Application of IgG antibody titer and subtype in diagnosis and severity assessment of hemolytic disease of the newborn

Ding, Zi-Jun; Zhang, Xinhua; Li, Hai

doi:10.21037/tp-22-385

Cited by 2 publications

(2 citation statements)

References 41 publications

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“…28,29 Several studies have shown that higher maternal anti-A or anti-B titers are associated with a greater degree placental transfer and thus a greater degree of hemolysis. [30][31][32] In our patient cohort, type Bþ blood was more likely versus Aþ to require phototherapy (p < 0.001) and for a longer duration (p ¼ 0.001) as well as more likely to receive IVIG (p ¼ 0.003) even though DAT positivity, baseline hemoglobin, APGAR, and bilirubin were all similar. This correlation suggests that neonates with type B blood and subsequently the presence of anti-B antibodies may present a higher risk of ABO HDN.…”

Section: Discussionmentioning

confidence: 76%

A Description of IVIG Use in Term Neonates with ABO Incompatibility

Daunov,

Schlosser,

Malay

et al. 2024

Am J Perinatol

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Objective To determine if treatment with IVIG of neonates with ABO incompatibility (without Rh incompatibility) results in decreased number of packed red blood cell (pRBC) transfusions and phototherapy use. Study Design An IRB-approved, single-institution retrospective study was conducted. Neonates ≥38 weeks gestational age born between 01/01/2007 and 12/31/2016 with ABO incompatibility were included. The comparison among groups was performed using Chi square and Fisher exact test for categorical variables; continuous variables were assessed by Kruskal-Wallis test. Results Six hundred and sixty-eight neonates with ABO incompatibility met inclusion criteria, 579 were included in the analyses. From those, 431 (74%) neonates had positive Direct Antiglobulin Test (DAT); 98 (17%) received IVIG and 352 (61%) received phototherapy. Thirty-six (6%) neonates received pRBC and 6 (1%) required exchange transfusions. Only 3 (0.5%) infants received pRBC transfusions post discharge, by 3 months of age. Neonates requiring IVIG had lower initial hemoglobin (13.6 g/dL vs 16.0 g/dL, p=<0.0001) and higher bilirubin at start of phototherapy (9.1 vs 8.1 mg/dL, p=0.0064). From the 42(7%) neonates who received simple and exchange transfusions, IVIG use was not associated with decreased use or number of transfusions (p=0.5148 and 0.3333, respectively). Newborns with A+ and B+ blood types had comparable initial hemoglobin, DAT positivity, APGARs, and bilirubin. However, infants with B+ blood group were more likely than A+ to require phototherapy (p<0.001), receive IVIG (p=0.003), and need phototherapy for a longer duration (p=0.001). Conclusion The results of this large retrospective study reveal that neonates with ABO incompatibility who received IVIG in the newborn period did not have reduced need for simple or exchange transfusions. Newborns with B+ blood type required more phototherapy and IVIG. Further studies are needed to better stratify neonates who would benefit from IVIG use in order to optimize treatment strategies and avoid unnecessary risks and adverse events.

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Section: Discussionmentioning

confidence: 76%

A Description of IVIG Use in Term Neonates with ABO Incompatibility

Daunov,

Schlosser,

Malay

et al. 2024

Am J Perinatol

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“…ABO hemolytic disease of the newborn (ABO-HDN) always occurs in the offspring of blood group O mother and newborns born to mothers with blood type A or B [5,6]. The pathogenesis of ABO-HDN resulting from ABO incompatibility remains unclear, but it is widely accepted that maternal antibodies directed against fetal erythrocytes due to ABO incompatibility initiate erythrocyte destruction, leading to the release of excessive bilirubin [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Potential of the L Score for ABO Hemolytic Disease of the Newborn: Insights from a Cross-Sectional Study

Li,

Deng

2024

Indian J Hematol Blood Transfus

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Purpose This study aimed to evaluate the diagnostic efficacy of the L score, a novel scoring system, in distinguishing between ABO hemolytic disease of the newborn (ABO-HDN) and non-hemolytic disease of newborn hyperbilirubinemia (NHDNH). Methods A cross-sectional prospective study was conducted to assess the effectiveness of the L score in distinguishing between ABO-HDN (n = 118) and NHDNH (n = 213). Blood routine examination results were collected, and relevant statistical analyses were performed to identify clinically significant parameters. Binary logistic regression analysis was employed to assess the relationship between the L score and the development of these conditions, considering relevant variables. Results Our study identified the red blood cell count, mean corpuscular volume, red blood cell distribution width—coefficient of variation, and red blood cell distribution width—standard deviation as independent risk factors for distinguishing ABO-HDN from other high bilirubinemia conditions (P < 0.001). The L score demonstrated superior predictive performance for ABO-HDN, exhibiting an area under the curve (AUC) of 0.746, with an optimal cutoff value of − 3.0816. The RBC-L score exhibited superior predictive performance (z: 5.596, P < 0.0001) compared to the single-factor RBC indicator, indicating its efficacy in accurately identifying the desired outcome. Conclusion The L score represents a valuable tool for predicting neonatal hyperbilirubinemia and hemolytic disease, facilitating differentiation, and guiding early intervention for improved outcomes. Further research is warranted to validate and expand the applicability of the L score in clinical practice.

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Application of IgG antibody titer and subtype in diagnosis and severity assessment of hemolytic disease of the newborn

Cited by 2 publications

References 41 publications

A Description of IVIG Use in Term Neonates with ABO Incompatibility

A Description of IVIG Use in Term Neonates with ABO Incompatibility

The Diagnostic Potential of the L Score for ABO Hemolytic Disease of the Newborn: Insights from a Cross-Sectional Study

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