CLINICAL PROFILE OF MATERNAL ANTIBODY-MEDIATED ABO HAEMOLYTIC DISEASE OF FOETUS AND NEWBORN.

Corresponding Author:
Dr. Sajith Vilambil,
Assistant Professor,
Department of Transfusion Medicine,
Government Medical College,
Thrissur-680596, Kerala.
E-mail: drsajithmenon@gmail.com

ABSTRACT

BACKGROUND

ABO incompatibility can cause neonatal jaundice and haemolytic disease of foetus and newborn (HDFN). The aim of this study is to describe the clinical profile of ABO HDFN in a tertiary care centre.

Settings and Design- This was a descriptive study conducted in neonates suffering from ABO HDFN. Setting for the research was Dept. of Transfusion Medicine and Neonatology, Division of Sree Avittom Thirunal Hospital for women and children attached to Govt. Medical College, Trivandrum.

MATERIALs and methods

Neonates who fulfilled the inclusion criteria were enrolled in this study. Demographic details, maternal history, birth details, neonatal blood group, haemoglobin, reticulocyte count, peripheral smear, bilirubin levels, mode of treatment, duration of treatment, ICU stay and followup status, etc. were recorded. Risk of jaundice, severity of disease and intensity of treatment was assessed.

Statistical Analysis- All statistical data were analysed using SPSS software version 16.

RESULTS

The mean bilirubin levels in neonates on Day 1, 2, 3, 4 and 5 were 5.16, 9.55, 11.95, 13.42 and 13.8 mg% respectively. Among 110 neonates with ABO HDFN 51 (46.4%) belonged to low risk, 22 (20%) to low intermediate risk, 19 (17.3%) to high intermediate risk and 18 (16.4%) to high risk categories. Among infants no anaemia was detected in 58 (52.7%), mild anaemia was detected in 40 (36.4%), moderate anaemia in 8 (7.3%) and severe anaemia in 4 (3.6%). Spherocytes were seen in peripheral smears of 94 (85.5%) infants, whereas it was absent in the rest 16 (14.5%) of cases. Disease was mild, moderate and severe among 101 (91.8%), 7 (6.4%) and 2 (1.8%) infants respectively; 74 (67.3%) infants required no treatment. Phototherapy alone was the modality of treatment in 21 (19.1%) infants. IVIG was given along with phototherapy in 13 (11.8%) infants; 2 (1.8%) of infants required exchange transfusion along with IVIG and phototherapy. Regarding transfusion 7 (6.4%) received packed red cells, 3 (2.7%) received platelet concentrate and 1 (0.9%) received fresh frozen plasma. Intensity of treatment was as follows- 74 (67.3%) belonged to grade-0, 21 (19.1%) belonged to grade-1, 13 (11.8%) to grade-2 and 2 (1.8%) to grade-3 category of treatment.

CONCLUSION

Majority of infants had mild hyperbilirubinaemia and no or minimal anaemia. Disease was mild in majority of infants with ABO HDFN, thereby requiring no interventions.

KEYWORDS

Haemolytic disease of foetus and newborn, hyperbilirubinaemia, antibody, ABO, phototherapy, IVIG, exchange transfusion.