Pediatrics Department, Neonatology Division, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey.
Blood Transfusion Center, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey.
Pediatr Neonatol. 2024 Jan;65(1):11-16. doi: 10.1016/j.pedneo.2023.05.001. Epub 2023 Jun 16.
In newborns with hemolysis, the direct antiglobulin test (DAT) and indirect antiglobulin test (IAT) play a key role in demonstrating the presence of an immune cause. We aimed to emphasize the importance of IAT in mothers of DAT-positive babies.
DAT was performed with forward blood grouping on cord blood in term babies who were born between September 2020 and September 2022. IAT was performed in the mothers of the babies who were found to have a positive DAT and antibody identification was performed in the mothers who were found to have a positive IAT. Specific antibodies detected and identified were associated with the clinical course.
The study included 2769 babies and their mothers. The prevalence of DAT positivity was found to be 3.3% (87 of 2661). In DAT-positive babies, the rate of ABO incompatibility was 45.9%, the rate of RhD incompatibility was 5.7% and the rate of RhD and ABO incompatibility in association was 10.3%. The rate of subgroup incompatibility and other red blood cell antibodies was 18.3%. Phototherapy was applied because of indirect hyperbilirubinemia in 16.6% of the DAT-negative babies and in 51.5% of the DAT-positive babies. The need for phototherapy was significantly higher in DAT-positive infants (p < 0.01). Severe hemolytic disease of the newborn, bilirubin level, duration of phototherapy and use of intravenous immunoglobulin were found to be significantly higher in the babies whose mothers were IAT positive compared with the babies whose mothers were IAT negative (p < 0.01).
IAT should be performed on all pregnant women. When screening with IAT is not performed during pregnancy, performing DAT in the baby plays a key role. We showed that the clinical course was more severe when mothers of DAT-positive babies were IAT positive.
在新生儿溶血病中，直接抗球蛋白试验（DAT）和间接抗球蛋白试验（IAT）在证明免疫病因方面起着关键作用。我们旨在强调 IAT 在 DAT 阳性婴儿的母亲中的重要性。
对 2020 年 9 月至 2022 年 9 月间足月出生的婴儿脐带血进行正向血型鉴定，并进行 DAT。对 DAT 阳性婴儿的母亲进行 IAT，对 IAT 阳性的母亲进行抗体鉴定。将检测到的特异性抗体与临床病程相关联。
该研究共纳入 2769 名婴儿及其母亲。DAT 阳性率为 3.3%（2661 例中的 87 例）。在 DAT 阳性婴儿中，ABO 不合的发生率为 45.9%，RhD 不合的发生率为 5.7%，RhD 和 ABO 不合的发生率为 10.3%。亚群不合和其他红细胞抗体的发生率为 18.3%。由于间接高胆红素血症，16.6%的 DAT 阴性婴儿和 51.5%的 DAT 阳性婴儿接受了光疗。DAT 阳性婴儿对光疗的需求明显更高（p<0.01）。与 IAT 阴性婴儿相比，IAT 阳性婴儿的新生儿重度溶血病、胆红素水平、光疗持续时间和静脉注射免疫球蛋白的使用明显更高（p<0.01）。
应在所有孕妇中进行 IAT。如果在怀孕期间未进行 IAT 筛查，则在婴儿中进行 DAT 筛查起着关键作用。我们发现，DAT 阳性婴儿的母亲的 IAT 阳性时，临床病程更为严重。
