neonatal pathological jaundice.

Predictive value of cord blood bilirubin level for subsequent neonatal hyperbilirubinemia in ABO hemolytic term infants

Objective To evaluate the predictive value of cord blood bilirubin levels for subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease. Methods A total of 292 term newborns with ABO hemolytic disease admitted from August 1, 2011 to July 31, 2012 were enrolled. Cord blood bilirubin levels were analyzed and the clinical characteristics of the neonatal hyperbilirubinemia group (n=34) and non-hyperbilirubinemia group (n=258) were compared. A receiver operating characteristic (ROC) curve analysis was performed to identify the predictive value of the occurrence and cut-off point of hyperbilirubinemia in term infants with ABO hemolytic disease. Paired-t-test, Chi-square test and Spearman correlation were used for statistical analysis. Results Of the 292 term infants with ABO hemolytic disease, 34 cases had hyperbilirubinemia, with an incidence of 11.6%. Cord blood bilirubin levels were significantly associated with the presence of hyperbilirubinemia. The mean cord blood bilirubin level in infants who developed hyperbilirubinemia was (52.4±13.2) μmol/L, and was (35.0±8.0) μmol/L for those who did not develop hyperbilirubinemia (t=7.540, P=0.001). When cord blood bilirubin concentration increased, the incidence of hyperbilirubinemia gradually increased (χ2=113.715, P<0.001; rs=7.19, P<0.001). The ROC area under the curve of 0.882 (standard error 0.005, 95%CI: 0.873-0.891, P<0.001) was significant in predicting neonatal hyperbilirubinemia by cord blood bilirubin, and the occurrence of hyperbilirubinemia increased with increasing cord blood bilirubin level. Neonatal cord blood total bilirubin ≥50 μmol/L predicted hyperbilirubinemia, and the positive predictive value was 0.683, negative predictive value was 0.959, sensitivity was 0.690 and specificity was 0.958. Conclusions Cord blood bilirubin level is useful in predicting subsequent neonatal hyperbilirubinemia in term infants with ABO hemolytic disease. Key words: ABO blood-group system; Blood group incompatibility; Hyperbilirubinemia, neonatal; Bilirubin; Fetal blood

Detection and analysis of ABO Hemolytic disease in newborn

This study was purposed to investigate the incidence and the model of ABO hemolytic disease in newborn (ABO-HDN) and the results of the three hemolysis test, so as to provide the evidences for clinical diagnosis and therapy. A total of 227 cases of maternal-fetal ABO incompatibility from January 2013 to October 2013 in the First Affiliated Hospital of Xiamen University were enrolled in the study. The ABO blood group of newborn and mother was detemined and three hemolysis tests (direct antiglobulin test, free antibody test, RBC antibody release test) were performed. The results indicated that in 227 cases of ABO incompatible pregnancies,186 cases were ABO-HDN (81.94%). There was no significant difference in the incidence between O-A and O-B incompatible pregnancies (P > 0.05). The positive ratio of direct antiglobulin test, free antibody test and RBC antibody release test were 59.14% (110/186), 84.78% (156/186) and 94.62% (176/186) respectively. It is concluded that the incidence of ABO-HDN is high. The main models of ABO-HDN were O-A and O-B. There was no significant difference in the incidence between O-A and O-B incompatible pregnancies. Three hemolysis tests are high sensitivity and are helpful in early diagnosis and early treatment of HDN.

Efficacité et tolérance des immunoglobulines polyvalentes dans l’hyperbilirubinémie néonatale par incompatibilité ABO. Méta-analyse

ABO fetomaternal red blood cell incompatibility (ABO FMI) induces an immune hemolysis after fetal transfer of hemolyzing maternal anti-A or anti-B. ABO hemolytic disease (ABO HD) remains the most frequent cause of severe and early jaundice in newborns. High levels of unconjugated hyperbilirubinemia may induce acute and chronic neurological complications. Severe hyperbilirubinemia can be prevented by first-line phototherapy (PT) treatment, but exchange transfusion (ET) is required if treatment is not effective, even if ET is linked with high hemodynamic, infectious, gastrointestinal, and/or biological morbidity. Intravenous human polyclonal immunoglobulins (IVIg) have been proposed in concomitant use with PT in order to avoid the requirement for ET in ABO FMI. Electronic databases of all published clinical trials in neonatal hyperbilirubinemia due to ABO incompatibility were systematically queried for randomized controlled clinical trials comparing PT alone to PT associated with IVIg based on the requirement for ET. Duration of PT and adverse events were optional criteria. A meta-analysis of the selected data was performed on six selected trials out of 28 found. IVIg doses ranged from 0.5 to 1.5 g/Kg in one to three administrations. Requirement for ET was lower in the IgIV+PT group, with a relative risk of 0.27 [CI 95% 0.17-0.42; P<0.00001], expressed as a number needed to treat of five neonates to avoid one ET. The mean duration of PT was 4 days in the PT group and association of PT with IVIg significantly reduced the duration of PT treatment by 0.84 days. The tolerance of the IVIg and PT association was good with no reported cases of ulcerative enterocolitis in 265 treated newborns. IVIG associated with PT reduces the need for ET and the duration of PT in newborns with hyperbilirubinemia due to ABO hemolytic disease. Their efficacy and good tolerance prompt consideration of IVIg as a therapeutic adjuvant to PT in severe hemolytic hyperbilirubinemia due to ABO incompatibility.

Causes of hemolysis in neonates with extreme hyperbilirubinemia

We instituted a quality improvement process to enhance our capacity to diagnose genetic hemolytic conditions in neonates with extreme hyperbilirubinemia. During a 1-year period, whenever the total serum bilirubin (TSB) was >25 mg dl(-1) a special evaluation was performed. If we deemed an erythrocyte membrane defect likely, based on red blood cell morphology, EMA-flow cytometry was performed. Otherwise 'next-generation' sequencing was performed using a panel of genes involved in neonatal hyperbilirubinemia. Ten neonates had a TSB ⩾ 25 mg dl(-1). Two others were evaluated as part of this process at the request of their attending neonatologists, because each had a TSB >14 mg dl(-1) in the first hours after birth and required phototherapy for ⩾ 1 week. Explanations for the jaundice were found in all 12 neonates. Five had hereditary spherocytosis, three of which also had ABO hemolytic disease. Two had pyruvate kinase deficiency. One had severe G6PD deficiency. The other four had ABO hemolytic disease. On the basis of the present small case series, we suggest that among neonates with extreme hyperbilirubinemia, it can be productive to pursue a genetic basis for hemolytic disease.

Neonatal Hyperbilirubinemia Due to ABO Incompatibility

Aim: ABO incompatibility is a common condition occurring in about 15-25% of all maternal/fetal pairs. The features of ABO incompatibility range from asymptomatic through to severe hemolysis with hyperbilirubinemia and anemia. The aim of this study is to assess the clinical course of ABO incompatibility and to evaluate the effect of blood groups on the severity of neonatal jaundice. Material and Methods: Neonates with ABO hemolytic disease of newborn were retrospectively studied. Risk factors for the severity of jaundice were recorded. Demographic, clinic, and laboratory features were compared in infants with blood groups A and B. Results: Within 13 months, 165 term infants with neonatal jaundice were treated. 32 (19.4%) of these patients had jaundice due to maternal-fetal ABO incompatibility. The O-A group included 23 infants (71.9%) while the O-B group included for 9 infants (28.1%). All the infants received phototherapy while none of the cases required exchange transfusion. Mean total bilirubin level was 15.6p4.5 mg/dl on the 2.9p2.1 days of mean age after the initiation of treatment. There were no differences between the infants with blood group A or B in terms of demographics, initial bilirubin level, anemia in first 24 hours, the rate of hemolysis, and direct Coombs test. Conclusion: ABO incompatibility may have risks of significant hyperbilirubinemia and hemolysis in infants. Neonatal jaundice due to ABO incompatibility can be successfully managed with early admission of intensive phototherapy through close follow-ups. Blood type has no effect on the severity of jaundice. Key words: Neonate; Jaundice; ABO Incompatibility; Blood Group; Phototherapy.

CD144+ endothelial microparticles as a marker of endothelial injury in neonatal ABO blood group incompatibility.

ABO antigens are expressed on the surfaces of red blood cells and the vascular endothelium. We studied circulating endothelial microparticles (EMP) in ABO haemolytic disease of the newborn (ABO HDN) as a marker of endothelial activation to test a hypothesis of possible endothelial injury in neonates with ABO HDN, and its relation with the occurrence and severity of haemolysis. Forty-five neonates with ABO HDN were compared with 20 neonates with Rhesus incompatibility (Rh HDN; haemolytic controls) and 20 healthy neonates with matched mother and infant blood groups (healthy controls). Laboratory investigations were done for markers of haemolysis and von Willebrand factor antigen (vWF Ag). EMP (CD144(+)) levels were measured before and after therapy (exchange transfusion and/or phototherapy). vWF Ag and pre-therapy EMP levels were higher in infants with ABO HDN or Rh HDN than in healthy controls, and were significantly higher in babies with ABO HDN than in those with Rh HDN (p<0.05). In ABO HDN, pre-therapy EMP levels were higher in patients with severe hyperbilirubinaemia than in those with mild and moderate disease or those with Rh HDN (p<0.001). Post-therapy EMP levels were lower than pre-therapy levels in both the ABO HDN and Rh HDN groups; however, the decline in EMP levels was particularly evident after exchange transfusion in ABO neonates with severe hyperbilirubinaemia (p<0.001). Multiple regression analysis revealed that the concentrations of haemoglobin, lactate dehydrogenase and indirect bilirubin were independently correlated with pre-therapy EMP levels in ABO HDN. Elevated EMP levels in ABO HDN may reflect an IgG-mediated endothelial injury parallel to the IgG-mediated erythrocyte destruction and could serve as a surrogate marker of vascular dysfunction and disease severity in neonates with this condition.

Association of high-dose intravenous gamma globulin with necrotizing enterocolitis in the treatment of ABO hemolytic disease of the newborn

Objective To explore the association of high-dose intravenous gamma globulin with necrotizing enterdcolitis in the treatment of ABO hemolytic disease of the newborn.Methods 100 cases of ABO hemolytic disease of the newborn who had been treated in our hospital were selected.58 were male and 42 were female and they aged between one month to one year.According to the digital form,the infants were randomly divided into a control group and a study group,50 for each group.The control group received routine treatment; while the study group received high-dose intravenous gamma globulin in addition to routine treatment.The clinical efficacy of the therapy and the association of high-dose intravenous gamma globulin with necrotizing enterocolitis were anaalyzed by using statistical theory.Results After a period of treatment and nursing,the total bilirubin level was at higher baseline level in the study group,and time to jaundice disappearance was shorter in the study group than in the control group.Necrotizing enterocolitis was diagnosed in 10 infants in the study group and in 2 in the control group.After surgical and medical treatment,one infant died of severe intestinal necrosis and 2 died of short bowel syndrome.Conclusions Intravenous high-dose gamma globulin has certain association with necrotizing enterocolitis in the treatment of ABO hemolytic disease of the newborn; however,it has a better clinical efficacy. Key words: ABO hemolytic disease; Newborn; Necrotizing enterocolitis; Intravenous immunoglobulin; Association; Research

Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates

Neonates with ABO hemolytic disease are at greater risk for developing significant hyperbilirubinemia. We aimed to determine whether sixth hour transcutaneous bilirubin (TcB) could predict such a risk. TcB measurements were obtained at the 6th hour of life in blood group A or B neonates born to blood group O, rhesus factor compatible mothers. Subsequent hyperbilirubinemia was monitored and considered significant if a neonate required phototherapy/exchange transfusion. The predictive role of sixth hour TcB was estimated. Of 144 ABO incompatible neonates, 41(OA, 24; O-B, 17) had significant hyperbilirubinemia. Mean sixth hour TcB was significantly higher among neonates who developed significant hyperbilirubinemia than those who did not (5.83±1.35 mg/dL vs. 3.65±0.96 mg/dL, P<0.001). Sixth hour TcB value >4 mg/dL had the highest sensitivity of 93.5% and >6 mg/dL had the highest specificity of 99%. Area under receiver operating characteristic curve was 0.898. Sixth hour TcB predicts subsequent significant hyperbilirubinemia in ABO incompatible neonates.

Relation between antibody titer in pregnant women with maternal-fetal ABO blood incompatibility and hemolytic disease of fetuses and newborns

Objective To investigate the relationship between IgG antibody titer in pregnant women with maternal-fetal ABO blood incompatibility and hemolytic disease of fetuses and newborns.Methods From January 31 2009 to January 31 2010,1269 singleton pregnant women who were suspected to have maternal fetal ABO blood incompatibility in Department of Obstetrics and Gynecology,Southwest Hospital,Third Military University were collected.Anti-A or anti-B IgG titers of them were detected at 28-30 gestational age,and umbilical cord blood were taken when delivery and hemolytic disease of the newborn serological test were done to diagnose hemolytic disease of the newborn (HDN).The relationship between the titers and incidence of fetal or neonatal hemolytic disease was retrospectively analyzed by Kendall tau rank correlation.Results No IgG of anti-A or anti-B in serum were found in 58.4％ (741/1269) pregnant women,while the antibody titer of 5.1％ (65/1269) pregnant women were more than or equal to 1 ∶ 128.When they were tested again at 36 gestational week,the titer of 17 cases increased twice but lower than 1 ∶ 512.No signs of intrauterine hemolysis,such as edema,ascites and pleural effusion,were found.Three hundred and eighty neonates (29.9％,380/1269) were diagnosed as HDN.Among which,12 cases (3.2％,12/380) showed mild anemia and (or) jaundice within 24 hours after delivery.There was positive correlation between incidence of neonatal hemolysis and antibody titer(Tb=-0.293,P＜0.01).The incidence of HDN increased from 85.4％ (35/41) in women with antibody titer of 1 ∶ 128 to 5/5 inwomen with antibody titer at 1 ∶ 512 (x2=108.906,P＜0.01).Among 380 HDN neonates,322 cases were transferred to neonatal intensive care unit for phototherapy based comprehensive therapy,and two underwent exchange transfusion.All patients were cured.Conclusions The intrauterine hemolysis incidence of patients with suspected maternal-fetal ABO blood incompatibility is very low,and no special care is required during pregnancy.Anti-A or anti-B tests during pregnancy is helpful in early diagnosis and management of HDN. Key words: Maternal-fetal ABO blood incompatibility; Intrauterine fetus hemolysis; Neonatal hemolysis ; Treatment outcomes

The Clinical Spectrum of ABO Incompatibility and Hemolytic Disease in the Newborn

Abstract 1182 Introduction:ABO hemolytic disease of the newborn occurs almost exclusively in infants of blood group A or B who are born to group O mothers. Although ABO incompatibility is common, its related hemolytic disease has been reported to be low. In this study, we aimed to investigate the rate of direct anti-globulin test (DAT) positivity and clinical events, such as hyperbilirubinemia or anemia in infants born to group O mothers. Methods:Using the charge code for cord blood evaluation, we were able to identify all cord blood evaluations from January 1, 2006 - December 31, 2007, and then select out the ABO incompatible births from group O mothers. We then reviewed the electronic medical records for demographic, clinical and laboratory information. Clinical events (anemia, jaundice, hemolytic disease) were investigated only in babies born at 37 weeks or higher gestation. Chi-square tests were used to cross-tabulate clinical events, demographic parameters (gender, ethnicity), and laboratory parameters (AO versus BO incompatibility, DAT-positivity). Results:There were 10,891 live births during the two-year period and 1519 (14%) of these were ABO incompatible. ‘Black' ethnicity was registered in 80% of these babies. AO and BO incompatibility comprised 57.8% and 42.2% of the cases, respectively. 5.3% of the cases had concomitant Rh incompatibility. DAT was positive in 16.7% of the cases: 13.8% weakly or 1+ positive, and 2.9% 2+ or 3+ positive. DAT was more commonly positive among BO-incompatible cases compared to AO-incompatible cases (21.7% versus 13.1%). Among blacks, DAT-positivity in BO incompatibility was more common (24.9% among blacks compared to 7.8% among non-blacks, p<0.001). Concomitant Rh incompatibility did not affect DAT positivity rate. Among AO-incompatible babies, DAT-positivity was more frequent among females (15.5% in females vs 10.8% in males, p=0.045).1299 babies were born at term (3 37 weeks gestation).of these infants, hyperbilirubinemia (defined as indirect bilirubin 3 8 mg/dL) was detected in 17.3% of babies. This was significantly associated with DAT positivity (40.6% in DAT-positive cases vs 12.3% in DAT-negative cases, p<0.001) and BO incompatibility (p=0.001). Hemolytic anemia (defined as hematocrit £ 45% and reticulocyte count 3 250,000/mm3 in the first week of life) was noted in 3.4% of cases, and was significantly associated with DAT positivity (13.2% in DAT-positive cases vs 1.1% in DAT-negative cases, p<0.001); BO incompatibility (p=0.001); and black ethnicity (p=0.001). Discussion:Our study indicated that cord blood DAT was positive in 16.7% of ABO incompatible pregnancies. BO-incompatible cases were more likely to be DAT-positive in blacks. AO-incompatibility was more common among girls, consistent with earlier studies that had shown a stronger A antigen expression among female newborns. DAT-positive cases were more likely to develop hyperbilirubinemia or hemolytic anemia. In addition, black ethnicity and BO incompatibility conferred significantly increased risk of hemolytic anemia in our study. Despite this strong association, the sensitivity of the positive DAT was 41.3% for hyperbilirubinemia and 70.5% for hemolytic anemia in ABO incompatibility. Disclosures:No relevant conflicts of interest to declare.

535 Necrotizing Enterocolitis in a Newborn following Intravenous Immunglobulin Treatment for Hemolytic Disease

ABO iso-immunization is the most frequent hemolytic disease of the newborn. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 h of...

Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real?

Intravenous Immunoglobulin G (IVIG) therapy has been used as a component of the treatment of hemolytic disease of the newborn. There is still no consensus on its use in ABO hemolytic disease of the newborn routinely. The aim of this study is to determine whether administration of IVIG to newborns with ABO incompatibility is necessary. One hundred and seventeen patients with ABO hemolytic disease and positive Coombs test were enrolled into the study. The subjects were healthy except jaundice. Infants were divided into two groups: Group I (n=71) received one dose of IVIG (1g/kg) and LED phototherapy whereas Group II (n=46) received only LED phototherapy. One patient received erythrocyte transfusion in Group I, no exchange transfusion was performed in both groups. Mean duration of phototherapy was 3.1±1.3days in Group I and 2.27±0.7days in Group II (p<0.05). Mean duration of hospital stay was 5.34±2.2days in Group I and 3.53±1.3days in Group II (p<0.05). Mean duration of phototherapy was 4.0±1.5days and 2.73±1.1days in double and single doses of IVIG respectively, and this was statistically significant (p<0.05). IVIG therapy didn't decrease neither phototherapy nor hospitalization duration in infants with ABO hemolytic disease. Meticulus follow-up of infants with ABO hemolytic disease and LED phototherapy decreases morbidity. IVIG failed to show preventing hemolysis in ABO hemolytic disease.