Abstract
Yenidoğan döneminde
eritrositlerin hemolizi sonucunda ortaya çıkan yüksek bilirubin düzeyleri ve
onun yol açtığı klinik tabloya ‘Yenidoğanın Hemolitik Hastalığı’ denir.
Çoğunlukla ABO ve Rh D uygunsuzluğuna bağlı gelişen Yenidoğanın Hemolitik
Hastalığı ayrıca eritrosit membran defektleri, enzim eksikliklikleri ve hemoglobinopatiler nedeniyle de gelişebilir. Ayrıca nadiren Rh sisteminin D dışı diğer alt
gruplarıyla (C, c, E, e) ilişkili de görülebildiği gibi 50’den fazla eritrosit
antijeniyle ilişkili Yenidoğanın Hemolitik Hastalığı raporlanmıştır. Ocak 2014 ile Aralık 2017 arasında
hastanemizde Yenidoğanın Hemolitik Hastalığı veya uzamış sarılık nedeniyle
tetkik ve tedavi edilen olgularda saptanan Rh sistemi D dışı alt grup
uygunsuzluklarının kayıtlarını bilgisayar ortamındaki sonuç ve epikrizlerinden
yola çıkarak inceledik. Retrospektif dosya tarama incelememizde toplam 16
hastada Rh sistemi ‘D’ dışı alt grup uygunsuzluğu kaydedildi. Hastaların
ortalama başvuru günü 9.6±8.4 (2-26 gün), başvuruda ortalama hemoglobin değeri
15.1±3 (9.8-19.1 gr/dl) ve total bilurubin düzeyi 15.8±3.8 (9.6-22 mg/dl) saptandı.
.Onbir hastada Rh’ın D dışı bir alt grup uygunsuzluğu (iki ‘C’, dört ‘c’, beş
‘E’), beş hastada iki alt gruba (üç ‘c-E’, bir ‘c-e’, bir ‘C-e’) ait
uygunsuzluk saptandı. Direk veya indirek
antikor tarama testlerinden en az biri beş (%31) hastada pozitif saptandı. Gebelikte
ABO ve Rh fenotiplemenin yanı sıra indirek antikor tarama ile major kan grup uygunsuzluklarının yanı sıra Rh
sistemi D dışı alt grup ve diğer
eritrosit antijen sistemleriyle ilişkili antikorlar saptanabilir. Direk
veya indirek antikor tarama testlerinin pozitifliği klinik seyiri etkileyen bir
faktördür. Hidrops fetalis‘e ilerleyebilen kliniklere neden olabilecek Rh D
dışı alt grup ve Kell kan grubu uygunsuzlukları için gebe kadınlar ilk
trimesterde IAT ile taranmalıdır.
References
- 1.Delaney M, Matthews DC. Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn. Hematology Am Soc Hematol Educ Program. 2015;2015:146-51.
- 2.Fasano RM. Hemolytic disease of the fetus and newborn in the molecular era. Semin Fetal Neonatal Med. 2016 Feb;21(1):28-34.
- 3. Altuntas N, Yenicesu I, Himmetoglu O. ve ark. The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey. Transfus Apher Sci. 2013 Jun;48(3):377-80.
- 4. Koelewijn JM, Vrijkotte TG, van der Schoot CE, Bonsel GJ, de Haas M. Effect of screening for red cell antibodies, other than anti-D, to detect hemolytic disease of the fetus and newborn: a population study in the Netherlands. Transfusion. 2008 May;48(5):941-52.
- 5. Dajak S, Culić S, Stefanović V, Lukačević J. Relationship between previous maternal transfusions and haemolytic disease of the foetus and newborn mediated by non-RhD antibodies. Blood Transfus. 2013 Oct;11(4):528-32.
- 6. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001 Feb 22;344(8):581-90.
- 7. Eder AF. Update on HDFN: new information on long-standing controversies. Immunohematology. 2006;22(4):188-95.
- 8. Gottvall T, Filbey D. Alloimmunization in pregnancy during the years 1992-2005 in the central west region of Sweden. Acta Obstet Gynecol Scand. 2008;87(8):843-8.
- 9. Hackney DN, Knudtson EJ, Rossi KQ, Krugh D, O'Shaughnessy RW. Management of pregnancies complicated by anti-c isoimmunization. Obstet Gynecol. 2004 Jan;103(1):24-30.
- 10. Murki S, Kandraju H, Devi SA. Hemolytic disease of the newborn- anti c antibody induced hemolysis. Indian J Pediatr. 2012 Feb;79(2):265-6.
- 11. Özdemir ÖMA, Küçüktaşçı K, Şahin Ö, Eliaçık Ç, Ergin H. Yenidoğanda anti-E’ye bağlı subgrup uyuşmazlığı: iki olgu sunumu. Adnan Menderes Üniversitesi Tıp Fakültesi Dergisi, (2014): 15(2), 77-78.
- 12. Sharma D, Dannapuneni N, Murki S, Pratap T. Combined Anti e and Anti C Rh Isoimmunisation and Severe Hyperbilirubinemia. Indian J Pediatr. 2015 Jun;82(6):570..
- 13. Thakral B, Agrawal SK, Dhawan HK, Saluja K, Dutta S, Marwaha N. First report from India of haemolytic disease of newborn by anti-c and anti-E in Rh (D) positive mothers. Hematology. 2007 Oct;12(5):377-80
Abstract
High bilurubine levels resulting
form hemolysis of erythrocytes, it causes a disease called ‘Hemolytic Disease
of Newborn ’ in neonatal period. The most common causes of Hemolytic Disease of
Newborn are incompatibility of ABO and Rh D blood group systems. According to
previously reports also non-Rh D subgroups (C, c, E, e) and with them 50
different erythrocyte antigens can be related with Hemolytic Disease of
Newborn. We want to report that 16 patients with non Rh D subgroup incompatibility
and their clinical progresses. We
studied to patients with Hemolytic Disease of Newborn or prolonged jaundice
Janunary 2014 to December 2017 in our hospital. We examined to 16 patients whom
treated or followed-up with non Rh D subgroup incompatibility. Retrospective
file screening revealed a total of 16 cases of non- Rh D subgroup
incompatibility recorded. The mean
hemoglobin level was 15.1 ± 3 (9.8-19.1 gr / dl) and total bilurubin level was
15.8 ± 3.8 (9.6-22 mg / dl) at admission day in the patients. The mean
admission day of the patients was 9.6 ± 8.4 (2-26 days). In eleven patients, a
non-D subgroup incongruity (two 'C', four 'c', and five 'E') in Rh patients,
two subgroups (three 'c-E', one 'c- C-e '). Direct or indirect antibody
screening tests were positive in five (31%) patients. Indirect antibody screening as well as ABO and Rh phenotyping in
pregnancy may detect major blood group incompatibilities as well as antibodies
related to the Rh system non-D subgroup and other erythrocyte antigen systems.
Positivity of direct or indirect antibody screening tests is a factor affecting
clinical course. Pregnant women should be screened with IAT in the first
trimester for non-Rh subgroup and Kell blood group incompatibilities that may
lead to clinics that can progress to hydrops fetalis.
References
- 1.Delaney M, Matthews DC. Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn. Hematology Am Soc Hematol Educ Program. 2015;2015:146-51.
- 2.Fasano RM. Hemolytic disease of the fetus and newborn in the molecular era. Semin Fetal Neonatal Med. 2016 Feb;21(1):28-34.
- 3. Altuntas N, Yenicesu I, Himmetoglu O. ve ark. The risk assessment study for hemolytic disease of the fetus and newborn in a University Hospital in Turkey. Transfus Apher Sci. 2013 Jun;48(3):377-80.
- 4. Koelewijn JM, Vrijkotte TG, van der Schoot CE, Bonsel GJ, de Haas M. Effect of screening for red cell antibodies, other than anti-D, to detect hemolytic disease of the fetus and newborn: a population study in the Netherlands. Transfusion. 2008 May;48(5):941-52.
- 5. Dajak S, Culić S, Stefanović V, Lukačević J. Relationship between previous maternal transfusions and haemolytic disease of the foetus and newborn mediated by non-RhD antibodies. Blood Transfus. 2013 Oct;11(4):528-32.
- 6. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001 Feb 22;344(8):581-90.
- 7. Eder AF. Update on HDFN: new information on long-standing controversies. Immunohematology. 2006;22(4):188-95.
- 8. Gottvall T, Filbey D. Alloimmunization in pregnancy during the years 1992-2005 in the central west region of Sweden. Acta Obstet Gynecol Scand. 2008;87(8):843-8.
- 9. Hackney DN, Knudtson EJ, Rossi KQ, Krugh D, O'Shaughnessy RW. Management of pregnancies complicated by anti-c isoimmunization. Obstet Gynecol. 2004 Jan;103(1):24-30.
- 10. Murki S, Kandraju H, Devi SA. Hemolytic disease of the newborn- anti c antibody induced hemolysis. Indian J Pediatr. 2012 Feb;79(2):265-6.
- 11. Özdemir ÖMA, Küçüktaşçı K, Şahin Ö, Eliaçık Ç, Ergin H. Yenidoğanda anti-E’ye bağlı subgrup uyuşmazlığı: iki olgu sunumu. Adnan Menderes Üniversitesi Tıp Fakültesi Dergisi, (2014): 15(2), 77-78.
- 12. Sharma D, Dannapuneni N, Murki S, Pratap T. Combined Anti e and Anti C Rh Isoimmunisation and Severe Hyperbilirubinemia. Indian J Pediatr. 2015 Jun;82(6):570..
- 13. Thakral B, Agrawal SK, Dhawan HK, Saluja K, Dutta S, Marwaha N. First report from India of haemolytic disease of newborn by anti-c and anti-E in Rh (D) positive mothers. Hematology. 2007 Oct;12(5):377-80
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | ORİJİNAL MAKALE |
| Authors | |
| Publication Date | April 1, 2019 |
| Published in Issue | Year 2019 Volume: 41 Issue: 2 |