Hematological morbidity and management in neonates with hemolytic disease due to red cell alloimmunization.

Treatment of severe anemia with intrauterine red cell transfusions in fetuses with red cell alloimmunization has led to a dramatic increase in perinatal survival. Due to this increased survival focus is nowadays shifting towards improving postnatal treatment options. Phototherapy, exchange transfusions and intravenous immunoglobulin are used to treat hyperbilirubinemia and prevent kernicterus. Postnatal treatment of anemia consists of top-up transfusions, supplements to support erythropoiesis such as folic acid and iron, and occasionally erythropoietin treatment. In addition to anemia, other hematological complications such as thrombocytopenia, coagulation disturbances, leucopenia and iron overload have been reported. This review focuses on the hematological morbidity in neonates with red cell alloimmunization and summarizes the current evidence on management options.

[The Hospital Information System of the Brazilian National Unified Health System: a preliminary evaluation of performance in monitoring RhD hemolytic disease of the newborn]. / Sistema de informações hospitalares do sistema único de saúde (SIH-SUS): uma avaliação preliminar do seu desempenho no monitoramento da doença hemolítica perinatal Rh(D).

This study aimed to evaluate the adequacy of the Hospital Information System of the National Unified Health System (SIH-SUS) in identifying cases of RhD hemolytic disease of the newborn (HDN) at the Fernandes Figueira Institute (IFF/FIOCRUZ) from 1998 to 2003. Neonatal records, data from the Medical Archives, and AIH (Hospital Admissions Authorization Form) data consolidated in the SIH-SUS were analyzed. Cases were identified according to the following fields: principal diagnosis, secondary diagnosis, and procedure performed. During the period studied, 194 cases of HDN were diagnosed. The Medical Archives registered 148 newborns with HDN, however only 147 AIHs were issued and 145 consolidated in the SIH-SUS. Among these 145 cases, 84 cited HDN as the principal diagnosis, while secondary diagnosis identified 38 additional cases and the procedures performed failed to identify any further cases. Thus, the SIH-SUS identified only 122 (62.9%) of the 194 cases of HDN treated at the IFF/FIOCRUZ. Although it is necessary to evaluate other units, the SIH-SUS does not appear to be reliable for monitoring HDN. Additional studies are essential for employing secondary administrative data in the context of epidemiological surveillance.

Should we continue screening rhesus D positive women for the development of atypical antibodies in late pregnancy?

OBJECTIVE: The purpose of this study was to calculate the incidence of the new development of atypical antibodies (other than anti-rhesus D) in women attending for antenatal care, and to assess the clinical impact and cost-effectiveness of a second test to detect these antibodies. METHOD: A three-year retrospective analysis was undertaken to calculate the number of rhesus positive women who developed new antibodies in the last trimester of pregnancy. RESULTS: Of 13,143 rhesus positive women, 20 (0.15%) developed new antibodies; fetal outcome was not compromised in any of these cases. CONCLUSION: Repeat testing in late pregnancy would appear an unnecessary expense in our population.

Perfil de la morbilidad del recién nacido en la Unidad de Neonatología del Hospital Clínico de la Universidad de Chile durante 1996 y 1997 / Morbility profile of the newborn in neonatology unit at Hospital Clínico Universidad de Chile during 1996 and 1997

Se analizan los egresos y se presenta la morbilidad acaecida entre 1996 y 1997 en la Unidad de Neonatología del Hospital Clínico de la Universidad de Chile. La mortalidad se analiza en publicación aparte. Sobre un universo de 4827 partos producen 1231 egresos. La principal causa de egreso es el sindrome ictérico (40,2 por ciento) seguidos por hipoglicemia (9,8 por ciento), prematurez (8,8 por ciento), sindrome de dificultad respiratoria (5,4), enfermedad hemolítica (5,1 por ciento), infecciones neonatales (4,8 por ciento). La infección grave está presente en el 7,3 por ciento de los neonatos. El promedio general de días de estada es de 6,6 días. El 62,7 por ciento corresponde a RN de mas de 3000g de peso que evolucionan con una estada de 2,9 días promedio en contraste con el 8 por ciento de niños de menos de 1500g que tienen un promedio de 42,2 días. Se hace necesario una clasificación diagnóstica que tenga aplicación clínica y que sea fácilmente comprensible y comparable a otras casuísticas

Haematolytic disease due to ABO incompatibility: incidence and value of screening in an Asian population.

The population in Singapore is predominantly Asian, with Chinese forming the major ethnic group. The incidence of haemolytic disease of the newborn (HDN) due to Rh incompatibility is very low. The true incidence of HDN due to ABO incompatibility is unknown. Early discharge is practised in Singapore making it important to predict severe HDN due to ABO incompatibility as this would constitute the main cause of haemolysis next to G6PD deficiency. One thousand, six hundred and eight baby-maternal pairs were typed for ABO, Rh, and tested for direct Coombs' test, maternal titre, cord bilirubin and haptoglobin levels. Two hundred and fifty-one were found to be ABO incompatible, with 141 group A and 110 group B babies. The incidence of HDN due to ABO incompatibility was 3.7% of all group O mothers. Coombs' test, maternal antibody titre, cord bilirubin and haptoglobin levels were of low predictive value for severe HDN due to ABO incompatibility. The data further support the notion that it is not cost effective to screen for ABO incompatibility.

Should anti-D immunoglobulin be given antenatally?

A survey of 246 Rh-negative expectant mothers who had Rh antibodies for the first time has shown that in about 50% sensitisation might have been prevented had anti-D immunoglobulin (Ig) been injected after delivery of the previous Rh-positive baby. Sensitisation of the other mothers could have been prevented only by giving anti-D Ig antenatally during pregnancy. Perinatal mortality and morbidity in Britain from Rh-haemolytic disease in first-affected babies is now so low that an attempt to eliminate Rh-haemolytic disease by giving anti-D Ig to all expectant Rh-negative mothers during the antenatal period is not cost effective. If all Rh-negative mothers who abort or give birth to an Rh-positive baby are injected with an adequate dose of anti-D Ig within 72 h of delivery, the small number of mothers in whom measures to prevent sensitisation have failed can be reduced by 50%.