Ali ANNAGÜR, Hüseyin ALTUNHAN, Murat KONAK, Hasan KOÇ, Rahmi ÖRS

Role of Subgroup Incompatibility in Newborn Jaundice Requiring Exchange Transfusion

Bu çalışmada yenidoğan sarılığı nedeniyle kan değişimi (KD) yapılan hastalarda etiyoloji, tedavi, KD ile ilgili komplikasyonlar ve subgrup uyuşmazlığının rolünü belirlemeyi amaçladık. Dört yıl boyunca yenidoğan sarılığı nedeniyle yatırılarak 89 KD yapılan toplam 82 hasta retrospektif olarak değerlendirildi. KD öncesi ortalama total serum bilirubin düzeyi 29,2±9,83 mg/dl idi. En sık KD sebebi ABO uyuşmazlığı (%31), bunu Rh uyuşmazlığı (%19) ve subgrup uyuşmazlığı (SGU) (%17) izliyordu. Tüm hastaların %46’sında ve SGU olan hastaların %71’inde direkt coombs testi (+) idi. Hastaların %49’una İVİG verildi. KD yapılan hastalardan 5’inde hidrops fetalis tablosu mevcuttu. Bunların 3’ünde Rh, 1’inde ABO ve diğerinde SGU mevcuttu. KD gereksinimi gösteren ciddi sarılığın en önemli sebebi ABO ve Rh uyuşmazlığı olsa da özellikle Rhogamın yaygın kullanılması, bu risk nedenlerinin önceden tanımlanarak gerekli öneriler ve önlemler sayesinde KD ihtiyacı eskiye oranla azaltılmıştır. Ancak bunun aksine SGU’na bağlı ciddi hemolitik sarılık ve KD ihtiyacı rölatif olarak artmıştır. Kaldi ki SGU hidrops fetalis, kernikterus ve ölüme yol açabilmektedir. Riskli grupların önceden bilinmesi ve erken yoğun fototerapi sayesinde hiperbilirubineminin komplikasyonları ve KD oranı önemli ölçüde azaltılabilecektir

Anahtar Kelimeler:

Kan değişimi, yenidoğan sarılığı, hiperbilirubinemi, subgrup uyuşmazlığı, minör kan grubu uyuşmazlığı

Role of Subgroup Incompatibility in Newborn Jaundice Requiring Exchange Transfusion

We aimed to determine the role of exchange transfusion related complications, treatment, and etiology as well as subgroup incompatibility in patients subject to ET (exchange transfusion) due to newborn jaundice. 82 patients hospitalized due to newborn jaundice and exposed to exchange transfusion between August 2007 and August 2011 were retrospectively studied. Before ET mean total serum bilirubin was 29,2±9,83. The most frequent cause of ET was ABO incompatibility (31%) followed by Rh incompatibility (19%) and subgroup incompatibility (17%), respectively. In 46% of all patients and in 71% of the patients presenting with subgroup incompatibility , direct combs test was detected to be (+). 49% of the patients were administrated with intravenous immunoglobulin. 5 of the patients who were exposed to ET presented with hydrops fetalis. Of these patients 3 had Rh, 1 had ABO while the other had subgroup incompatibility. Although ABO and Rh incompatibility are substantial underlying reasons of severe jaundice requiring exchange transfusion, particularly widespread use of RhoGAM thereby enabling the prior identification and precautions, ET need was reduced compared to previous cases. On the contrary, SGU related severe hemolytic jaundice relatively enhanced, however.

Keywords:

Exchange transfusion, newborn jaundice, hyperbilirubinemia, subgroup incompatibility, minor blood group incompatibility,

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