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Direct antiglobulin titer strength and hyperbilirubinemia.
Pediatrics. 2014 Nov; 134(5):e1340-4.Ped

Abstract

BACKGROUND AND OBJECTIVES

We recently demonstrated that direct antiglobulin titer (DAT) positive, blood group A or B newborns born to group O mothers had a high incidence of hyperbilirubinemia, attributable to increased hemolysis. We reanalyzed our data asking whether increasing DAT strength plays a modulating role in the pathophysiology of the hemolysis and hyperbilirubinemia.

METHODS

Data from previously published DAT-positive, ABO-heterospecific neonates were analyzed for hyperbilirubinemia and hemolysis according to strength of DAT. DAT was measured by using a gel agglutination technique and reported as values ranging from DAT ± to DAT ++++. Hemolysis was evaluated by blood carboxyhemoglobin corrected for inspired, ambient CO (COHbc), and expressed as percent total hemoglobin (tHb). Hyperbilirubinemia was defined as any plasma total bilirubin value >95th percentile on the hour-specific nomogram.

RESULTS

Hyperbilirubinemia was more prevalent in those with DAT ++ readings (16 of 20, 80%) than those both DAT ± (37 of 87 [42.5%], relative risk: 1.88, 95% confidence interval: 1.35-2.61) and DAT + (32 of 56 [57.1%], relative risk: 1.40, 95% confidence interval: 1.02-1.92). COHbc values were higher for those with DAT ++ (1.45 ± 0.49% tHb [mean ± SD]) than those DAT ± (1.20 ± 0.37% tHb, P = .01) or DAT + (1.22 ± 0.37% tHb, P = .02).

CONCLUSIONS

DAT ++ readings were associated with a higher incidence of hyperbilirubinemia and higher COHbc values than DAT ± or DAT + counterparts. Increasing DAT strength may be a modulator of hemolysis and hyperbilirubinemia in ABO-heterospecific neonates. DAT strength, and not merely DAT presence or absence, should be taken into consideration in the management of ABO-heterospecific newborns.

Authors+Show Affiliations

Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine of The Hebrew University, Jerusalem, Israel; and mkaplan@mail.huji.ac.il.Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine of The Hebrew University, Jerusalem, Israel; and.Department of Pediatrics, Stanford University School of Medicine, Stanford, California.Department of Pediatrics, Stanford University School of Medicine, Stanford, California.Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25332496

Citation

Kaplan, Michael, et al. "Direct Antiglobulin Titer Strength and Hyperbilirubinemia." Pediatrics, vol. 134, no. 5, 2014, pp. e1340-4.
Kaplan M, Hammerman C, Vreman HJ, et al. Direct antiglobulin titer strength and hyperbilirubinemia. Pediatrics. 2014;134(5):e1340-4.
Kaplan, M., Hammerman, C., Vreman, H. J., Wong, R. J., & Stevenson, D. K. (2014). Direct antiglobulin titer strength and hyperbilirubinemia. Pediatrics, 134(5), e1340-4. https://doi.org/10.1542/peds.2014-1290
Kaplan M, et al. Direct Antiglobulin Titer Strength and Hyperbilirubinemia. Pediatrics. 2014;134(5):e1340-4. PubMed PMID: 25332496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct antiglobulin titer strength and hyperbilirubinemia. AU - Kaplan,Michael, AU - Hammerman,Cathy, AU - Vreman,Hendrik J, AU - Wong,Ronald J, AU - Stevenson,David K, Y1 - 2014/10/20/ PY - 2014/10/22/entrez PY - 2014/10/22/pubmed PY - 2015/1/24/medline KW - ABO heterospecificity KW - carboxyhemoglobin KW - direct antiglobulin titer KW - hemolysis KW - hyperbilirubinemia SP - e1340 EP - 4 JF - Pediatrics JO - Pediatrics VL - 134 IS - 5 N2 - BACKGROUND AND OBJECTIVES: We recently demonstrated that direct antiglobulin titer (DAT) positive, blood group A or B newborns born to group O mothers had a high incidence of hyperbilirubinemia, attributable to increased hemolysis. We reanalyzed our data asking whether increasing DAT strength plays a modulating role in the pathophysiology of the hemolysis and hyperbilirubinemia. METHODS: Data from previously published DAT-positive, ABO-heterospecific neonates were analyzed for hyperbilirubinemia and hemolysis according to strength of DAT. DAT was measured by using a gel agglutination technique and reported as values ranging from DAT ± to DAT ++++. Hemolysis was evaluated by blood carboxyhemoglobin corrected for inspired, ambient CO (COHbc), and expressed as percent total hemoglobin (tHb). Hyperbilirubinemia was defined as any plasma total bilirubin value >95th percentile on the hour-specific nomogram. RESULTS: Hyperbilirubinemia was more prevalent in those with DAT ++ readings (16 of 20, 80%) than those both DAT ± (37 of 87 [42.5%], relative risk: 1.88, 95% confidence interval: 1.35-2.61) and DAT + (32 of 56 [57.1%], relative risk: 1.40, 95% confidence interval: 1.02-1.92). COHbc values were higher for those with DAT ++ (1.45 ± 0.49% tHb [mean ± SD]) than those DAT ± (1.20 ± 0.37% tHb, P = .01) or DAT + (1.22 ± 0.37% tHb, P = .02). CONCLUSIONS: DAT ++ readings were associated with a higher incidence of hyperbilirubinemia and higher COHbc values than DAT ± or DAT + counterparts. Increasing DAT strength may be a modulator of hemolysis and hyperbilirubinemia in ABO-heterospecific neonates. DAT strength, and not merely DAT presence or absence, should be taken into consideration in the management of ABO-heterospecific newborns. SN - 1098-4275 UR - https://wwww.unboundmedicine.com/medline/citation/25332496/Direct_antiglobulin_titer_strength_and_hyperbilirubinemia_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=25332496 DB - PRIME DP - Unbound Medicine ER -