Yenidoğanlarda direkt antiglobülin test pozitifliğinin değerlendirilmesi
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Tarih
2011
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info:eu-repo/semantics/openAccess
Özet
Amaç: Yenidoğan bebeklerde, direkt antiglobulin test (DAT) pozitif saptananlarda klinik ve laboratuar bulgularını, uygulanan tedavi ve prognozlarını değerlendirmek amacıyla bu çalışma yapılmıştır. Gereç ve Yöntem: Kliniğimizde Haziran 2004-Kasım 2006 yılları arasında takip edilen bebeklerden direkt coombs testi pozitif saptanan 97 vakanın dosyası retrospektif olarak incelendi. Gruplar karşılaştırılırken ki-kare testi kullanıldı. Bulgular: Direkt intiglobulin test pozitiflik prevalansı %4.1 olarak bulundu. Olguların 26’sı prematüre idi. DAT 75 hastada başlangıçta pozitif idi. Prematürelerin %34.6’sında, matür bebeklerin ise %14’ünde DAT pozitifliği sonradan saptandı. 41 hastada hemoliz saptandı. 62 hastada kan grubu uyuşmazlığı (ABO:44, Rh:12, ABO ve Rh: 6) vardı. 67 hasta fototerapi, 52 hasta intravenöz immunglobulin (IVIG) tedavisi aldı. 15 hastaya exchange transfüzyon yapıldı. İzlem sırasında hastalardan altısında neonatal kolestaz gelişti, 10’u öldü. Sonuç: Yenidoğanlarda DAT pozitifliğinin en sık sebebi kan grup uygunsuzluğudur ve IVIG tedavisi özellikle ABO hemolitik hastalığı olanlarda exchange ihtiyacını azaltmaktadır. Prematürite ve eşlik eden sistemik inflamatuar yanıt sendromu (SIRS) ve/veya enfeksiyonlar immün hemolitik anemi dışında DAT’nin pozitif saptanmasında rol almaktadır.
Aim: The objective of the present study is to determine clinical, laboratory findings, treatment and prognosis in newborns with positive direct antiglobulin test (DAT). Methods: Ninety-seven patients with positive direct coomb’s test from 2362 newborns who were hospitalized in Neonatology Unit of Eskisehir Osmangazi University Faculty of Medicine between June 2004-November 2006 were reviewed retrospectively. Chi-square test was used for statistical analysis. Results: The prevalance of DAT was 4.1%. Twenty-six patients were premature. In 75 patients DAT was positive initially. The initial DATs were negative in 34.6% of prematures and 14% of term newborns. But later, the DATs of all these babies were positive, when they were being followed up in hospital. Hemolysis was determined in 41 patients. There were blood group incompatibilities (ABO:44, Rh:12, ABO and Rh:6) in 62 patients. 67 patients were underwent phototherapy and 52 patients were treated with intravenous immunoglobulin (IVIG). Exchange transfusion was performed in 15 patients. Eventually; neonatal cholestasis devoloped in six patients and ten patients died. Conclusion: The most common etiologic factor in the newborns with positive DAT is blood group incompatibility. IVIG therapy reduces the need for exchange especially in the early diagnosis of ABO hemolytic disease. Prematurity and accompanying systemic inflammatory response syndrome (SIRS) and/or infections may be the causes of positive DAT without immune hemolytic anemia.
Aim: The objective of the present study is to determine clinical, laboratory findings, treatment and prognosis in newborns with positive direct antiglobulin test (DAT). Methods: Ninety-seven patients with positive direct coomb’s test from 2362 newborns who were hospitalized in Neonatology Unit of Eskisehir Osmangazi University Faculty of Medicine between June 2004-November 2006 were reviewed retrospectively. Chi-square test was used for statistical analysis. Results: The prevalance of DAT was 4.1%. Twenty-six patients were premature. In 75 patients DAT was positive initially. The initial DATs were negative in 34.6% of prematures and 14% of term newborns. But later, the DATs of all these babies were positive, when they were being followed up in hospital. Hemolysis was determined in 41 patients. There were blood group incompatibilities (ABO:44, Rh:12, ABO and Rh:6) in 62 patients. 67 patients were underwent phototherapy and 52 patients were treated with intravenous immunoglobulin (IVIG). Exchange transfusion was performed in 15 patients. Eventually; neonatal cholestasis devoloped in six patients and ten patients died. Conclusion: The most common etiologic factor in the newborns with positive DAT is blood group incompatibility. IVIG therapy reduces the need for exchange especially in the early diagnosis of ABO hemolytic disease. Prematurity and accompanying systemic inflammatory response syndrome (SIRS) and/or infections may be the causes of positive DAT without immune hemolytic anemia.
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13
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2
