Table of Contents

HK J Paediatr (New Series)
Vol 24. No. 3, 2019

HK J Paediatr (New Series) 2019;24:120-126

Original Article

Impact of Minor Blood Group Incompatibility Versus ABO and Rh Blood Group Incompatibility in Newborns with Indirect Hyperbilirubinaemia: A Single-Centre Clinical Experience
次要血型不相容與ABO血型及Rh血型不相容引起的新生兒高間接膽紅素血症的比較:單一中心臨床經驗

K Çelik, S Aydin Koker, MT Özkul, Ö Olukman, TH Karapinar, RC Vergin, Ş Çalkavur


Abstract

Introduction: Haemolytic disease of the fetus and newborn (HDFN) is caused by the destruction of red blood cells of the neonate or fetus by maternal immunoglobulin G (IgG) antibodies. Alloimmune HDFN primarily involves the major blood groups of Rhesus (Rh), A, B, AB, and O, although minor blood group incompatibilities (Kell, Duffy, MNS, P, and Diego systems) can also result in significant disease. Objective: The main objective was to provide insight about the impact of minor blood group incompatibility against ABO and Rh blood group incompatibility in newborns with hyperbilirubinaemia in terms of the demographic data, laboratory values, clinical course, and responses to treatment. Methods: Three hundred fifty-five infants hospitalised with the diagnosis of unconjugated hyperbilirubinaemia (UHB) had data collected retrospectively. The mother and the baby's blood group type as C, c, E, e, Kell, D, d, A, B, O was detected by gel centrifugation method. Patients were divided into 4 groups: group 1, ABO blood group incompatibility; group 2, Rh blood group incompatibility; group 3, ABO+Rh blood group incompatibility; and group 4, minor blood group incompatibility. A total of 355 patients of which 230 (64.7%) were in group 1, 68 (19.1%) were in group 2, 15 (4.2%) were in group 3, and 42 (12%) were in group 4 were evaluated, respectively. Results: Among those with minor blood group incompatibility, 12 (28%), 11 (26%), 9 (21%), 6 (14%), and 4 (9%) patients had "C," "c," "E+c," "E," and "Kell" incompatibilities, respectively. The mean age of diagnosing jaundice (8±7.5 days) was significantly higher (p=0.015), and the mean haemoglobin and the mean haematocrit levels at admission were lower (p=0.007, p=0.041) in group 4. The rebound elevation of serum bilirubin was remarkably high in group 2 and group 4 (p=0.025). The requirement of intravenous immunglobulin, exchange-erythrocyte transfusions, as well as rehospitalisation for phototherapy, after discharge was significantly higher in group 4. Conclusions: We should keep mind the minor blood group incompatibility in infants who have late hospital admission, prolonged jaundice, prominent anaemia, rebound elevation of serum bilirubin after treatment termination, requirement of exchange and/or erythrocyte transfusions, and increased rehospitalisation rate.

簡介:胎兒及新生兒溶血性疾病(HDFN)是由母體免疫球蛋白G(IgG)抗體破壞新生兒或胎兒紅細胞引起的。同種異體免疫HDFN主要涉及Rh(Rhesus,恒河猴)、A、B、AB和O的主要血型,但次要血型不相容(Kell、 Duffy、MNS、P和Diego系統)也可導致嚴重疾病。目的:主要目的是預測次要血型不相容與ABO血型和Rh 血型不相容引起的新生兒高膽紅素血症在人口學資料、實驗室價值、臨床病程和治療反應的差異。方法:回顧性收集355例診斷為高間接膽紅素血症(UHB)住院患兒的資料。採用凝膠離心法檢測母嬰血型C、c、E、e、 Kell、D、d、A、B、O。患者分為4組:第1組,ABO血型不相容;第 2組,Rh血型不相容;第3組,ABO+Rh血型不相容;第4組,次要血型不相容。共355例患者進行評估,其中第1組230例(64.7%),第2組68例(19.1%),15人(4.2%)屬於第3組,42例(12%)在第4組。結果:在那些血型不相容的人中,分別有12例(28%)、11例(26%)、9例(21%)、6例(14%)和4例(9%)患者存在"C"、"c"、"E+c"、"E"和"Kell"不相容。第4組診斷黃疸的平均年齡(8±7.5天)明顯高於對照組(p=0.015),入院時平均血紅蛋白、紅細胞壓積均較對照組低(p=0.007, p=0.041)。第2組和第4組血清膽紅素反彈升高顯著(p=0.025)。第4組患者需要靜脈注射免疫球蛋白、換血、再次住院光療明顯高於對照組。討論:我們應該注意那些因次要血型不相容所致的黃疸患兒,他們具有住院時間較晚,黃疸時間延長,明顯貧血,血清膽紅素治療後反彈,需換血或輸注紅細胞,以及再住院率增加。

Keyword : ABO; Indirect hyperbilirubinaemia; Neonatal; Rh and minor blood group incompatibility

關鍵詞:ABO血型、高間接膽紅素血症、新生兒、Rh血型與次要血型不相容

 
 

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