Elsevier

The Journal of Pediatrics

Volume 157, Issue 5, November 2010, Pages 772-777
The Journal of Pediatrics

Original Article
Hemolysis and Hyperbilirubinemia in Antiglobulin Positive, Direct ABO Blood Group Heterospecific Neonates

https://doi.org/10.1016/j.jpeds.2010.05.024Get rights and content

Objective

We quantified hemolysis and determined the incidence of hyperbilirubinemia in neonates who were direct antiglobulin titer (DAT)-positive, ABO heterospecific, and compared variables among O-A and O-B subgroups.

Study design

Plasma total bilirubin (PTB) was determined before the neonates were discharged from the hospital and more frequently when clinically warranted, in neonates who were DAT positive with blood group A or B and with mothers who had blood group O. Heme catabolism (and therefore bilirubin production) was indexed by blood carboxyhemoglobin corrected for inspired carbon monoxide (COHbc). Hyperbilirubinemia was defined as any PTB concentration >95th percentile on the hour-of-life-specific bilirubin nomogram.

Results

Of 164 neonates, 111 were O-A and 53 O-B. Overall, hyperbilirubinemia developed 85 neonates (51.8%), and it tended to be more prevalent in the O-B neonates than O-A neonates (62.3% versus 46.8%; P = .053). Hyperbilirubinemia developed in more O-B newborns than O-A newborns at <24 hours (93.9% versus 48.1%; P< .0001). COHbc values were globally higher than our previously published newborn values. Babies in whom hyperbilirubinemia developed had higher COHbc values than the already high values of babies who were non-hyperbilirubinemic, and O-B newborns tended to have higher values than their O-A counterparts.

Conclusions

DAT-positive, ABO heterospecificity is associated with increased hemolysis and a high incidence of neonatal hyperbilirubinemia. O-B heterospecificity tends to confer even higher risk than O-A counterparts.

Section snippets

Methods

The study was approved by the institutional review board of the Shaare Zedek Medical Center. Because of the benign nature of the study, which did not involve randomization or administration of a study drug, oral parental consent only was required. The clinical wing of the study was conducted in the well-infant nurseries of the Shaare Zedek Medical Center from January 2006 to April 2007. A sample of consecutive (except for the conditions mentioned below) infants who were DAT-positive with blood

Results

One hundred sixty-four newborns who were DAT positive with blood group A or B born to blood group O mothers were enrolled between January 2006 and April 2007 (Table I). Overall, a PTB value >95th percentile for hour-of-life at any point 85 developed in newborns (51.8%). Age at first PTB >95th percentile was 19 ± 11 hours (range, 1-48 hours; one additional newborn was re-admitted at age 80 hours), with corresponding PTB 9.9 ± 2.5 mg/dL (range, 5.1-17.8 mg/dL). Early hyperbilirubinemia (PTB >95th

Discussion

Of the neonatal population delivered at the Shaare Zedek Medical Center, 21% comprise blood group A or B newborns born to group O mothers, and 15% of them are DAT positive.16 In this study, we documented a 52% incidence of hyperbilirubinemia in the DAT-positive subgroup. This incidence is clearly many-fold that of other population groups studied with the identical definition of hyperbilirubinemia. For example, in a multicenter, multinational study of 1370 newborns, hyperbilirubinemia developed

References (38)

  • J.V. Bjerre et al.

    Surveillance of extreme hyperbilirubinaemia in Denmark. A method to identify the newborn infants

    Acta Paediatr

    (2008)
  • Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation

    Pediatrics

    (2004)
  • M.J. Maisels et al.

    Hyperbilirubinemia in the newborn infant > or =35 weeks' gestation: an update with clarifications

    Pediatrics

    (2009)
  • V.K. Bhutani et al.

    Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns

    Pediatrics

    (1999)
  • D.K. Stevenson et al.

    Prediction of hyperbilirubinemia in near-term and term infants

    Pediatrics

    (2001)
  • M. Kaplan et al.

    Hyperbilirubinemia among African American, glucose-6-phosphate dehydrogenase-deficient neonates

    Pediatrics

    (2004)
  • V.K. Bhutani et al.

    Kernicterus: epidemiological strategies for its prevention through systems-based approaches

    J Perinatol

    (2004)
  • M. Kaplan et al.

    Failure to predict hemolysis and hyperbilirubinemia by IgG subclass in blood group A or B infants born to group O mothers

    Pediatrics

    (2009)
  • M. Kaplan et al.

    Israel guidelines for the management of neonatal hyperbilirubinemia and prevention of kernicterus

    J Perinatol

    (2008)
  • Cited by (51)

    • Is it necessary to add the eluate testing to the direct antiglobulin test to improve the detection of maternal erythrocyte alloantibodies?

      2021, Transfusion and Apheresis Science
      Citation Excerpt :

      The primary cause of maternal erythrocyte alloimmunization in the present study was the ABO fetal-maternal incompatibility (79.6 %) similar to that reported in the literature [25,26]. Therefore, in agreement with previous reports [11,27–29], the present study evidenced the importance of screening for ABO alloantibodies in type A and type B neonates of type O mothers and not only by the DAT test but also the eluate testing. Additionally, the finding of irregular alloantibodies apart from anti-RhD (13.6 %), anti-RhC (2.3 %), and anti-Fya (2.3 %) were also detected emphasizing the need to include the IAT in the prenatal follow-up independent of the RhD phenotype of the mother.

    View all citing articles on Scopus

    Supported at Stanford University by the National Institutes of Health (grants RR00070 and RR025744), the Hess Research Fund, the HM Lui Research Fund, and the Mary L Johnson Research Fund. The authors declare no conflicts of interest.

    View full text