Levine D H, Meyer H B
Clin Pediatr (Phila). 1985 Jul;24(7):391-4. doi: 10.1177/000992288502400707.
Confusion still exists regarding the true incidence of ABO hemolytic disease and the significance of the various laboratory investigations commonly employed in its evaluation. With such imprecision in diagnosis, early hospital discharge of newborns can be a potential problem. To evaluate the usefulness of more extensive screening than commonly employed and to identify possible indicators of severity, a pilot study of cord blood screening was undertaken. In the study, 1391 cord blood specimens were tested for type, Rh, direct antiglobulin test (DAT), indirect Coombs, and total and indirect bilirubin. Of the specimens, 53.3 percent were type A, B, or AB, and 19.3 percent of both A and B infants and 7 percent of AB infants had immune antibodies in their sera. DAT was neither diagnostic nor predictive of severity. DAT was negative in 48 percent of infants with serum antibody and did not correlate with cord blood or peak serum bilirubin levels. The cord blood bilirubin also was not diagnostic of hemolytic disease but was moderately predictive of peak bilirubin levels. The data do not support the use of any routine screening tests in the management of ABO hemolytic disease.
关于ABO溶血病的真实发病率以及在其评估中常用的各种实验室检查的意义，目前仍存在混淆。由于诊断存在这种不精确性，新生儿早期出院可能会成为一个潜在问题。为了评估比常规更广泛的筛查的有用性，并确定可能的严重程度指标，我们进行了一项脐带血筛查的试点研究。在该研究中，对1391份脐带血标本进行了血型、Rh、直接抗球蛋白试验（DAT）、间接抗人球蛋白试验以及总胆红素和间接胆红素检测。在这些标本中，53.3%为A型、B型或AB型，A 型和B型婴儿中有19.3%以及AB型婴儿中有7%的血清中存在免疫抗体。DAT既不能诊断也不能预测严重程度。在有血清抗体的婴儿中，48%的DAT为阴性，且DAT与脐带血或血清胆红素峰值水平无关。脐带血胆红素也不能诊断溶血病，但对胆红素峰值水平有一定的预测作用。这些数据不支持在ABO溶血病管理中使用任何常规筛查试验。
