Direkt antiglobulin testin fetüs ve yenidoğanın hemolitik hastalığını tanımlama ve şiddetini tahminde klinik değeri
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Dosyalar
Tarih
2019
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Fetus ve Yenidoğanın Hemolitik Hastalığı (FYHH) son yıllarda sıklığında azalma olmakla beraber yüksek mortalite oranları ve uzun dönem morbiditesi nedeniyle önemini halen korumaktadır. Amaç: Bu çalışma ile Ege Üniversitesi Tıp Fakültesi Hastanesinde (EÜTFH) doğan bebeklerde, ABO ve ABO dışı FYHH sıklığını saptamayı ve Direkt Antiglobulin Test (DAT) pozitifliğinin FYHH'nı ve şiddetini öngörmedeki değerini incelemeyi ve FYHH tanısındaki diğer immun-hematolojik test algoritmalarını gözden geçirmeyi planladık. Gereç ve Yöntem: EÜTFH'de 1 Ocak 2018 – 31 Aralık 2018 tarihleri arasında doğan ve kan merkezimize DAT çalışılmak üzere kan örneği gönderilmiş olan 1737 yenidoğan ve anneleri çalışmaya dahil edildi. Perinatal döneme ait ABO, Rh(D) kan grubu, DAT sonucu, hastaneye yatış durumu, fototerapi gereksinimi, bilirubin ve hematokrit seviyeleri, intrauterin hastalık durumu, intrauterin gelişme geriliği (İUGG), antikor tarama ve antikor tanımlama çalışmaları kayıt altına alındı. Yenidoğanların annelerine ait gestasyon haftası, önceki gebelikler, Rh(D) ve ABO kan grubu, indirekt antiglobulin test (İAT), antikor tarama sonuçları, gereklilik halinde yapılan İAT titrasyonu ve antikor tanımlama özelikleri incelendi. Rh D negatif annelere yapılan anti D immunglobulin ile FYHH ilişkisi incelendi. Bu bilgilere KHD (Kadın Hastalıkları ve Doğum Anabilim Dalı) hastaneye yatış dosyaları, Yenidoğan Bilim Dalı hastaneye yatış epikrizleri ve doğum kayıt dosyalarından ulaşıldı. Bulgular: Çalışmaya alınan 1737 yenidoğanın 95 (%5,4)'inde DAT pozitif saptanırken bu grupta fototerapi alma oranları, fototerapi süresi, maksimum bilirubin ortalaması, İUGG varlığı istatistiksel olarak anlamlı derecede yüksek saptandı. ABO uygunsuzluğu olan grupta fototerapi alma oranı, ABO uygunsuzluğu olmayan gruba göre istatistiksel olarak anlamlı yüksek iken (p=0,018), Rh(D) uygunsuzluğu olan ve olmayan yenidoğanlar arasında fototerapi alma oranı açısından istatistiksel anlamlı bir fark yoktu. Gebelerin 820 (%47,2)'sine antikor tarama yapılmış ve 50'inde (%60) pozitif saptanmıştı. Antikor taraması pozitif olan bu gebelerin 43'üne (%86) antikor tanımlama yapılmıştı. En sık D (%69)' ye karşı antikor mevcut olup bunu %11 ile Kell'e karşı antikor varlığı izlemekteydi. RhD ilişkili FYHH önlenmesinde en etkin yol olan Rh(D) immunglobulin uygulamasının 172 gebeden 104'üne (%60,5) yapıldığı, yapılmayan 68 gebeden de 52'sine yapılmama nedeninin bebeğin Rh(D) negatif saptanması olduğu belirlendi. DAT pozitif saptanan 95 bebeğin sadece bir tanesinde antikor tarama yapıldığı belirlendi. DAT pozitifliği bulunmayan 31 yenidoğana antikor tarama yapılmış olup bunlardan hiçbiri fototerapi almamıştı. DAT pozitif olguların fototerapi alma oranı (%9.4), DAT negatif olgulara (%1.8) göre anlamlı olarak yüksek bulundu. DAT<2 pozitif olan hiçbir yenidoğan fototerapi almamıştı. Buna karşın DAT ≥2+ olan ve fototerapi alan 9 hastanın 8'i ABO uygunsuzluğu olan yenidoğanlardı. Rh D uygunsuzluğu bulunan 116 yenidoğanın sadece 20'inde zayıf DAT pozitifliği (<2+) mevcuttu ve hiçbirinin fototerapi gereksinimi olmamıştı. Sonuç: Zayıf (<2+) DAT pozitifliğinin olgu grubumuzda hemoliz ile ilişkili klinik bir anlam taşımadığı görüldü. Anlamlı DAT ≥2+ pozitifliğine klinik hemolizin eşlik etme olasılığı da güçlü değildi. Yenidoğanlarda DAT pozitifliğinin ve DAT negatif ancak fototerapi gereksinimi olan bebeklerin immun hemoliz açısından incelenmesinde uygun immun-hematolojik algoritmin izlenmediği görüldü. Buna karşın, allo-immunizasyon gelişiminin izlemi ve yönetimi bakımından maternal izlem yeterli ve uygun bulundu.
Hemolytic disease of fetus and newborn (HDFN) is still important because of its high mortality and long-term morbidity although its incidence has been decreasing in recent years. Aim: In this study, we aimed to determine the incidence of ABO and non-ABO HDN (Hemolytic disease of newborn) and to investigate the value of Direct Antiglobulin Test (DAT) positivity in detecting FHM (Hemolytic disease of fetus). Since prenatal treatment options are available, immunohematological tests and algorithms have been developed to identify HDFN during pregnancy. We aimed to review the algorithms that have been developed to prevent alloimmunization and to ensure proper management if developed. We purposed to investigate the use of immunohematological laboratory tests in detection and management of perinatal HDFN. Materials and Methods: 1737 newborns who were born in Ege University Medical School Hospital between January 1, 2018 and December 31, 2018 and whose blood samples were sent to our blood center to study DAT and their mothers are included. ABO, Rh blood group, DAT result, hospitalization, phototherapy requirement, bilirubin and hematocrit levels, intrauterine disease status, presence of IUGR, antibody screening and antibody identification studies of were recorded to detect the presence of perinatal HDFN. Gestational week, gravida, Rh and ABO blood group, indirect antiglobulin (IAT), antibody screening results, IAT titration and antibody identification performed if needed of the pregnant women are recorded. The relationship between HDFN and anti-D immunoglobulin administered to Rh D negative mothers was examined. This information was obtained from Department of Obstetrics and Gynecology hospitalization files, hospitalization epicrisis of the Newborn Department and birth registry files. The rate of phototherapy (9.4%) in DAT positive cases was significantly higher than in DAT negative cases (1.8%). No newborn phototherapy with DAT <2 was positive. In contrast, 8 of 9 patients with DAT ≥2 + who received phototherapy were newborns with ABO incompatibility. Only 20 out of 116 newborns with Rh D incompatibility had weak DAT positivity (<2+) and none required phototherapy. Results: 95(5.4%) of 1737 newborns in this study was detected DAT positive and phototherapy receiving rates, duration of phototherapy, mean maximum bilirubin and IUGR presence in this group was statistically significantly higher. While the rate of receiving phototherapy was statistically significant in the ABO incompatibility group (p = 0.018), there was no statistically significant difference in the rate of receiving phototherapy in newborns with Rh D incompatibility. Antibody screening was performed in 820 (47.2%) of the pregnant women and 50 of them were positive. Antibodies were identified in 43 (86%) of these pregnant women with positive antibody screening. Antibodies against D (69%) were the most common, followed by the presence of antibodies against Kell 11%. Rh D immunoglobulin, which is the most effective way to prevent HDFN, was performed to 104 (60.5%) of 172 pregnant women and not in 52 of 68 pregnant women because newborn was Rh D negative. Only one of the 95 DAT positive patients had antibody screening. A total of 31 newborns underwent antibody screening and none of them received phototherapy. Conclusion: Weak (<+2) DAT positivity was not found to have a clinical significance associated with hemolysis in our case group. The possibility of clinical hemolysis to be associated with significant DAT ≥+2 positivity was also not strong. In neonates, DAT positivity and DAT negative infants who needed phototherapy were not examined for immune hemolysis. On the other hand, maternal follow-up was adequate and appropriate for monitoring and management of allo-immunization development.
Hemolytic disease of fetus and newborn (HDFN) is still important because of its high mortality and long-term morbidity although its incidence has been decreasing in recent years. Aim: In this study, we aimed to determine the incidence of ABO and non-ABO HDN (Hemolytic disease of newborn) and to investigate the value of Direct Antiglobulin Test (DAT) positivity in detecting FHM (Hemolytic disease of fetus). Since prenatal treatment options are available, immunohematological tests and algorithms have been developed to identify HDFN during pregnancy. We aimed to review the algorithms that have been developed to prevent alloimmunization and to ensure proper management if developed. We purposed to investigate the use of immunohematological laboratory tests in detection and management of perinatal HDFN. Materials and Methods: 1737 newborns who were born in Ege University Medical School Hospital between January 1, 2018 and December 31, 2018 and whose blood samples were sent to our blood center to study DAT and their mothers are included. ABO, Rh blood group, DAT result, hospitalization, phototherapy requirement, bilirubin and hematocrit levels, intrauterine disease status, presence of IUGR, antibody screening and antibody identification studies of were recorded to detect the presence of perinatal HDFN. Gestational week, gravida, Rh and ABO blood group, indirect antiglobulin (IAT), antibody screening results, IAT titration and antibody identification performed if needed of the pregnant women are recorded. The relationship between HDFN and anti-D immunoglobulin administered to Rh D negative mothers was examined. This information was obtained from Department of Obstetrics and Gynecology hospitalization files, hospitalization epicrisis of the Newborn Department and birth registry files. The rate of phototherapy (9.4%) in DAT positive cases was significantly higher than in DAT negative cases (1.8%). No newborn phototherapy with DAT <2 was positive. In contrast, 8 of 9 patients with DAT ≥2 + who received phototherapy were newborns with ABO incompatibility. Only 20 out of 116 newborns with Rh D incompatibility had weak DAT positivity (<2+) and none required phototherapy. Results: 95(5.4%) of 1737 newborns in this study was detected DAT positive and phototherapy receiving rates, duration of phototherapy, mean maximum bilirubin and IUGR presence in this group was statistically significantly higher. While the rate of receiving phototherapy was statistically significant in the ABO incompatibility group (p = 0.018), there was no statistically significant difference in the rate of receiving phototherapy in newborns with Rh D incompatibility. Antibody screening was performed in 820 (47.2%) of the pregnant women and 50 of them were positive. Antibodies were identified in 43 (86%) of these pregnant women with positive antibody screening. Antibodies against D (69%) were the most common, followed by the presence of antibodies against Kell 11%. Rh D immunoglobulin, which is the most effective way to prevent HDFN, was performed to 104 (60.5%) of 172 pregnant women and not in 52 of 68 pregnant women because newborn was Rh D negative. Only one of the 95 DAT positive patients had antibody screening. A total of 31 newborns underwent antibody screening and none of them received phototherapy. Conclusion: Weak (<+2) DAT positivity was not found to have a clinical significance associated with hemolysis in our case group. The possibility of clinical hemolysis to be associated with significant DAT ≥+2 positivity was also not strong. In neonates, DAT positivity and DAT negative infants who needed phototherapy were not examined for immune hemolysis. On the other hand, maternal follow-up was adequate and appropriate for monitoring and management of allo-immunization development.
Açıklama
Anahtar Kelimeler
Fetüs Ve Yenidoğanın Hemolitik Hastalığı, Direkt Antiglobulin Test, Hemolytic Disease Of Fetus And Newborn, Direct Antiglobulin Test
