Lin Hongxing, Luo Pingxiang, Liu Chen, Lin Xiaosong, Que Chengwen, Zhong Wenhui
Department of Blood Transfusion, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, China.
Department of Neonatology, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, China.
Front Pediatr. 2024 Aug 5;12:1392308. doi: 10.3389/fped.2024.1392308. eCollection 2024.
To explore the risk of low-level blood group antibody-mediated hemolysis in ABO-incompatible newborns with negative three hemolysis tests, aiming to assist in the identification and management of neonatal jaundice.
A retrospective case-control study was performed in 892 children with jaundice. The patients were divided into three groups: group I, ABO compatible, negative three hemolysis tests; group II, ABO incompatible, negative three hemolysis tests; and group III, ABO incompatible, positive three hemolysis tests. We analyzed the differences in clinical data, blood routine and biochemical laboratory results.
(1) Patients in group II had higher levels of mean corpuscular volume (MCV), standard deviation of red blood cell volume distribution width (RDW-SD), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and bile acid (BA) than those in group I ( < 0.05). However, there were no statistically significant differences in the MCV, ALT, ALP and BA levels between groups II and III ( > 0.05). (2) Mean corpuscular hemoglobin concentration (MCHC) >359.5 g/L, cell volume distribution width (RDW-CV) >15.95%, and reticulocyte count (RET) >4.235% were identified as independent predictors of positive hemolysis test results ( < 0.001). The combination of MCHC, RDW-CV, and RET% yielded an AUC of 0.841.
Low-level blood group antibody-mediated hemolysis may occur in ABO-incompatible neonates even when three hemolysis tests are negative. Changes in liver function parameters must be monitored. The combination of MCHC, RDW-CV, and RET% can be used to improve the detection rate of HDN.
探讨三项溶血试验均为阴性的ABO血型不合新生儿发生低水平血型抗体介导溶血的风险，旨在协助新生儿黄疸的识别与管理。
对892例黄疸患儿进行回顾性病例对照研究。将患者分为三组：第一组，ABO血型相合，三项溶血试验均为阴性；第二组，ABO血型不合，三项溶血试验均为阴性；第三组，ABO血型不合，三项溶血试验均为阳性。分析临床资料、血常规及生化实验室结果的差异。
（1）第二组患者的平均红细胞体积（MCV）、红细胞体积分布宽度标准差（RDW-SD）、丙氨酸氨基转移酶（ALT）、乳酸脱氢酶（LDH）、碱性磷酸酶（ALP）和胆汁酸（BA）水平高于第一组（P<0.05）。然而，第二组和第三组之间的MCV、ALT、ALP和BA水平无统计学显著差异（P>0.05）。（2）平均红细胞血红蛋白浓度（MCHC）>359.5 g/L、红细胞体积分布宽度（RDW-CV）>15.95%和网织红细胞计数（RET）>4.235%被确定为溶血试验阳性结果的独立预测因素（P<0.001）。MCHC、RDW-CV和RET%的组合产生的曲线下面积（AUC）为0.841。
即使三项溶血试验均为阴性，ABO血型不合的新生儿也可能发生低水平血型抗体介导的溶血。必须监测肝功能参数的变化。MCHC、RDW-CV和RET%的组合可用于提高新生儿溶血病（HDN）的检出率。
