Value of three hemolysis tests and carboxyhemoglobin in the diagnosis of hemolytic disease of the fetus and newborn
Journal Title: Chinese Journal of Blood Transfusion - Year 2023, Vol 36, Issue 9
Abstract
Objective To investigate the value of three hemolysis tests and carboxyhemoglobin (COHb) level in the diagnosis of hemolytic disease of the fetus and newborn (HDFN). Methods From January 1, 2019 to December 31, 2022, the neonates hospitalized in the Department of Neonatology of Hebei Provincial Children's Hospital with suspected hemolytic disease who had serological testing were retrospectively enrolled in the study. They were distributed into HDFN group and non-HDFN group according to the final diagnosis. Their clinical and laboratory data were collected and analyzed, and the COHb level was detected by blood gas analyzer. Results A total of 378 neonates with HDFN and 217 neonates without HDFN were included in the study. Most of the neonates in HDFN group were full-term infants (348/378, 92.1%), with median gestational age of 39.1 (38.3, 40.0) weeks. Three hundred and fifty-four cases (354/378, 93.7%) were ABO-HDFN and the rest were Rh HDFN. There were significant differences in the level of serum total bilirubin, hemoglobin, COHb and reticulocyte percentage at admission between the two groups(P<0.05). The positive rate of three hemolysis tests in HDFN group decreased with the increase of the days after birth. The highest positive rate (more than 80%) was observed within 2 days after birth. Correlation analysis showed a negative relationship between the COHb level and the age (rs = -0.434, P<0.001) . Among the three hemolysis tests in HDFN group, the positive rate of antibody release test was the highest (69.0%), followed by the free antibody test (55.6%) and the direct antiglobulin test (DAT) (36.0%). Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value of COHb was 1.15%.The sensitivity of COHb ≥ 1.15% was 51.8%, higher than single DAT (36.0%) . The diagnosis effectiveness of three hemolysis tests couldn't be improved when combined with COHb detection(Z = -0.727, P>0.05) . Conclusion The three hemolysis tests are important in the diagnosis of HDFN, among which the antibody release test has the highest sensitivity. COHb has certain value for the diagnosis of HDFN, but joint testing cannot improve the diagnosis effectiveness of three hemolysis tests. Hemolysis tests and/or COHb detection should be conducted for neonates at risk of hemolysis as early as possible after birth.
Authors and Affiliations
Fan ZHAO, Zhili SHAO, Xiaohan YOU, Jiancheng JIAO, Lili FAN, Min SUN, Lingzhi MENG, Li MA
Unexpected antibody distribution among tumor patients: analysis of 111 483 cases
Objective To analyze the distribution of unexpected antibodies in tumor patients retrospectively and explore the clinical significance. Methods Unexpected antibody screening was performed on inpatients with blood prepara...
Construction of a whole business process supervision and management system: based on management information system of blood banks
Objective To achieve supervision and management of the whole business process of blood center, raise productivity and ensure blood quality by enabling blood center managers comprehensively grasp the key business operatio...
Distribution and molecular basis of A2 subtype in Guangzhou blood donors
Objective To investigate the distribution and molecular basis of A2 subtype among blood donors in Guangzhou. Methods Whole blood samples of 793 group A blood donors in Guangzhou Blood Center were randomly collected. A2 s...
Research status and application prospect of hemoglobin-based oxygen carriers in organ transplantation
Hemoglobin-based oxygen carriers(HBOCs) is a category of artificial blood substitute with efficient oxygen carrying and delivery functions. Due to the outstanding oxygen-carrying properties of HBOCs, the studies of expan...
Hemolytic transfusion reaction analysis and domestic literature review
Objective To investigate the causes of hemolytic transfusion reaction (HTR), identify clinical symptoms and severity, explore clinical detection methods, so as to provide reference for safe and rational blood use. Method...