Ahmet KARATAŞ, Mehmet Arif AKŞİT, Neslihan TEKİN, Zehra KARATAŞ

Yenidoğanlarda Direkt Antiglobülin Test Pozitifliğinin Değerlendirilmesi

Amaç: Yenidoğan bebeklerde, direkt antiglobulin test (DAT) pozitif saptananlarda klinik velaboratuar bulgularını, uygulanan tedavi ve prognozlarını değerlendirmek amacıyla bu çalışmayapılmıştır.Gereç ve Yöntem: Kliniğimizde Haziran 2004-Kasım 2006 yılları arasında takip edilenbebeklerden direkt coombs testi pozitif saptanan 97 vakanın dosyası retrospektif olarakincelendi. Gruplar karşılaştırılırken ki-kare testi kullanıldı.Bulgular: Direkt intiglobulin test pozitiflik prevalansı %4.1 olarak bulundu. Olguların 26’sıprematüre idi. DAT 75 hastada başlangıçta pozitif idi. Prematürelerin %34.6’sında, matürbebeklerin ise %14’ünde DAT pozitifliği sonradan saptandı. 41 hastada hemoliz saptandı. 62hastada kan grubu uyuşmazlığı (ABO:44, Rh:12, ABO ve Rh: 6) vardı. 67 hasta fototerapi, 52hasta 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 IVIGtedavisi özellikle ABO hemolitik hastalığı olanlarda exchange ihtiyacını azaltmaktadır.Prematürite ve eşlik eden sistemik inflamatuar yanıt sendromu (SIRS) ve/veya enfeksiyonlarimmün hemolitik anemi dışında DAT’nin pozitif saptanmasında rol almaktadır

Anahtar Kelimeler:

Direkt coombs test, yenidoğan, prematüre

Evaluation Of Direct Antiglobulin Test Positivity In Neonates

Aim: The objective of the present study is to determine clinical, laboratory findings, treatmentand prognosis in newborns with positive direct antiglobulin test (DAT).Methods: Ninety-seven patients with positive direct coomb’s test from 2362 newborns whowere hospitalized in Neonatology Unit of Eskisehir Osmangazi University Faculty of Medicinebetween June 2004-November 2006 were reviewed retrospectively. Chi-square test was usedfor statistical analysis.Results: The prevalance of DAT was 4.1%. Twenty-six patients were premature. In 75 patientsDAT was positive initially. The initial DATs were negative in 34.6% of prematures and 14% ofterm newborns. But later, the DATs of all these babies were positive, when they were beingfollowed up in hospital. Hemolysis was determined in 41 patients. There were blood groupincompatibilities (ABO:44, Rh:12, ABO and Rh:6) in 62 patients. 67 patients were underwentphototherapy and 52 patients were treated with intravenous immunoglobulin (IVIG). Exchangetransfusion was performed in 15 patients. Eventually; neonatal cholestasis devoloped in sixpatients and ten patients died.Conclusion: The most common etiologic factor in the newborns with positive DAT is bloodgroup incompatibility. IVIG therapy reduces the need for exchange especially in the earlydiagnosis of ABO hemolytic disease. Prematurity and accompanying systemic inflammatoryresponse syndrome (SIRS) and/or infections may be the causes of positive DAT without immunehemolytic anemia

Keywords:

Direct coomb’s test, newborn, premature,

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