Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Sq., 917798564, Mashhad, Iran.
Neonatal Research Center, Mashhad University of Medical Sciences, Neonatal Intensive Care Unit, Imam Reza Hospital, 9177899191, Mashhad, Iran.
Transfus Apher Sci. 2022 Jun;61(3):103358. doi: 10.1016/j.transci.2022.103358. Epub 2022 Jan 19.
Hemolytic disease of the fetus and newborn (HDFN) is a clinically significant problem that may potentially affect any pregnancy. Direct antiglobulin test (DAT) is considered to be an important test in identifying newborns who are suspected to have HDN. This study aims in reviewing data regarding a positive DAT result concerning etiology and the development of HDN over a period of 10 years.
A retrospective study of all neonates with a positive DAT result between January 2011 and December 2020 was performed. Data were obtained from patients' electronic hospital files, transfusion medicine databases, and medical birth records. Laboratory parameters along with clinical interventions in neonates with a DAT-positive result and a comparison group of DAT-negative neonates were performed.
36,000 deliveries were registered in this period. 176 (2.65 %) neonates had a positive DAT result. ABO-incompatibility was the most common cause with 59.1 %; Rh incompatibility 13.8 %, minor blood group incompatibility, and other RBC-related antibodies 10.1 %, and unspecified etiology in 17 % of cases. Among DAT-positive cases, 32.7 % of neonates were diagnosed with HDN. ABO-incompatibility was the major reason as well. Initial mean total bilirubin levels were higher in the DAT-positive group than the control group (p < 0.001), and these neonates also had a lower initial hemoglobin level (p < 0.001). The need for therapeutic interventions was significantly higher in DAT-positive neonates (p < 0.001) as 86.8 % underwent phototherapy, with 32.7 %, and 17.6 % receiving exchange transfusion (ET) and intravenous immunoglobulin (IVIG), respectively.
In conclusion, ABO incompatibility was the most common cause for neonatal DAT positivity. Besides the common causes of DAT positivity, there would be rare but important conditions that may lead to a positive result, such as antibodies passively acquired from mothers in the context of alloimmunizations or using drugs. In addition, as a high rate of therapeutic intervention was identified among neonates with a DAT-positive result, there is a crucial need for increasing awareness regarding early diagnosis of the condition, careful monitoring, and the employment of prenatal alloimmunization screening tests.
胎儿和新生儿溶血病（HDFN）是一种临床显著的问题，可能会影响任何妊娠。直接抗球蛋白试验（DAT）被认为是识别疑似患有 HDN 的新生儿的重要试验。本研究旨在回顾 10 年来 DAT 阳性结果的病因和 HDFN 发展的数据。
对 2011 年 1 月至 2020 年 12 月期间所有 DAT 阳性的新生儿进行了回顾性研究。数据来自患者的电子病历、输血医学数据库和医疗分娩记录。对 DAT 阳性新生儿和 DAT 阴性新生儿的实验室参数和临床干预进行了比较。
在此期间，有 36000 例分娩登记。176 例（2.65%）新生儿 DAT 阳性。ABO 不合是最常见的原因，占 59.1%；Rh 不合占 13.8%，次要血型不合和其他 RBC 相关抗体占 10.1%，原因不明占 17%。在 DAT 阳性病例中，32.7%的新生儿被诊断为 HDFN。ABO 不合也是主要原因。DAT 阳性组新生儿的初始总胆红素水平明显高于对照组（p<0.001），且血红蛋白水平也较低（p<0.001）。DAT 阳性新生儿需要治疗干预的比例明显更高（p<0.001），86.8%接受了光疗，分别有 32.7%和 17.6%接受了换血（ET）和静脉注射免疫球蛋白（IVIG）。
综上所述，ABO 不合是新生儿 DAT 阳性的最常见原因。除了 DAT 阳性的常见原因外，还有一些罕见但重要的情况可能导致阳性结果，如母亲在同种免疫情况下被动获得的抗体或使用药物。此外，由于 DAT 阳性新生儿需要进行高比例的治疗干预，因此迫切需要提高对该疾病的早期诊断、仔细监测和产前同种免疫筛查试验的认识。
