Kristinsdottir Thordis, Kjartansson Sveinn, Hardardottir Hildur, Jonsson Thorbjorn, Halldorsdottir Anna Margret
Laeknabladid. 2016 Jul;102(7-8):326-31. doi: 10.17992/lbl.2016.0708.90.
INTRODUCTION: Hemolytic disease of the fetus and newborn (HDFN) is caused by the destruction of fetal red blood cells due to red cell antibodies produced by the mother. HDFN can cause fetal hydrops during pregnancy or neonatal jaundice after birth. Direct Antiglobulin Test (DAT) detects antibodies bound to red cells and is a valuable test aiding in the diagnosis of HDFN. In Iceland DAT is routinely performed on cord blood or newborn blood samples if the mother is Rhesus D negative or has non-A/B red cell alloantibodies. The aim of this study was to investigate the causes and consequences of positive DAT in newborns in Iceland over a period of eight years. MATERIAL AND METHODS: The study population was infants diagnosed with a positive DAT in the Blood Bank in Iceland in the years 2005-2012. Relevant data on the blood group and antibody status of mother and child, blood transfusion and DAT results were retrieved from the Blood Bank information system ProSang. Birth records provided information on birth weight, gestational age and phototherapy. Health records from the Children's Hospital provided information on the management and fate of the newborn. RESULTS: Over the study period 383 newborns had a positive DAT result at the Blood Bank. In 73.6% of cases the underlying cause was ABO blood group mismatch between mother and infant, in 20.4% of cases the mother had non-A/B red cell alloantibodies, in 3.9% both of above factors were present, while in 2.1% the cause was unclear. A total of 179 (47.6%) children had neonatal jaundice that required treatment, of which 167 (93.3%) only needed phototherapy. Eight infants required exchange transfusion, five of these had Rhesus antibodies and three ABO blood group mismatch. CONCLUSION: ABO blood group mismatch between mother and child was the most common cause for a positive DAT in neonates in Iceland in the years 2005-2012. Almost half of the neonates required treatment but usually phototherapy was sufficient. Rarely, blood transfusion or exchange transfusion was necessary in severe cases of ABO blood group mismatch or non-A/B red cell alloantibodies. KEY WORDS: Coombs test, Direct Antiglobulin Test (DAT), Hemolytic disease of the fetus and newborn (HDFN), ABO blood group mismatch, red cell alloantibodies, neonatal jaundice, exchange transfusion. Correspondence: Anna Margret Halldorsdottir, annamha@landspitali.is.
引言：胎儿和新生儿溶血病（HDFN）是由于母亲产生的红细胞抗体导致胎儿红细胞被破坏所致。HDFN可在孕期引起胎儿水肿或出生后导致新生儿黄疸。直接抗人球蛋白试验（DAT）可检测与红细胞结合的抗体，是辅助诊断HDFN的一项重要检测。在冰岛，如果母亲为RhD阴性或有非A/B红细胞同种抗体，则常规对脐带血或新生儿血样进行DAT检测。本研究的目的是调查冰岛八年间新生儿DAT阳性的原因及后果。 材料与方法：研究对象为2005年至2012年在冰岛血库被诊断为DAT阳性的婴儿。从血库信息系统ProSang中检索母婴血型和抗体状态、输血及DAT结果的相关数据。出生记录提供了出生体重、胎龄和光疗信息。儿童医院的健康记录提供了新生儿的管理及转归信息。 结果：在研究期间，383名新生儿在血库的DAT结果为阳性。在73.6%的病例中，根本原因是母婴ABO血型不合，20.4%的病例中母亲有非A/B红细胞同种抗体，3.9%的病例中上述两种因素均存在，而2.1%的病例原因不明。共有179名（47.6%）儿童患有需要治疗的新生儿黄疸，其中167名（93.3%）仅需光疗。8名婴儿需要换血治疗，其中5名有Rh抗体，3名是ABO血型不合。 结论：2005年至2012年期间，母婴ABO血型不合是冰岛新生儿DAT阳性最常见的原因。近一半的新生儿需要治疗，但通常光疗就足够了。在ABO血型不合或非A/B红细胞同种抗体的严重病例中，很少需要输血或换血治疗。 关键词：库姆斯试验；直接抗人球蛋白试验（DAT）；胎儿和新生儿溶血病（HDFN）；ABO血型不合；红细胞同种抗体；新生儿黄疸；换血治疗。通信作者：Anna Margret Halldorsdottir，annamha@landspitali.is
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