ABO血型不合中新生儿高胆红素血症发生情况的预测

Prediction of the development of neonatal hyperbilirubinemia in ABO incompatibility.

作者信息

Chen J Y, Ling U P

机构信息

Department of Pediatrics, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan, R.O.C.

出版信息

Zhonghua Yi Xue Za Zhi (Taipei). 1994 Jan;53(1):13-8.

PMID:8173995

Abstract

BACKGROUND

ABO incompatibility is now the most common cause of isoimmune hemolytic disease of the newborn here. Although hemolytic disease because of ABO incompatibility is clinically milder than that from Rh incompatibility, severe hemolysis occasionally occurs, and some cases require exchange transfusion. It is desirable to assess the accuracy of a group of tests to predict the development of neonatal hyperbilirubinemia in ABO incompatibility. Then, early treatment is available for minimizing the frequency of exchange transfusion.

METHODS

Eighty-eight healthy full-term newborn infants born to blood group 0 mothers were studied and divided into four groups. Each baby weighed 2.5 Kg or more, had no evidence of G-6-PD deficiency. Group 1 consisted of 29 blood group A or B infants with hyperbilirubinemia (serum bilirubin levels > or = 15 mg/dl) and/or icterus praecox. Group 2 consisted of 24 blood group A or B infants without hyperbilirubinemia (serum bilirubin levels < 15 mg/dl). Group 3 consisted of 7 blood group 0 neonates with hyperbilirubinemia. Group 4 consisted of 28 blood group 0 neonates without hyperbilirubinemia. Titers of maternal IgG anti-A and anti-B antibodies were measured. Cord blood was used to performed direct Coombs' test and for bilirubin level determinations.

RESULTS

A total of 18 (62.1%) mothers had IgG anti-A or anti-B titers > or = 512X in Group 1. The majority of mothers (91.5%) in Group 2, 3 and 4 had anti-A or anti-B titers < or = 128X. Thirteen (44.8%) neonates in Group 1 had positive direct Coombs' test of the cord blood. Only one neonate (4.2%) in Group 2 and one neonate (3.6%) in Group 4 had positive direct Coombs' test. A total of 12 neonates (41.4%) in Group 1 had cord bilirubin levels > or = 4 mg/dl, whereas none in the other groups had cord bilirubin levels > or = 4 mg/dl.

CONCLUSIONS

ABO incompatible newborn infants with maternal IgG anti-A or anti-B titers > or = 512X, cord bilirubin levels > or = 4 mg/dl or positive direct Coombs' test of the cord blood represent a "high risk" category, and should be placed in hospital where frequent re-evaluation and appropriate therapy are available.

摘要

背景

ABO血型不合现已成为本地新生儿同种免疫性溶血病最常见的病因。尽管ABO血型不合所致的溶血病在临床上较Rh血型不合所致者症状轻，但偶尔也会发生严重溶血，部分病例需要进行换血治疗。评估一组检测预测ABO血型不合新生儿高胆红素血症发生情况的准确性很有必要。这样就能尽早进行治疗，以减少换血治疗的频率。

方法

对88名母亲血型为O型的健康足月新生儿进行研究，并将其分为四组。每个婴儿体重2.5千克或以上，无葡萄糖-6-磷酸脱氢酶（G-6-PD）缺乏的证据。第1组由29名患有高胆红素血症（血清胆红素水平≥15毫克/分升）和/或早发性黄疸的A型或B型血婴儿组成。第2组由24名无高胆红素血症（血清胆红素水平＜15毫克/分升）的A型或B型血婴儿组成。第3组由7名患有高胆红素血症的O型血新生儿组成。第4组由28名无高胆红素血症的O型血新生儿组成。检测母体IgG抗A和抗B抗体的效价。采集脐血进行直接抗人球蛋白试验和胆红素水平测定。

结果

第1组共有18名（62.1%）母亲的IgG抗A或抗B效价≥512倍。第2、3和4组的大多数母亲（91.5%）抗A或抗B效价≤128倍。第1组中有13名（44.8%）新生儿脐血直接抗人球蛋白试验呈阳性。第2组中只有1名新生儿（4.2%）和第4组中只有1名新生儿（3.6%）脐血直接抗人球蛋白试验呈阳性。第1组共有12名新生儿（41.4%）脐血胆红素水平≥4毫克/分升，而其他组中无一例脐血胆红素水平≥4毫克/分升。