Ghaemi Sedigheh, Saneian Hosein, Mo'ayedi Behjatosadat, Pourazar Abbasali
Department of Pediatrics, School of Medicine and Child Health Promotion Research Center, Isfahan, Iran.
J Pak Med Assoc. 2012 Mar;62(3 Suppl 2):S45-8.
Exchange transfusion (ET) has been known as an effective treatment in sever neonatal jaundice. Prescribing appropriate blood group makes an important role in patient's outcome and no single component is unequivocally the best. The purpose of this study was to evaluate the effect of ABO compatible packed cell, dried O, and routine O groups on exchange transfusion outcomes.
This multicenter clinical trial study is the combination of two studies which were conducted at three university hospitals (Isfahan University of Medical Sciences, Isfahan, Iran). A hundred full term infants with more than 2.5 kg body weight, serum bilirubin > or = 20 mg/dl and confirmed ABO-Hemolytic Disease of the Newborn (HDN) were participated in first study. Among 40 infants, 20 underwent the exchange transfusion with O packed cell (group 1) and other 20 were transfused with O dried packed cell (Hematocrit = 90%) (group 2). In the second study with the same eligibility criteria with first study, among the 60 infants, 30 had exchange transfusion with O packed cell (group 3) and the rest were transfused with infant isogroup (group 4). Serum bilirubin and hemoglobin (Hb) were evaluated before and 6, 12, 24 and 48 hours after the exchange transfusion.
The means of Hb after the exchange transfusion were 14.3 mg/dl in group 1, 15.62 mg/dl in group 2, 14.98 mg/dl in group 3 and 14.30 mg/dl in group 4 with significantly higher in group 2 compared with others (p = 0.02). The mean of the bilirubin after the exchange transfusion had no statistical significant difference between the four groups (p > 0.05). The mean of Hb and bilirubin before exchange transfusion had no statistically difference between all groups (p > 0.05). The mean of bilirubin before the exchange transfusion in infants who had two transfusion was significantly higher than the mean of the bilirubin before the exchange transfusion in infants with one time transfusion (p = 0.05). There was no significant difference between four groups in exchange transfusion frequency (p > 0.05).
This study indicated that the level of bilirubin before exchange transfusion is the only important factor which sometimes causes the necessity of second or third exchange.
换血疗法（ET）一直被认为是治疗重度新生儿黄疸的有效方法。选择合适的血型对患者的治疗结果起着重要作用，没有单一成分是绝对最佳的。本研究的目的是评估ABO血型相容的红细胞悬液、冻干O型血和常规O型血对换血治疗效果的影响。
这项多中心临床试验研究是在三家大学医院（伊朗伊斯法罕医科大学）进行的两项研究的结合。100名足月、体重超过2.5千克、血清胆红素≥20mg/dl且确诊为ABO溶血病（HDN）的婴儿参与了第一项研究。在40名婴儿中，20名接受了O型红细胞悬液换血（第1组），另外20名接受了O型冻干红细胞悬液（血细胞比容=90%）换血（第2组）。在第二项与第一项研究纳入标准相同的研究中，60名婴儿中，30名接受了O型红细胞悬液换血（第3组），其余接受了与婴儿同型血换血（第4组）。在换血前以及换血后6、12、24和48小时评估血清胆红素和血红蛋白（Hb）。
换血后第1组的Hb平均值为14.3mg/dl，第2组为15.62mg/dl，第3组为14.98mg/dl，第4组为14.30mg/dl，第2组显著高于其他组（p=0.02）。换血后四组胆红素平均值无统计学显著差异（p>0.05）。换血前所有组的Hb和胆红素平均值无统计学差异（p>0.05）。接受两次换血的婴儿换血前胆红素平均值显著高于接受一次换血的婴儿换血前胆红素平均值（p=0.05）。四组换血频率无显著差异（p>0.05）。
本研究表明，换血前胆红素水平是唯一有时导致需要进行第二次或第三次换血的重要因素。
