Erythroblastosis, Fetal ; blood ; diagnosis ; Female ; Humans ; Infant, Newborn ; MNSs Blood-Group System

OBJECTIVE: To explore the feasibility of remote monitoring of neonatal jaundice in newborns with ABO hemolytic disease. METHODS: Forty six neonates of gestational age >35 weeks with ABO hemolytic disease admitted to Women's Hospital, Zhejiang University School of Medicine from January 20th, 2020 to February 29th, 2020 were enrolled in the study (study group). The newborns were followed up at home after discharge, the transcutaneous bilirubin (TCB) levels were measured by parents using the provided device and the results were sent to the doctor by smart phone using the installed APP. Fifty six newborns with ABO hemolytic disease admitted in 2018 who received conventional outpatient follow-up after discharge served as the control group. The demographic characteristics, total serum bilirubin (TSB) level during hospitalization, number of outpatient visit and rate of re-admission due to rebound hyperbilirubinemia were compared between the two groups. RESULTS: There were no significant differences between the two groups in gestational age, birth weight, delivery mode, gender, length of the first hospitalization, TSB level before phototherapy and before discharge, and the managements during the first hospitalization (all CONCLUSIONS The remote follow-up for neonatal jaundice at home can effectively reduce the number of outpatient visits without increasing the risk of readmission and severe neonatal hyperbilirubinemia for newborns with ABO hemolytic disease.
Bilirubin ; Erythroblastosis, Fetal/diagnosis* ; Female ; Humans ; Hyperbilirubinemia, Neonatal/diagnosis* ; Infant, Newborn ; Jaundice, Neonatal/diagnosis* ; Monitoring, Physiologic/methods* ; Phototherapy

This study was purposed to investigate the incidence and the model of ABO hemolytic disease in newborn (ABO-HDN) and the results of the three hemolysis test, so as to provide the evidences for clinical diagnosis and therapy. A total of 227 cases of maternal-fetal ABO incompatibility from January 2013 to October 2013 in the First Affiliated Hospital of Xiamen University were enrolled in the study. The ABO blood group of newborn and mother was detemined and three hemolysis tests (direct antiglobulin test, free antibody test, RBC antibody release test) were performed. The results indicated that in 227 cases of ABO incompatible pregnancies,186 cases were ABO-HDN (81.94%). There was no significant difference in the incidence between O-A and O-B incompatible pregnancies (P > 0.05). The positive ratio of direct antiglobulin test, free antibody test and RBC antibody release test were 59.14% (110/186), 84.78% (156/186) and 94.62% (176/186) respectively. It is concluded that the incidence of ABO-HDN is high. The main models of ABO-HDN were O-A and O-B. There was no significant difference in the incidence between O-A and O-B incompatible pregnancies. Three hemolysis tests are high sensitivity and are helpful in early diagnosis and early treatment of HDN.
ABO Blood-Group System ; Blood Group Incompatibility ; Coombs Test ; Erythroblastosis, Fetal ; diagnosis ; Hemolysis ; Humans ; Incidence ; Infant, Newborn

BACKGROUND: Irregular antibodies are antibodies that are not regularly present in the serum of particular blood groups and its presence results in many problems including HDN (hemolytic disease of newborn) in transfusion medicine. Column agglutination test was recently introduced and has been widely used for advantages of standardized working procedures, standard reactions, stable reactions for hours and Coombs test without washing steps. We tested irregular antibodies in cord blood by column agglutination test and investigated its incidence and relation with HDN. METHODS: We tested the cord blood collected during delivery from 200 pregnant women. Column agglutination test was done on DiaMed ID MicroTyping System (DiaMed, Switzerland) and both LISS/Coombs and NaCl/Enzyme ID-cards were used. The antibody screening test was done first and antibody identification test was done to positive cases in same way. The cell typing and Rh phenotyping for cord blood of positive cases were also done. RESULTS: 2 cases of 200 samples (1%) were positive in the antibody screening test and each was identified as anti-D and anti-E antibody. CONCLUSIONS: Irregular antibody screening in cord blood by column agglutination test is thought to be helpful in early diagnosis and treatment of HDN.
Agglutination Tests* ; Agglutination* ; Antibodies ; Blood Group Antigens ; Coombs Test ; Early Diagnosis ; Erythroblastosis, Fetal ; Female ; Fetal Blood* ; Humans ; Incidence ; Infant, Newborn ; Mass Screening* ; Pregnant Women ; Transfusion Medicine

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di(a) antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di(a) panel cells. The frequency of the Di(a) antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di(a) antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di(a) antigen positive cells in antibody identification test for Korean.
Alleles ; Bilirubin/blood ; Erythroblastosis, Fetal/*diagnosis/*immunology ; Humans ; Infant, Newborn ; Isoantibodies/*analysis ; Male ; Polymerase Chain Reaction ; Rh-Hr Blood-Group System/*analysis/blood

Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.
Adult ; Blood Group Antigens/immunology ; *Blood Group Incompatibility ; Diseases in Twins/diagnosis/*immunology ; Erythroblastosis, Fetal/*diagnosis/immunology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Isoantigens/immunology ; Jaundice, Neonatal/complications/immunology/therapy ; Male ; Phenotype ; Phototherapy ; Pregnancy ; Pregnancy Complications, Hematologic/diagnosis/*immunology ; Twins

OBJECTIVEAnti-D IgG in RhD negative pregnant women is the main antibody of Rh-induced hemolytic disease of newborn (HDN). The study aimed to investigate the clinical significance of anti-D IgG screening and titer detection in RhD negative pregnant women.

METHODSSera of 286 RhD negative pregnant women were collected. Microtube column indirect antiglobulin test was used to screen and identify anti-D IgG. The indirect antiglobulin test was used to test the titer of anti-D IgG.

RESULTSAnti-D IgG was identified in 21 cases (7.3%). The titer of anti-D showed an increasing trend with pregnancy progresses. The clinical outcomes of 12 fetuses (newborns) from positive anti-D pregnant women were observed. Two cases died in utero, 2 cases did not show abnormality and 8 cases had hemolysis. The 8 cases with hemolysis were treated with exchange transfusion or blood transfusion, and they had a good prognosis.

CONCLUSIONSThe screening and titer detection of anti-D IgG in RhD negative pregnant women are valuable in the prediction and treatment of HDN.

ABO Blood-Group System ; immunology ; Adult ; Blood Group Incompatibility ; Erythroblastosis, Fetal ; diagnosis ; Female ; Humans ; Immunoglobulin G ; blood ; Isoantibodies ; blood ; Pregnancy ; Rh-Hr Blood-Group System ; blood ; Rho(D) Immune Globulin

OBJECTIVETo report a rare case of hemolytic disease of the newborn (HDN) with kernicterus caused by anti-Di(a) diagnosed using high-throughput genotyping multiplex ligation-dependent probe amplification (MLPA).

METHODSConventional serological methods were used to detect the antibodies related with HDN. The genotypes of more than 40 red blood cell antigens for the newborn and her parents were obtained using the high-throughput MLPA assay. The antibody titers were tested using a standard serological method.

RESULTSThe unknown antibody against the low-frequency antigens was predicted based on the primary serological tests. The genotyping results for more than 40 red blood cell antigens of the newborn and her parents showed incompatible antigens of MNS and Diego blood group system, indicating the existence of anti-N or anti-Di(a). Further serological tests confirmed anti-Di(a) existence in the plasma of the newborn and her mother. The titer of anti-Di(a) in the mother's plasma was 1:32.

CONCLUSIONSevere HDN including kernicterus can result from anti-Di(a). High-throughput genotyping MLPA assay can help type some rare antigens in complicated cases. The reagent red cell panels including Di(a)-positive cells are necessary in routine antibody screening test in Chinese population.

Blood Group Incompatibility ; genetics ; Erythroblastosis, Fetal ; diagnosis ; immunology ; Exchange Transfusion, Whole Blood ; Female ; Genotype ; Humans ; Infant, Newborn ; Nucleic Acid Amplification Techniques ; methods ; Rh-Hr Blood-Group System ; genetics ; immunology ; Rho(D) Immune Globulin ; genetics ; immunology

ABO Blood-Group System ; immunology ; Drugs, Chinese Herbal ; therapeutic use ; Erythroblastosis, Fetal ; classification ; prevention & control ; Female ; Humans ; Hyperbilirubinemia ; prevention & control ; Immunoglobulin G ; blood ; Infant, Newborn ; Phytotherapy ; Pregnancy ; Prenatal Diagnosis

Palpation of an abdominal mass in an infant or child presents a challenging problem in diagnosis and treatment. We reviewed the data on 166 patients under age 15 years who admitted to Ped. Dept. of PMC due to palpable abdominal mass in Jan. 1972-July 1977. The results are as follows 1. Of the 57 surgical cases, pathologically confirmed abdominal tumors were 39 cases. Of the 20 retroperitoneal tumors, Wilms tumors were 13 cases, neuroblastomas were 3 cases, polycystic kidney was 1 case, and retroperitoneal teratoma was 1 case. Of the 19 intraperitonel tumors, hepatomas were 3 cases, hepatoblastoma was 1 case, choledocal cysts were 3 cases, mesenteric and omental cysts were 4 cases, malignant lymphomas were 4 cases and ovarian cysts were 3 cases. Other surgical diseases were 2 cases of ascariasis and 2 cases of bezoar. 2. Medical cases were as follows : 35 cases of leukemia, 15 cases of infectious hepatitis, 14 cases of congenital syphilis 7 cases of liver cirrhosis 7 cases of lirerabscesses, 4 cases of miliary Tbc., 3 cases of congenital spherocytosis, 1 case of cryptococosis, I case of osteopetrosis and 1 case of erythroblastosis fetalis. 3. In age distribution, almost all cases(94%) of Wilms tumor and neuroblastoma were under age of 4 and half of medical cases in infancy were congenital syphilis. 4. Of the pathologically confirmed 39 abdominal tumors, 20 cases were retroperitoneal tumor and 19 cases were intraperitoneal tumor. Of the 20 retroperitonel tumor cases, 16 cases were renal origin, 3 cases were adrenal origin, and 1 case was teratoma. Of the 19 intraperitoneal tum orcases, 8 cases were hepatobiliary origin, 3 cases were ovary origin, 4 cases were omental and mesenteric origin and 4 cases were lymphatics origin. 5. Of the 39 abdominal tumor cases, 34 cases (87%) visited the hospital with the chief complaint of palpable abdominal mass. But, of the 94 medical cases, only 16 cases(17%) visited the hospital with the chief complaint of palpable abdominal mass. 6. In some cases presumptive diagnosis on the base of history taking, physical examination, chest X-ray, simple abdominal X-ray. Peripheral blood findings on admission were uncorrect. In 1 case of Wilms tumor, we suspected liver abscess on admission. In 1/3 case of intraperitoneal tumors, we suspected retroperitoneal tumor on admission. We suspected lymphoma on admission in 1 case of ascariasis and 1 case of bezoar. We misdiagnoed 1 case of miliary Tbc. As hepatoma, 1 case of liver cirrhosis as retroperitoneal tumor and 1 case of congenital syphilis as retroperitoneal tumor on admission. 7. In the treatment of malignant abdominal tumor, we tried all possible measures such as surgery, chemotherapy, and radiation therapy. But prognosis of all malignant abdominal tumors were very poor. Only 1 case of Wilms tumor and 1 case of hepatoblastoma were survived at the time of review.
Age Distribution ; Ascariasis ; Bezoars ; Carcinoma, Hepatocellular ; Child* ; Diagnosis ; Drug Therapy ; Erythroblastosis, Fetal ; Female ; Hepatitis A ; Hepatoblastoma ; Humans ; Infant* ; Infant, Newborn ; Leukemia ; Liver Abscess ; Liver Cirrhosis ; Lymphoma ; Neuroblastoma ; Osteopetrosis ; Ovarian Cysts ; Ovary ; Palpation ; Physical Examination ; Polycystic Kidney Diseases ; Prognosis ; Syphilis, Congenital ; Teratoma ; Thorax ; Wilms Tumor