Role of Subgroup Incompatibility in Newborn Jaundice Requiring Exchange Transfusion

Year 2014, Volume: 11 Issue: 2, 2 - 6, 01.06.2014

Ali Annagür Hüseyin Altunhan Murat Konak Hasan Koç Rahmi Örs

https://doi.org/10.15197/sabad.1.11.41

Abstract

We aimed to determine the role of exchange transfusion related complications, treatment, and etiology as well as subgroup incompatibility in patients subject to ET (exchange transfusion) due to newborn jaundice. 82 patients hospitalized due to newborn jaundice and exposed to exchange transfusion between August 2007 and August 2011 were retrospectively studied. Before ET mean total serum bilirubin was 29,2±9,83. The most frequent cause of ET was ABO incompatibility (31%) followed by Rh incompatibility (19%) and subgroup incompatibility (17%), respectively. In 46% of all patients and in 71% of the patients presenting with subgroup incompatibility , direct combs test was detected to be (+). 49% of the patients were administrated with intravenous immunoglobulin. 5 of the patients who were exposed to ET presented with hydrops fetalis. Of these patients 3 had Rh, 1 had ABO while the other had subgroup incompatibility. Although ABO and Rh incompatibility are substantial underlying reasons of severe jaundice requiring exchange transfusion, particularly widespread use of RhoGAM thereby enabling the prior identification and precautions, ET need was reduced compared to previous cases. On the contrary, SGU related severe hemolytic jaundice relatively enhanced, however.

Keywords

Exchange transfusion, newborn jaundice, hyperbilirubinemia, subgroup incompatibility, minor blood group incompatibility

Role of Subgroup Incompatibility in Newborn Jaundice Requiring Exchange Transfusion

Abstract

Bu çalışmada yenidoğan sarılığı nedeniyle kan değişimi (KD) yapılan hastalarda etiyoloji, tedavi, KD ile ilgili komplikasyonlar ve subgrup uyuşmazlığının rolünü belirlemeyi amaçladık. Dört yıl boyunca yenidoğan sarılığı nedeniyle yatırılarak 89 KD yapılan toplam 82 hasta retrospektif olarak değerlendirildi. KD öncesi ortalama total serum bilirubin düzeyi 29,2±9,83 mg/dl idi. En sık KD sebebi ABO uyuşmazlığı (%31), bunu Rh uyuşmazlığı (%19) ve subgrup uyuşmazlığı (SGU) (%17) izliyordu. Tüm hastaların %46’sında ve SGU olan hastaların %71’inde direkt coombs testi (+) idi. Hastaların %49’una İVİG verildi. KD yapılan hastalardan 5’inde hidrops fetalis tablosu mevcuttu. Bunların 3’ünde Rh, 1’inde ABO ve diğerinde SGU mevcuttu. KD gereksinimi gösteren ciddi sarılığın en önemli sebebi ABO ve Rh uyuşmazlığı olsa da özellikle Rhogamın yaygın kullanılması, bu risk nedenlerinin önceden tanımlanarak gerekli öneriler ve önlemler sayesinde KD ihtiyacı eskiye oranla azaltılmıştır. Ancak bunun aksine SGU’na bağlı ciddi hemolitik sarılık ve KD ihtiyacı rölatif olarak artmıştır. Kaldi ki SGU hidrops fetalis, kernikterus ve ölüme yol açabilmektedir. Riskli grupların önceden bilinmesi ve erken yoğun fototerapi sayesinde hiperbilirubineminin komplikasyonları ve KD oranı önemli ölçüde azaltılabilecektir

Keywords

Kan değişimi, yenidoğan sarılığı, hiperbilirubinemi, subgrup uyuşmazlığı, minör kan grubu uyuşmazlığı

References

• Murki S, Kumar P. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. Semin Perinatol 2011; 35 (3): 175–84.
• Ip S, Chung M, Kulig J, et al. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. An evi- dence-based review of important issues concerning neona- tal hyperbilirubinemia. Pediatrics 2004;114(1): e130–53.
• American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114(1): 297–316.
• Robitaille N, Nuyt AM, Panagopoulos A, Hume HA. Exchange Transfusion in the Infant In: CD Hillyer, RG Strauss, Luban NLC, editors. Handbook of pediatric trans- fusion medicine, first ed. Elsevier, Philadelphia 2004: 159–65.
• Tıraş Ü, Yılmaz R, Dallar Y. Neonatal Exchange Transfusion: Experience of a State Hospital in Ankara During a Four Year Period. ADU Medical Faculty J 2008; 9 (2): 5–10. (Turkish)
• Owa JA, Ogunlesi TA. Why we are still doing so many ex- change blood transfusion for neonatal jaundice in Nigeria. World J Pediatr 2009; 5 (1): 51–5.
• Bolat F, Uslu S, Bülbül A, Cömert S, Can E, Nuhoğlu A. Evalution of term newborns hospitalized in our NICU with the diagnosis of indirect hyperbilirubinemia. Pediatrics J 2010; 10 (2): 69–74.(Turkish)
• Özkaya H, Karademir F, Süleymanoğlu S, et al. Anti-E antibody related hemolytic disease of newborn: Case re- port. Nobel Med 2006; 2(1):24-6.
• Aslan Y, Erduran E, Gedik Y, Mocan H, Yıldıran A, Soylu H. Kell C and E subgroup incompatibilities in neonates with indirect hyperbilirubinemia. Turkey Clin J Pediatr 1996; 5 (3): 93–8.
• Can E, Özkaya H, Meral C, et al. Anti-C hemolytic disease of the newborn and prolonged jaundice: report of three cases. Pediatrisc Dis Health J 2009; 52: 88–90.
• Hosseinpour Sakha S, Gharehbaghi MM. Exchange trans- fusion in severe hyperbilirubinemia: an experience in northwest Iran. Turk J Pediatr 2010; 52 (4): 367–71.
• Davutoğlu M, Garipardiç M, Güler E, Karabiber H, Erhan D. The etiology of severe neonatal hyperbilirubinemia and complications of exchange transfusion. Turk J Pediatr 2010; 52 (2): 163–6.
• Tİnne A, Meberg A, Hager HB. Trends in the diagnosis and management of neonatal hyperbilirubinaemia. Tidsskr Nor Laegeforen 2010; 130 (1): 18–20.
• Kaplan M, Bromiker R, Schimmel MS, Algur N, Hammerman C. Evaluation of discharge management in the predic- tion of hyperbilirubinemia: the Jerusalem experience. J Pediatr 2007; 150 (4): 412–7.
• Mishra S, Agarwal R, Deorari AK, Paul VK. Jaundice in the newborns. Indian J Pediatr 2008; 75 (2): 157–63.
• Bhutani VK, Johnson LH, Keren R. Diagnosis and manage- ment of hyperbilirubinemia in the term neonate: for a safer first week. Pediatr Clin North Am 2004; 51 (4): 843–61.
• Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange trans- fusions and its effect on exchange-related morbidity and mortality. Pediatrics 2007; 120 (1): 27–32.
• Badiee Z. Exchange transfusion in neonatal hyperbilirubi- nemia: experience in Isfahan, Iran. Singapore Med J 2007; 48 (5): 421–3.
• Sgro M, Campbell D, Shah V. Incidence and causes of se- vere neonatal hyperbilirubinemia in Canada. Can Med Assoc J 2006; 175: 587–90.
• Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near- term newborns. Pediatrics 1999; 103: 6–14.
• Zipursky A, Bowman JM. Isoimmune hemolytic diseases. In: Nathan DG, Oski FA (eds). Hematology of Infancy and Childhood (6th ed) Vol 1. Philadelphia: WB Saunders, 2003: 44–73.
• Geifman-Holtzman O, Wojtowycz M, Kosmas E, Artal R. Female alloimmunization with antibodies known to cause hemolytic disease. Obstet Gynecol 1997; 89: 272–5.
• Van Dijk BA, Hirasing RA, Overbeeke MA. Hemolytic dis- ease of the newborn and irregular blood group antibod- ies in the Netherlands: prevalence and morbidity. Ned Tijdschr Geneeskd 1999; 143: 1465–9.
• Wagner T, Resch B, Legler TJ, et al. Severe HDN due to anti-Ce that required exchange transfusion. Transfusion 2000; 40: 571–4.
• Bowman JM, Pollock JM, Manning FA, et al. Severe anti-C hemolytic disease of the newborn. Am J Obstet Gynecol 1992; 166: 1239–43.
• Hammerman C, Kaplan M. Recent developments in the management of neonatal hyperbilirubinemia. Neo Reviews 2000; 1: e19-e24.
• Kubo S, Ariga T, Tsuneta H, Ishii T. Can high-dose immuno- globulin therapy be indicated in neonatal rhesus haemol- ysis? A successful case of haemolytic disease due to rhesus (c + E) incompatibility. Eur J Pediatr 1991; 150 (7): 507–8.