Valsami Serena, Politou Marianna, Boutsikou Τheodora, Briana Despina, Papatesta Milena, Malamitsi-Puchner Ariadne
Blood Transfusion Department, Aretaieion Hospital, Athens University Medical School, Athens, Greece.
Blood Transfusion Department, Aretaieion Hospital, Athens University Medical School, Athens, Greece.
Pediatr Neonatol. 2015 Aug;56(4):256-60. doi: 10.1016/j.pedneo.2014.11.005. Epub 2014 Dec 24.
The direct antiglobulin test (DAT) is the cornerstone of the diagnosis of hemolytic disease of the newborn (HDN). The aim of this study was to review the incidence and causes of positive DAT in cord blood in relation to development of HDN.
We retrospectively reviewed all results of DAT, which is routinely performed in cord blood samples, along with the laboratory and infants' medical records.
DAT was positive in 70/2695 (2.59%) cases. In 64/70 (91.43%) cases, DAT positivity was attributed to ABO incompatibility. There were 50/218 (22.93%) DAT (+) cases in the A/O group and 13/97 (13.40%) cases in the B/O group (p = 0.0664). Two DAT (+) cases were attributed to maternal alloimmunization (anti-Fya and anti-JKb, respectively), and one to maternal IgG autoantibodies that developed after methyldopa treatment. Among the 70 DAT (+) cases, 30 (42.86%) cases required phototherapy with no difference between the A/O and B/O groups. The duration of phototherapy in the B/O group was significantly longer than in the A/O group (p = 0.024). There was a trend of correlation of increasing strength of DAT positivity with phototherapy need. No false positive DAT case was detected.
Although ABO incompatibility remains the main reason of DAT (+), other causes (e.g., alloimmunization, drugs) should also be explored. The relevant impact of DAT (+) on HDN development should be considered.
直接抗球蛋白试验（DAT）是新生儿溶血病（HDN）诊断的基石。本研究的目的是回顾脐血中DAT阳性的发生率及原因与HDN发生发展的关系。
我们回顾性分析了脐血样本中常规进行的DAT的所有结果，以及实验室和婴儿的病历。
2695例中有70例（2.59%）DAT呈阳性。在70例中的64例（91.43%）中，DAT阳性归因于ABO血型不合。A/O组218例中有50例（22.93%）DAT（+），B/O组97例中有13例（13.40%）（p = 0.0664）。2例DAT（+）归因于母体同种免疫（分别为抗Fya和抗JKb），1例归因于甲基多巴治疗后产生的母体IgG自身抗体。在70例DAT（+）病例中，30例（42.86%）需要光疗，A/O组和B/O组之间无差异。B/O组的光疗持续时间明显长于A/O组（p = 0.024）。DAT阳性强度增加与光疗需求之间存在相关性趋势。未检测到假阳性DAT病例。
尽管ABO血型不合仍然是DAT（+）的主要原因，但也应探索其他原因（如同种免疫、药物）。应考虑DAT（+）对HDN发生发展的相关影响。
