Isoimmunization Is Unlikely to Be the Cause of Hemolysis in ABO-Incompatible but Direct Antiglobulin Test-Negative Neonates

Author:

Herschel Marguerite1,Karrison Theodore2,Wen Ming2,Caldarelli Leslie1,Baron Beverly3

Affiliation:

1. Departments of Pediatrics

2. Health Studies

3. Pathology, the University of Chicago Pritzker School of Medicine, Chicago, Illinois

Abstract

Objective. It is stated that the direct antiglobulin (Coombs’) test (DAT) may be negative in ABO hemolytic disease of the newborn. Thus, significant jaundice in neonates who are A-B incompatible with their mothers but DAT test negative is often attributed to isoimmunization and another diagnosis is not sought. We wished to determine the rate of bilirubin production, as an objective measure of hemolysis, in 2 groups of DAT-negative neonates—ABO-compatible and ABO-incompatible—and in DAT-positive ABO-incompatible neonates. Methods. In consecutive, term, healthy newborns who were admitted to the general care nursery, we measured the level in parts per million (ppm) of end-tidal breath carbon monoxide (CO), corrected for inspired CO (ETCOc), an index of the rate of bilirubin production. We compared the levels in DAT-negative ABO-incompatible neonates with those in ABO-compatible neonates and with the levels in DAT-positive ABO-incompatible neonates. Statistical analysis was performed using 2-sample t and χ2 tests. Results. There was no significant difference between the mean 12-hour ETCOc levels in DAT-negative ABO-incompatible neonates (n = 60, 2.2 ± 0.6 ppm) versus DAT-negative ABO-compatible neonates (n = 171, 2.1 ± 0.6 ppm), although there was a difference between the mean levels in DAT-positive ABO-incompatible neonates (n = 14, 3.4 ± 1.8 ppm) and the DAT-negative groups. Four DAT-negative ABO-incompatible neonates had elevated ETCOc levels; in 2, we diagnosed a specific hematologic abnormality, namely, glucose-6-phosphate dehydrogenase deficiency in 1 and elliptocytosis in the other. Conclusion. In DAT-negative newborns with significant jaundice or increased bilirubin production, even if ABO-incompatible, a cause other than isoimmunization should be sought.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Reference16 articles.

1. Queenan JT. Erythroblastosis fetalis. In: Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 5th ed. St Louis, MO: Mosby-Year Book, Inc; 1992:242

2. Dacie J. Haemolytic disease of the newborn. In: The Haemolytic Anaemias. 3rd ed. London, United Kingdom: Churchill Livingstone; 1999:331–375

3. Alter AA, Feldman F, Twersky J, et al. Direct antiglobulin test in ABO hemolytic disease of the newborn. Obstet Gynecol.1969;33:846–851

4. Romans DG, Tilley CA, Dorrington KJ. Monogamous bivalency of IgG antibodies. J Immunol.1980;124:2807–2811

5. Bowman JM. ABO hemolytic disease. In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine. 4th ed. Philadelphia, PA: WB Saunders; 1999:736–767

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