Hemolytic Jaundice Research Articles

CASE REPORT: HELLP-LIKE SYNDROME IN A 19-YEAR-OLD WOMAN WITH NOT WELL - CONTROLLED HYPERTENSION

Objective: We report a young woman with malignant hypertension (HTN) and multiorgan damage due to microangiopathy. Design and method: A 19-year old woman with previously recognized HTN and family history of HTN developed acute symptoms related to long-standing not well-controlled HTN. The patient presented with high blood pressure (BP), vomiting, epigastric pain, jaundice, impaired consciousness, tonic-clonic seizures, complete left eye blindness and partial right eye blindness. On admission, the patient was conscious but obtunded, with marked cognitive dysfunction, BP 255/143 mm Hg, heart rate 130 bpm, breathing rate 34/min, temperature 36,9C, SpO2 95%. Following admission, a transient loss of consciousness with eyes turning to the left was observed upon sitting up, without any arrhythmia seen in ECG monitoring. Neurological examination was unremarkable. Fundoscopy showed grade IV changes with papilledema, numerous hemorrhages and cotton wool spots. Results: Pregnancy test was negative. Laboratory test abnormalities included macrocytic anemia (Hb 10.25 g/dL, Hct 33.6%, MCV 103 fL), elevated leukocyte count (17.1x10 3 /L), low platelet count (69x10 3 /L), elevated serum bilirubin (10.4 mg/dL) and creatinine (4.2 mg/dL), and slightly elevated AspAT and troponin I. Brain CT showed chronic vascular brain damage. BP was gradually normalized using intravenous/oral antihypertensive drugs. Clinical symptoms and laboratory abnormalities resolved, except for left eye blindness and serum creatinine (2.47 mg/dL at discharge). Secondary HTN was excluded. The final diagnosis was malignant HTN, acute hypertensive encephalopathy with seizures, acute liver damage, chronic kidney disease, acute hemolytic anemia due to hypertensive microangiopathy, and permanent left eye blindness. Due to hemolysis and low platelet count, differential diagnosis included hemolytic-uremic syndrome which was excluded. The clinical presentation resembled that of HELLP syndrome in pregnant women with eclampsia, with evidence of target organ damage, low platelet count, liver and kidney dysfunction, and hemolytic jaundice. Conclusions: Young patients with essential HTN rarely present with such fulminant malignant HTN manifesting with neurological symptoms, with evidence of multiorgan damage due to microangiopathy. Similarly, microangiopathic hemolytic anemia rarely complicates malignant HTN. Initial clinical presentation was challenging due to neurological symptoms and evidence of multiorgan failure.

Quantitative Assay of Glucose-6-Phosphate Dehydrogenase in Normal Non-Icteric Early Neonates: A Hospital-Based Study

Introduction: Glucose -6- phosphate dehydrogenase (G6PD) a housekeeping enzyme found in the mitochondria of all cells of the body plays a crucial role in preventing cells from oxidative damage by reactive oxygen species (ROS). As Red Blood Cell (RBC) lacks a sub-cellular structure like mitochondria, it is most vulnerable due to the lack of G6PD enzyme resulting in mild hemolytic jaundice to fetal death. The Prevalence of neonatal jaundice is most common but due to lack of newborn screening for the G6PD test, neonates are misdiagnosed and the whole treatment becomes worthless. The main aim of this study was to evaluate the level of G6PD in normal early neonates. Methods: This was a cross-sectional study conducted on 43 normal early neonates of the Indian sub-population from January to June 2019 at the Laboratory Department, Padmashree institute of clinical research, Bangalore, India. Blood parameters like G6PD levels, direct and total bilirubin, and hemoglobin levels of the normal neonates were measured. This study was approved by the ethical board of the hospital. Results: The bilirubin level (direct and total), and hemoglobin level were found within the established normal reference interval. The observed G6PD levels in normal healthy full-term neonates against the available various reference intervals were established. In this study the cut-off value of G6PD enzyme activity was determined as 8.05 ± 1.2 U/g Hb and this in-house obtained reference interval level was significantly (*p< 0.05) lower than that of other reference intervals such as Kit insert Ref. Interval (9.55 ± 4.6 U/g Hb) and Ref. interval (12.5 ± 2.3 U/g Hb) as inferred by other studies. Conclusions: In conclusion, we found evidence for a newly established reference interval for normal neonates between the ages of 1 to 11 days and the reference value is remarkably lower than the available reference interval.

Проблемні питання диференційної діагностики жовтяниць у дітей. Випадки з практики (клінічна лекція)

Залежно від того, на якому рівні відбулося порушення обміну білірубіну, виділяють такі види жовтяниць: надпечінкова, печінкова, підпечінкова. Для надпечінкової жовтяниці характерне підвищення рівня непрямого білірубіну в крові при нормальній активності печінковоклітинних ферментів, паралельно в крові має місце зниження рівня гемоглобіну, еритроцитів і високий ретикулоцитоз. Характерною лабораторною ознакою печінкової жовтяниці є підвищення рівня загального білірубіну за рахунок прямого й підвищення активності печінковоклітинних ферментів. Підпечінкова жовтяниця виникає при порушенні відтоку жовчі з жовчного міхура і жовчних проток у порожнину тонкої кишки.

Hemolytic anemia and jaundice in murray grey calves

This datasheet on hemolytic anemia and jaundice in murray grey calves covers Identity, Hosts/Species Affected, Diagnosis.

Liver Disorders in PregnancyA Retrospective Study

Introduction: Liver disorders associated with pregnancy are important medical disorders that carries grave prognosis and challenging for both obstetricians and hepatologists. It affects about 3% of pregnancies worldwide and about 3-5% pregnancies in India. It can present with various symptoms like yellowish discolouration of sclera, dark coloured urine, anorexia, nausea, vomiting, abdominal pain etc. The liver disorders unique to pregnancy includes-hyperemesis gravidarum, preeclampsia, eclampsia with liver dysfunction, HELLP syndrome, Intrahepatic Cholestasis of Pregnancy (IHCP) and acute fatty liver of pregnancy. Aim: This study aims to evaluate demographic variables, causes of liver dysfunction during pregnancy and foeto-maternal outcome of pregnancies complicated by jaundice and liver dysfunction. Materials and Methods: This was a retrospective hospital based observational study on the pregnant women admitted with jaundice or any liver disorders in department of Obstetrics and Gynaecology in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand over a period of one year from March 2018 to February 2019. The incidence of liver disorders in pregnancy, its causes, the foetal outcome in terms of preterm birth, stillbirth, Foetal Growth Restriction (FGR) and Intrauterine Foetal Death (IUFD), the maternal outcome in terms of mode of delivery, complications, need for ICU admissions and maternal mortality were evaluated. Descriptive statistics like percentage and mean calculation were used to interpret the data. Results: Out of 8264 obstetrics admissions, 126 had liver disorder in pregnancy, incidence being 1.52%. Total 87 (69%) cases were primigravida, 115 (91.3%) cases presented during 3rd trimester of pregnancy, 101 (80.1%) were unbooked for our institution. A total of 92 (73%) were referred to us. Preeclampsia, eclampsia, HELLP syndrome was the most common cause of liver dysfunction accounting for 46.8% followed by IHCP in 31 (24.6%) cases. Out of 126, 115 women admitted in labour, of which 75 (65.3%) delivered vaginally, 38 (33%) taken for caesarean section and 2 died undelivered. Nine cases were admitted in 1st trimester and two cases in 2nd trimester who did not turn up after discharge. Neonatal mortality was seen in 18 (15.6%). Conclusion: Liver dysfunction in pregnancy carries grave prognosis with high incidence of perinatal and maternal morbidity and mortality. This study emphasises the need for regular Antenatal Care (ANC), need to remain vigilant for preventable causes like haemolytic jaundice, early diagnosis, proper treatment and timely referral of liver disorders with pregnancy to prevent the complications and improve foetal and maternal outcome.

Role of Surgical Intervention in Hereditary Spherocytosis with Haemolytic Anaemia, Splenomegaly and Jaundice

haemolytic anaemia, splenomegaly and jaundice, admitted in Chettinad hospital and research institute during one year period from January 2019 to January 2020. Surgical intervention is indicated for selected patients with hereditary spherocytosis with haemolytic anaemia and jaundice to abate the hemolytic process after correction of anaemia with blood transfusion. Pigmented gallstones are seen in more than 50% cases for which incidence increases with severity of hemolysis and with age. Complications include aplastic anemia (most common after parvovirus B19 infection), haemolytic crisis during inter-current infection, megaloblastic crisis – during folic acid deficiency, cardiomyopathy, hematological malignancies.

Hemolytic anemia in a 2-years old caused by Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD): a case report

Background: Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency is an enzyme abnormality related to sex chromosomes (x-linked), which is inherited. The activity or stability of the G6PD enzyme decreases, thus causing the breakdown of red blood cells when an individual is exposed to exogenous substances that can cause oxidative damage. This case study aims to describe a rare case of hemolytic anemia caused by glucose 6 phosphate dehydrogenase deficiency in a two-year-old boy. Case Presentation: A two-year-old boy presented with agitated, pale, yellowish eyes and body and projectile vomiting after consuming fava beans. He had a prior history of packed red cell transfusion. Physical examination found the conjunctivae were pale with the icteric sclera. Laboratory examination revealed leukocytosis, moderate normochromic normocytic anemia, increased reticulocytes count, and elevated total and unconjugated bilirubin. Peripheral blood smear examination found microcytes, spherocytes, fragmentocytes, and burr cells. Coomb test was negative with decreased G6PD result. Conclusion: G6PD deficient patients have no symptoms until exposed to oxidizing drugs, infections or after fava beans ingestion which may cause hemolytic anemia and jaundice. Several methods of screening and diagnosis of G6PD can be performed to avoid morbidity and mortality.

Correlation between Non-invasive Measurement of Carboxyhemoglobin and Bilirubin Level Measurement in Near- Term and Term Neonates as a Predictor of Neonatal Hemolysis

Abstract Background Neonatal hyperbilirubinemia is common in the neonatal period. Yet, serious pathological hyperbilirubinemia may cause kernicterus with detrimental neurologic sequalae. Carbon monoxide (CO) is the byproduct of the breakdown of heme, it is transported as carboxyhemoglobin to the lungs to be exhaled. Thus, carboxyhemoglobin levels increase as a result of hemolysis, and is therefore considered a sensitive index for the degree and severity of the subsequent hyperbilirubinemia. Objectives To correlate between non-invasive carboxyhemoglobin levels and bilirubin levels in near-term and tem neonates starting hour I of life. Subjects and methods A total of 100 near-term and term neonates were studied, by measuring carboxyhemoglobin by a Pulse CO-oximetry and serum bilirubin level (hour l) and transcutaneous bilirubin (TcB) hourly since birth for the I st 6 hours then every 6 hours till the time of discharge in a cross sectional case-control study. Results A cut off value of 4 for non-invasive carboxyhemoglobin with sensitivity of 81.25%, specificity of 95.24% was found to the earliest non-invasive predictor for subsequent jaundice. In patients with proven hemolysis, carboxyhemoglobin when compared to TcB was found to increase significantly in the first 3 hours of life more than TcB, stalting hour 4 till time of discharge it was increased yet statistically insignificant Conclusion We found that non-invasive carboxyhemoglobin is an effective early predictor for subsequent jaundice starting first hour of life. It can be used as a screening tool for hemolytic jaundice especially in hospitals with early discharge policy.

The Spectrum of Hemolytic Disease of the Newborn: Evaluating the Etiology of Unconjugated Hyperbilirubinemia Among Neonates Pertinent to Immunohematological Workup.

Background and objectiveThe exact burden of hemolytic disease of the newborn (HDN) attributed to neonatal unconjugated hyperbilirubinemia (NUH) in developing nations is still unclear. Still, anti-D is reported to be the most common cause of HDN in India. ABO incompatibility has emerged as a leading cause of exchange transfusion (ET) in many countries. But many centers in our country rely on direct antiglobulin test (DAT) as a screening tool to evaluate immunological causes, whereas advanced immunohematological workup like antibody screening, identification, and elution tests are also required. Early identification of implicated antibodies resulting in HDN can aid in the proper selection of blood units when ET is indicated, and hence also in managing the subsequent pregnancy. This study focused on determining the causes of neonatal hyperbilirubinemia (NH), especially with respect to immunohematological evaluation. This cross-sectional study was conducted on 240 neonates requiring neonatal intensive care unit (NICU) support for NUH at a tertiary care hospital.Materials and methodsDemographic data, along with detailed history pertaining to the cause of hyperbilirubinemia, was collected. Clinical and laboratory evaluation and complete immunohematological work including DAT, heat elution, antibody screening, antibody identification, and Rh Kell phenotyping were performed from neonate blood samples. Data were analyzed using SPSS Statistics version 19 (IBM Corp., Armonk, NY).ResultsPathological jaundice was more common (62.1%) than physiological jaundice (37.9%). The various pathological causes identified were HDN (42.6%), sepsis (12%), cephalohematoma (5.4%), and idiopathic (1.7%). Among HDN cases, ABO incompatibility (39.2%) was the most prevalent cause, followed by Rh HDN and G6PD deficiency (1.7% each). DAT was positive in only 14 cases out of 94 ABO-incompatible cases. Elution revealed antibodies in four DAT-negative neonates with ABO incompatibility and more specificity to the OA setting. DAT was positive with 100% sensitivity in Rh HDN cases (n=4). Elution demonstrated the presence of anti-D (n=2), anti-D + anti-C (n=1) and anti-E (n=1), confirming Rh HDN. DAT strength was found to be significantly associated with hemoglobin (Hb) level (p=0.048). The majority of cases were treated with phototherapy only (94.1%), and 10 cases received both ET and phototherapy. Four neonates' condition improved without any intervention.ConclusionThis study highlighted the shift in the trend from Rh HDN to ABO incompatibility as the cause of hemolytic jaundice in NICU neonates. Elution tests can aid in the diagnosis of DAT-negative ABO-incompatible hemolytic anemia. Early diagnosis, along with timely intervention and appropriate measures, can prevent neonatal morbidity and mortality. Negative DAT does not rule out HDN. Sensitive techniques like elution must be used in the presence of clinical suspicion.

Management of Anesthesia During Splenectomy and Cholecystectomy in a Pregnant Woman With Hereditary Spherocytosis

Hereditary spherocytosis (HS) is a familial hemolytic disorder with intracorpuscular mechanism that characterized by the production of red blood cells with sphere-like shape prone to hemolysis and can lead to hemolytic anemia, splenomegaly, jaundice and gallstones. One of the main reasons for referring these patients to the operating room is splenectomy and cholecystectomy to treat the complications of HS. Perioperative concerns in these patients include severe anemia with a need for blood transfusion, aplastic attacks, hypoxemia and acidosis. On the other hand, management of anesthesia during splenectomy and cholecystectomy in pregnant woman with HS is very challenging due to physiological changes associated with pregnancy, choosing the appropriate time to perform the surgeries, and complications of anesthesia drugs on mother and fetus. This case study report the management of anesthesia in a pregnant woman with HS, candidate for simultaneous cholecystectomy and splenectomy.

Assessment of serum aflatoxin B1 levels in neonatal jaundice with glucose-6-phosphate dehydrogenase deficiency: a preliminary study.

Aflatoxin (AF) contamination of food products is still a major health issue globally. Prior studies suggest that exposure to AFs during pregnancy has harmful fetal outcomes. This preliminary study was designed to assess serum AFB1 levels in neonatal jaundice (NNJ) secondary to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Twenty-four full-term neonates with hemolytic jaundice secondary to G6PD deficiency were enrolled in the study. Erythrocyte G6PD status was assessed colorimetrically, and serum aflatoxin B1 (AFB1) concentrations were measured by high-performance liquid chromatography. The results revealed that AFB1 was detected in 58% (14/24) of the studied newborns while detected in 75% (18/24) of their mothers. AFB1 positive cases had a highly significantly lower birthweight and G6PD activity (P=0.001, each). Birthweight (r=-0.574, P=0.032) and G6PD activity (r=-0.585, P=0.028) negatively correlated with serum AFB1 levels while serum alanine aminotransferase activity positively correlated with serum AFB1 levels (r=0.536, P=0.048). Maternal AFB1 exposure is associated with adverse birth outcomes as verified by the low birthweight and the evident decline in the activity of G6PD enzyme with the resultant hemolytic NNJ.

Beta-thalassemia major of late diagnosis revealed by pregnancy: a double atypical observation

The diagnosis of beta thalassemia major is most often made in childhood, the discovery in adults is exceptional. We report an observation of a transfusion-dependent form of beta thalassemia diagnosed following a pathological pregnancy. A 30-year-old patient was being managed for transfusion-refractory anemia following a pregnancy with a 28-week amenorrhea abortion. The patient had anemic syndrome, hemolytic jaundice, splenomegaly and craniofacial dysmorphia. Biology noted microcytic hypochromic anemia with a hemoglobin level of 6.3 g/dl and significant erythroblastosis and an electrophoretic profile of major beta-thalassemia. Radiography of the skull showed cortical hypertrophy with a protrusion of the frontal bone and diffuse osteoporosis. The patient received iron chelation therapy combined with a transfusion regimen of red blood cell concentrate and folic acid. This observation illustrates a double atypia of symptomatic major beta thalassemia with transfusion need discovered late and exceptional spontaneous pregnancy in this field.

Prematurity and Dental Outcomes: A Short Communication Study

Background: The development of the teeth is affected by gestational age, and premature neonates are at greater risk for developing dental problems. In the present study, the deleterious effects of preterm birth on orodental tissues and structures were reviewed. Methods: A detailed research was carried out on MEDLINE, PubMed, and Google Scholar databases. English articles up to June 2019 were included and the search process was performed using the following keywords: “Dental outcomes”, “Tooth”, “Preterm”, “Prematurity”, and “Neonate”. Results: Literature review has revealed that alteration of tooth crown sizes, quantitative loss of enamel (i.e., enamel hypoplasia), and qualitative change in the enamel opacity (i.e., translucence appearance), or a combination of all are common in premature newborns. Delayed eruption of the first deciduous tooth is frequent among preterm neonates. Prematurity may also influence dental occlusion development, asymmetry in the jaws, and lateralization. Neonates with immature organs and enzymes are at greater risk for some complications, such as hemolytic jaundice and cholestasis. These complications, in addition to hyperbilirubinemia, may result in yellow, brown, or dark green discoloration in the primary teeth. Conclusion: Some measures can be adopted to improve dental outcomes in premature neonates, including prevention of preterm birth, avoiding problems associated with oral intubation, gentle passing and moistening oral tube feeding, and oral care with colostrum and soft swabs.

Novel nonsense mutation p. Gln264Ter in the ANK1 confirms causative role for hereditary spherocytosis: a case report

BackgroundHereditary spherocytosis (HS) is the most common haemolytic anaemia caused by congenital membrane defects of red blood cells. The name derives from the presence of spherical red blood cells in the peripheral blood. Clinical manifestations of HS are anaemia, haemolytic jaundice, and large spleen, and infection can worsen the condition, often with cholelithiasis. HS is mainly caused by abnormal functions of the products of six genes. Splenectomy is the main treatment for HS.Case presentationHalf a day after birth, the proband exhibited HS-related symptoms, with progressive aggravation. Routine examination in the outpatient department showed an increase in white blood cells and a decrease in red blood cells. His mother had HS and a partial splenectomy. We suspected that the infant might also have HS. Genomic DNA samples were extracted from the three members of the HS trio pedigree, and genomic whole-exome sequencing (WES) was performed. The three DNA samples were amplified by polymerase chain reaction (PCR), followed by Sanger sequencing to identify mutation sites. A novel nonsense heterozygous mutation, c.790C > T (p. Gln264Ter), in the ANK1 gene, which causes premature termination of translation, was found in this Chinese family with autosomal dominant HS.ConclusionsThis de novo nonsense mutation can cause the onset of HS in early childhood, with severe symptoms. Expanding the ANK1 genotype mutation spectrum will lay a foundation for the further application of mutation screening in genetic counselling.

A Rare Case Presentation of HbE/ β Thalassemia

HbE/β thalassemia (HbE/β thal) genotype accounts for approximately one half of severe β thalassemia cases worldwide. The disorder shows marked clinical variability ranging from mild asymptomatic anemia to life threatening disease. Here, we report a case of a 2-year-old boy from Bihar presenting with severe haemolytic jaundice. Complete haematological profile and Haemoglobin High Performance Liquid Chromatography (Hb HPLC) using Biorad version was done of the patient along with the family was done to arrive at the diagnosis of this rare hemoglobinopathy.

S1589 Zieve’s Syndrome: A Clinical Triad, or Perchance a Quartet?

INTRODUCTION: Zieve’s syndrome is a syndrome that presents with a triad of hemolytic anemia, jaundice, and hyperlipidemia secondary to alcohol use/alcohol-induced liver injury, hemolytic anemia being the hallmark feature. It was first described by Dr. Leslie Zieve in 1957. CASE DESCRIPTION/METHODS: A 29-year-old male with no medical history presented with acute epigastric abdominal pain radiating to his back. Pain is associated with nausea and vomiting. Social history is significant for heavy alcohol use but negative for smoking and illicit drug use. Vital signs stable on admission. Physical exam was uncovered epigastric tenderness. Labs significant for elevated lipase to 2145, elevated transaminase enzymes AST/ALT 163/209. TBILI 1.1 and DBILI 0.3. HIV negative, Ethanol < 10, IgG4 28.3 WNL, Triglycerides 62, HbG 15.8, Hct 47.8, RDW 15.6%. Abdominal ultrasound was negative for gallstones. CT abdomen/pelvis revealed findings consistent with pancreatitis. His acute pancreatitis was managed with IVF and pain control. Throughout the hospital course, his Hgb dropped from 15.8 to 12.3 and an unconjugated bilirubinemia was appreciated. TBILI went from 1.1 to 2.8 and Indirect BILI went from 0.8 to 1.9. Hemolysis labs were significant for LDH 1386, Haptoglobin < 20, Reticulocyte 3%, DAT Negative. Ceruloplasmin wnl, fibrinogen elevated to 563, direct coombs neg. Peripheral smear revealed immature granulocytes, no schistocytes, and occasional nucleated RBCs. DISCUSSION: Zieve syndrome is more common than originally perceived as it’s incidence is estimated at 1 in 1,600 admissions, but its mechanism is poorly understood. Zieve suggested transient hyperlipidemia, specifically Lysolecithin, caused RBC membrane disruption. Zieve’s study reported hyperlipidemia in 50% of patients. A follow-up study by Balcerzak et al. reported that transfused RBCs into patients with Zieve’s Syndrome hemolyzed. In Zieve’s study, pancreatitis was frequently suspected but rarely established as CT scans did not yet exist and amylase had poor specificity and sensitivity for acute pancreatitis. Timely recognition of this syndrome may help prevent unnecessary diagnostic or therapeutic interventions. Zieve’s syndrome and its association with pancreatitis should be suspected in patients with hemolytic anemia in the setting of acute alcohol intake without signs of gastrointestinal bleeding. Future studies should be considered to evaluate the association between Zieve's syndrome and pancreatitis.

Bacterial Hemolytic Jaundice

Bacterial Hemolytic Jaundice

Evaluation of Procalcitonin and C-reactive Protein in Early Differential Diagnosis of Neonatal Jaundice.

The purpose of this study was to investigate the clinical value of procalcitonin (PCT) and C-reactive protein (CRP) in the differential diagnosis of neonatal jaundice. Eighty-five cases of neonatal jaundice in our hospital from January 2016 to March 2019 were selected as research subjects, including 30 cases of physiological jaundice, 23 cases of infectious jaundice, and 32 cases of he-molytic jaundice. Five milliliters of non-anticoagulated venous peripheral blood and 3 mL EDTA-K+ anticoagulated venous peripheral blood were sampled from each newborn when the symptoms of jaundice occurred. The non-anticoagulated blood samples were then centrifuged at 3,500 rpm for 7 minutes and the serum was used for PCT and bilirubin examinations, and the anticoagulated blood samples were prepared for CRP examination. Receiver operating characteristic (ROC) curve analysis was performed for the evaluation of differential diagnosis of neonatal jaundice by PCT, CRP, and bilirubin levels. Analyses of variance showed the postnatal age of jaundice occurring in the physiological jaundice group was older than those in the infectious jaundice and hemolytic jaundice groups (p < 0.001), and the PCT and CRP levels in the infectious jaundice group were higher than those in the hemolytic jaundice and physiological jaundice groups (p < 0.001). Pearson's correlation analysis indicated that the levels of PCT and CRP were negatively correlated with postnatal age in the physiological jaundice group (p < 0.05). ROC curve analysis demonstrated that PCT and CRP had the highest differential diagnosis efficacy of neonatal pathological and neonatal physiological jaundice with PCT and CRP at 0.70 µg/L and 8.50 mg/L, respectively, as well as the highest differential diagnosis efficacy of neonatal infectious jaundice and neonatal hemolytic jaundice with PCT and CRP at 1.84 µg/L and 13.50 mg/L, respectively. This study suggested that PCT and CRP possessed important clinical values in the differential diagnosis of neonatal jaundice, and PCT was superior to the differential diagnosis of neonatal infectious jaundice.

Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society.

The frequency of neonatal exchange transfusion has declined in recent years, but is still performed in many countries. The procedure is associated with complications. The aim of the study was to determine the clinical features and etiologies of infants with hyperbilirubinemia who underwent exchange transfusion and evaluate the adverse events and clinical outcomes. We performed a secondary analysis of the multicenter Turkish Neonatal Jaundice Online Registry data. Otherwise healthy newborns born ≥35 weeks of gestation who were hospitalized for jaundice and underwent exchange transfusion were included. One-hundred thirty-two patients with a mean serum bilirubin level on admission of 24.9±9.1 mg/dL were enrolled in the study. The most common cause for exchange transfusion was hemolytic jaundice (63.6%), followed by lack of proper feeding (12.9%). It was found that the infants with lack of proper feeding were discharged earlier from the maternity ward (p=0.02), but they were admitted to hospital later (p<0.001) with a higher bilirubin level (p=0.001), and geater weight loss (p=0.04). The reported rate of adverse events associated with exchange transfusion was 11.4%. The most common complication was thrombocytopenia (40%). None of the infants died during the procedure. Acute bilirubin encephalopathy was reported in 13 (9.8%) patients. Severe hyperbilirubinemia requiring exchange transfusion and acute bilirubin encephalopathy are still challenging problems in neonatal periodin our country. The policies including blood group analysis of pregnant women, programs informing parents about breastfeeding and jaundice, and monitoring bilirubin levels of high-risk newborns should be developed to reduce the necessitating for exchange transfusion and to avoid related complications.

Autoimmune Thrombotic Thrombocytopenic Purpura, Disseminated Intravascular Coagulation, Haemophagocytic Lympho Histiocytosis—(Following Corona Virus Infection), Secondary to Fragmented Germ Cells {Liberal Global Abortions, Contraception—(Red Riverways, Blood Moon, Weakened Earth’s Magnet)} and Absence of Abstinence—Retrospective Analysis: Proof of Concept Study

Background: Autoimmunity has increased significantly, alarmingly secondary to global contraception, abortion, fragmenting germ cells; herewith three types of life threatening manifestations, are analysed. Case-1: 28-year-old afebrile lady, vegetarian, presented to emergency with impaired responsiveness, deep jaundice, menorrhagia of one day duration and she had been taking native treatment with leaves for primary infertility for the past five years; she had a few ecchymotic patches, investigations showed severe anaemia, thrombocytopenia, haemolytic jaundice, peripheral smear confirmed thrombotic thrombocytopenic purpura; she developed profound hematuria; she received treatment with intravenous immunoglobulin, fresh frozen plasma, platelet transfusions, packed red blood cells transfusions, plasmapheresis was planned; she improved gradually. In her sincere effort to conceive a baby, for the past five years, due to cultural ignorance which teaches only three days abstinence, instead of seven days abstinence after last menstrual periods, exposure of germ cells to raw endometrial surface, from 4th to 7th days of menstrual cycle, resulted in the cumulative autoimmunity-thrombotic thrombocytopenic purpura status. Case-2: 24-year-old lady who had undergone puerperal sterilisation, on the fourth day after last menstrual periods, presented, with unresponsiveness, to emergency, her investigations revealed prolonged prothrombin time, prolonged activated partial thromboplastin time, more than a minute, thrombocytopenia, reduced fibrinogen levels suggesting disseminated intravascular coagulation; her ultra sonogram abdomen showed, absence of gestational sac in the uterus; she received fresh frozen plasma transfusions, but succumbed within few hours. With puerperal sterilisation, [non evidence based medical practice], 20 million germ cells are fragmented to chromatid breaks, a-centric fragments, ring chromosomes, which get exposed to partly regenerated endometrial surface, on the fourth day after last menstrual periods, due to lack of awareness of abstinence upto seven days, initiating severe cumulative autoimmunity, resulting in fatal disseminated intravascular coagulation. Case-3: Fatal haemo-phagocytic lympho-histiocytosis-soaring autoimmunity, detected in the victim host of corona virus infection, correlated directly with extensive tissue damage produced in the victim host, by prior surgical abortions. Conclusion: Cases one and two followed absence of abstinence, with exposure of germ cells, to partly healed endometrial surface in the former culminating in thrombotic thrombocytopenic purpura; in the latter by exposure of fragmented 20 million germ cells [by contraception] to partly healed endometrial surface, culminating in fatal disseminated intravascular coagulation. In case three fatal autoimmune hemophagocytic lymphohistiocytosis followed corona virus infection, secondary to extensive tissue damage, of liberal global abortions. Red Russian riverways, is another evidence for global warming due to global aborted blood pollution, melting Perma-Frost crashing the Diesel tanks, with oil spill reflecting on aborted blood polluted river, turns bright red, similar to blood moon by abortion polluted air. Innumerable human lives with their iron of blood flowing within blood vessels, repelling magnet of earth, is mandatory to strengthen earth’s magnet. Arctic ozone hole closed this May, environmental pollution cleared, by absence of global abortions, contraception, and their ozone depleting blood pollution, due to lock down of corona virus pandemic.