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Evaluation Of Direct Antiglobulin Test Positivity In Neonates

Year 2011, Volume: 13 Issue: 2, 36 - 40, 01.07.2011

Abstract

Aim: The objective of the present study is to determine clinical, laboratory findings, treatmentand prognosis in newborns with positive direct antiglobulin test (DAT).Methods: Ninety-seven patients with positive direct coomb’s test from 2362 newborns whowere hospitalized in Neonatology Unit of Eskisehir Osmangazi University Faculty of Medicinebetween June 2004-November 2006 were reviewed retrospectively. Chi-square test was usedfor statistical analysis.Results: The prevalance of DAT was 4.1%. Twenty-six patients were premature. In 75 patientsDAT was positive initially. The initial DATs were negative in 34.6% of prematures and 14% ofterm newborns. But later, the DATs of all these babies were positive, when they were beingfollowed up in hospital. Hemolysis was determined in 41 patients. There were blood groupincompatibilities (ABO:44, Rh:12, ABO and Rh:6) in 62 patients. 67 patients were underwentphototherapy and 52 patients were treated with intravenous immunoglobulin (IVIG). Exchangetransfusion was performed in 15 patients. Eventually; neonatal cholestasis devoloped in sixpatients and ten patients died.Conclusion: The most common etiologic factor in the newborns with positive DAT is bloodgroup incompatibility. IVIG therapy reduces the need for exchange especially in the earlydiagnosis of ABO hemolytic disease. Prematurity and accompanying systemic inflammatoryresponse syndrome (SIRS) and/or infections may be the causes of positive DAT without immunehemolytic anemia

References

  • Strobel E, Wullenweber J, Peters J: Detection and side effects of immunoglobulin preparations. Infusionsther Transfusionsmed. 1995;22:31-35. intravenously administered
  • Packman CH: Hemolytic anemia due to warm autoantibodies. Blood Rev. 2008;22:17-31.
  • Ozdemir OM, Ergin H, Ince T: A newborn with positive antiglobulin test whose mother took methyldopa in pregnancy. Turk J Pediatr. 2008;50:592-594.
  • American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.
  • American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864-874.
  • Dinesh D: Review of positive direct antiglobulin tests found on cord blood sampling. J Paediatr Child Health. 2005;41:504- 507.
  • Cianciarullo MA, Ceccon ME, Vaz FA: Prevalence of immunohematologic tests at birth and the incidence of hemolytic disease in the newborn. Rev Assoc Med Bras. 2003;49:45-53.
  • Herschel M, Karrison T, Wen M: Evaluation of the direct antiglobulin (Coombs') test for identifying newborns at risk for hemolysis as determined by end-tidal carbon monoxide concentration (ETCOc); and comparison of the Coombs' test with ETCOc for detecting significant jaundice. J Perinatol. 2002;22:341-347.
  • Baptista-González H, Hernández-Martínez JA, Galindo- Delgado P: Usefulness of direct antiglobulin test in neonatal screening. Bol Med Hosp Infant Mex. 2009;66:500-507.
  • Kiruba R, Ong R, Han P: Direct enzyme linked antiglobulin tests (ELAT) for detecting in-vivo sensitized erythrocytes: evaluation of screening for ABO incompatibility of newborn. Pathology. 1988;20:147-151.
  • Chen JY, Ling UP: Prediction of the development of neonatal hyperbilirubinemia in ABO incompatibility (abs). Zhonghua Yi Xue Za Zhi (Taipei). 1994;53:13-18.
  • Bel Comos J, Ribera Crusafont A, Natal Pujol A: Value of the Coombs test in ABO incompatibility. An Esp Pediatr. 1991;35:248-250.
  • Cid Vidal J, Elies Fibla E: Immunohematologic study of ABO hemolytic disease.An Esp Pediatr. 53:249-252,2000.
  • Narter F, Ergüven M: Direkt Coombs Pozitif ABO Uygunsuzluğunda Doğum Sonrası On İkinci Saatte Bilirubin Persentilinin Profilaktik İntravenöz İmmünglobülin Kullanımında Belirleyici Rolü. Çocuk Dergisi. 9:22-24,2009.
  • Procianoy RS, Giacomini CB, Farina DM: Early diagnosis of ABO haemolytic disease of the newborn. Eur J Pediatr. 1987;146:390-393.
  • Ozolek JA, Watchko JF, Mimouni F: Prevalence and lack of clinical significance of blood group incompatibility in mothers with blood type A or B. J Pediatr. 1994;125:87-91.
  • Madan A, Huntsinger K, Burgos A: Readmission for newborn jaundice: the value of the Coombs' test in predicting the need for phototherapy. Clin Pediatr (Phila). 2004;43:63-68.
  • Kaplan M, Kaplan E, Hammerman C: Post-phototherapy neonatal bilirubin rebound: a potential cause of significant hyperbilirubinaemia. Arch Dis Child. 2006;91:31-34.
  • Roberts IAG: The changing face of haemolytic disease of the newborn. Early Hum Dev. 2008;84:515-323.
  • Heier HE, Fugelseth D, Lindemann R: Maternal blood group 0 as a risk factor of neonatal hyperbilirubinemia requring treatment (abs). Tidsskr Nor Laegeforen. 1996;116:34-36.
  • Shanwell A, Sallander S, Bremme K: Clinical evaluation of a solid-phase test for red cell antibody screening of pregnant women. Transfusion. 1999;39:26-31.
  • Pishva N, Madani A, Homayoon K: Prophylactic intravenous immuınoglobulin in neonatal immune hemolytic jaundice. Irn J Med Sci. 2000;2:129-133.
  • Miqdad AM, Abdelbasit OB, Shaheed MM: Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med. 2004;16:163-166.
  • Girish G, Chawla D, Agarwal R: Efficacy of two dose regimes of intravenous immunoglobulin in Rh hemolytic disease of newborn--a randomized controlled trial. Indian Pediatr. 2008;45:653-659.
  • Nasseri F, Mamouri GA, Babaei H: Intravenous immunoglobulin in ABO and Rh hemolytic diseases of newborn. Saudi Med J. 2006;27:1827-1830.
  • Arndt PA, Garratty G: The changing spectrum of drug-induced immune hemolytic anemia. Semin Hematol. 2005;42:137-144.
  • Johnson ST, Fueger JT, Gottschall JL: One center's experience: the serology and drugs associated with drug- induced immune hemolytic anemia--a new paradigm. Transfusion. 2007;47:697-702.
  • Bilgen H, Ozek E, Unver T: Urinary Tract Infection and hyperbilirubinemia. Turk J Pediatr. 2006;48:51-55.
  • Xinias I, Demertzidou V, Mavroudi A: Bilirubin levels predict renal cortical changes in jaundiced neonates with urinary tract infection. World J Pediatr. 2009;5:42-45.
  • Vucinovic M, Jadric H, Karelovic D: Haemolytic disease of the newborn-from a mother with anti-Kell, anti-E and anti-Vel anti-erythrocyte alloantibodies. Z Geburtshilfe Neonatol. 2004;208:197-202.

Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi

Year 2011, Volume: 13 Issue: 2, 36 - 40, 01.07.2011

Abstract

Amaç: Yenidoğan bebeklerde, direkt antiglobulin test (DAT) pozitif saptananlarda klinik velaboratuar bulgularını, uygulanan tedavi ve prognozlarını değerlendirmek amacıyla bu çalışmayapılmıştır.Gereç ve Yöntem: Kliniğimizde Haziran 2004-Kasım 2006 yılları arasında takip edilenbebeklerden direkt coombs testi pozitif saptanan 97 vakanın dosyası retrospektif olarakincelendi. Gruplar karşılaştırılırken ki-kare testi kullanıldı.Bulgular: Direkt intiglobulin test pozitiflik prevalansı %4.1 olarak bulundu. Olguların 26’sıprematüre idi. DAT 75 hastada başlangıçta pozitif idi. Prematürelerin %34.6’sında, matürbebeklerin ise %14’ünde DAT pozitifliği sonradan saptandı. 41 hastada hemoliz saptandı. 62hastada kan grubu uyuşmazlığı (ABO:44, Rh:12, ABO ve Rh: 6) vardı. 67 hasta fototerapi, 52hasta intravenöz immunglobulin (IVIG) tedavisi aldı. 15 hastaya exchange transfüzyon yapıldı.İzlem sırasında hastalardan altısında neonatal kolestaz gelişti, 10’u öldü.Sonuç: Yenidoğanlarda DAT pozitifliğinin en sık sebebi kan grup uygunsuzluğudur ve IVIGtedavisi özellikle ABO hemolitik hastalığı olanlarda exchange ihtiyacını azaltmaktadır.Prematürite ve eşlik eden sistemik inflamatuar yanıt sendromu (SIRS) ve/veya enfeksiyonlarimmün hemolitik anemi dışında DAT’nin pozitif saptanmasında rol almaktadır

References

  • Strobel E, Wullenweber J, Peters J: Detection and side effects of immunoglobulin preparations. Infusionsther Transfusionsmed. 1995;22:31-35. intravenously administered
  • Packman CH: Hemolytic anemia due to warm autoantibodies. Blood Rev. 2008;22:17-31.
  • Ozdemir OM, Ergin H, Ince T: A newborn with positive antiglobulin test whose mother took methyldopa in pregnancy. Turk J Pediatr. 2008;50:592-594.
  • American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.
  • American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864-874.
  • Dinesh D: Review of positive direct antiglobulin tests found on cord blood sampling. J Paediatr Child Health. 2005;41:504- 507.
  • Cianciarullo MA, Ceccon ME, Vaz FA: Prevalence of immunohematologic tests at birth and the incidence of hemolytic disease in the newborn. Rev Assoc Med Bras. 2003;49:45-53.
  • Herschel M, Karrison T, Wen M: Evaluation of the direct antiglobulin (Coombs') test for identifying newborns at risk for hemolysis as determined by end-tidal carbon monoxide concentration (ETCOc); and comparison of the Coombs' test with ETCOc for detecting significant jaundice. J Perinatol. 2002;22:341-347.
  • Baptista-González H, Hernández-Martínez JA, Galindo- Delgado P: Usefulness of direct antiglobulin test in neonatal screening. Bol Med Hosp Infant Mex. 2009;66:500-507.
  • Kiruba R, Ong R, Han P: Direct enzyme linked antiglobulin tests (ELAT) for detecting in-vivo sensitized erythrocytes: evaluation of screening for ABO incompatibility of newborn. Pathology. 1988;20:147-151.
  • Chen JY, Ling UP: Prediction of the development of neonatal hyperbilirubinemia in ABO incompatibility (abs). Zhonghua Yi Xue Za Zhi (Taipei). 1994;53:13-18.
  • Bel Comos J, Ribera Crusafont A, Natal Pujol A: Value of the Coombs test in ABO incompatibility. An Esp Pediatr. 1991;35:248-250.
  • Cid Vidal J, Elies Fibla E: Immunohematologic study of ABO hemolytic disease.An Esp Pediatr. 53:249-252,2000.
  • Narter F, Ergüven M: Direkt Coombs Pozitif ABO Uygunsuzluğunda Doğum Sonrası On İkinci Saatte Bilirubin Persentilinin Profilaktik İntravenöz İmmünglobülin Kullanımında Belirleyici Rolü. Çocuk Dergisi. 9:22-24,2009.
  • Procianoy RS, Giacomini CB, Farina DM: Early diagnosis of ABO haemolytic disease of the newborn. Eur J Pediatr. 1987;146:390-393.
  • Ozolek JA, Watchko JF, Mimouni F: Prevalence and lack of clinical significance of blood group incompatibility in mothers with blood type A or B. J Pediatr. 1994;125:87-91.
  • Madan A, Huntsinger K, Burgos A: Readmission for newborn jaundice: the value of the Coombs' test in predicting the need for phototherapy. Clin Pediatr (Phila). 2004;43:63-68.
  • Kaplan M, Kaplan E, Hammerman C: Post-phototherapy neonatal bilirubin rebound: a potential cause of significant hyperbilirubinaemia. Arch Dis Child. 2006;91:31-34.
  • Roberts IAG: The changing face of haemolytic disease of the newborn. Early Hum Dev. 2008;84:515-323.
  • Heier HE, Fugelseth D, Lindemann R: Maternal blood group 0 as a risk factor of neonatal hyperbilirubinemia requring treatment (abs). Tidsskr Nor Laegeforen. 1996;116:34-36.
  • Shanwell A, Sallander S, Bremme K: Clinical evaluation of a solid-phase test for red cell antibody screening of pregnant women. Transfusion. 1999;39:26-31.
  • Pishva N, Madani A, Homayoon K: Prophylactic intravenous immuınoglobulin in neonatal immune hemolytic jaundice. Irn J Med Sci. 2000;2:129-133.
  • Miqdad AM, Abdelbasit OB, Shaheed MM: Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med. 2004;16:163-166.
  • Girish G, Chawla D, Agarwal R: Efficacy of two dose regimes of intravenous immunoglobulin in Rh hemolytic disease of newborn--a randomized controlled trial. Indian Pediatr. 2008;45:653-659.
  • Nasseri F, Mamouri GA, Babaei H: Intravenous immunoglobulin in ABO and Rh hemolytic diseases of newborn. Saudi Med J. 2006;27:1827-1830.
  • Arndt PA, Garratty G: The changing spectrum of drug-induced immune hemolytic anemia. Semin Hematol. 2005;42:137-144.
  • Johnson ST, Fueger JT, Gottschall JL: One center's experience: the serology and drugs associated with drug- induced immune hemolytic anemia--a new paradigm. Transfusion. 2007;47:697-702.
  • Bilgen H, Ozek E, Unver T: Urinary Tract Infection and hyperbilirubinemia. Turk J Pediatr. 2006;48:51-55.
  • Xinias I, Demertzidou V, Mavroudi A: Bilirubin levels predict renal cortical changes in jaundiced neonates with urinary tract infection. World J Pediatr. 2009;5:42-45.
  • Vucinovic M, Jadric H, Karelovic D: Haemolytic disease of the newborn-from a mother with anti-Kell, anti-E and anti-Vel anti-erythrocyte alloantibodies. Z Geburtshilfe Neonatol. 2004;208:197-202.
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Ahmet Karataş This is me

Mehmet Arif Akşit This is me

Neslihan Tekin This is me

Zehra Karataş This is me

Publication Date July 1, 2011
Published in Issue Year 2011 Volume: 13 Issue: 2

Cite

APA Karataş, A., Akşit, M. A., Tekin, N., Karataş, Z. (2011). Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi. Duzce Medical Journal, 13(2), 36-40.
AMA Karataş A, Akşit MA, Tekin N, Karataş Z. Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi. Duzce Med J. July 2011;13(2):36-40.
Chicago Karataş, Ahmet, Mehmet Arif Akşit, Neslihan Tekin, and Zehra Karataş. “Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi”. Duzce Medical Journal 13, no. 2 (July 2011): 36-40.
EndNote Karataş A, Akşit MA, Tekin N, Karataş Z (July 1, 2011) Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi. Duzce Medical Journal 13 2 36–40.
IEEE A. Karataş, M. A. Akşit, N. Tekin, and Z. Karataş, “Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi”, Duzce Med J, vol. 13, no. 2, pp. 36–40, 2011.
ISNAD Karataş, Ahmet et al. “Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi”. Duzce Medical Journal 13/2 (July 2011), 36-40.
JAMA Karataş A, Akşit MA, Tekin N, Karataş Z. Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi. Duzce Med J. 2011;13:36–40.
MLA Karataş, Ahmet et al. “Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi”. Duzce Medical Journal, vol. 13, no. 2, 2011, pp. 36-40.
Vancouver Karataş A, Akşit MA, Tekin N, Karataş Z. Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi. Duzce Med J. 2011;13(2):36-40.