YENİDOĞAN KAN DEĞİŞİMİ: DÖRT YILLIK ANKARA HASTANESİ DENEYİMİ

Amaç:Bu çalışmada yenidoğan döneminde hiperbilirubinemi nedeniyle kan değişimi (KD) uygulananhastalarda etiyoloji, komplikasyon ve tedavinin yakın dönem sonuçlarının belirlenmesi amaçlanmıştır.Gereç ve Yöntem:Ocak 1998 ve Aralık 2001 tarihleri arasında S.B. Ankara Eğitim ve Araştırma HastanesiPediatri 1 ve 2 Kliniklerinde hiperbilirubinemi nedeniyle takip edilen hastalar retrospektif olarak değerlendirildi.Dört yıllık sürede 1152 hastanın hiperbilirubinemi nedeniyle izlendiği ve bunlardan 79'unda 91 kan değişimiuygulandığı belirlendi.Bulgular:Ortalama başvuru yaşı 4,1 ± 2,7 gündü. Olguların %36,7'sinde (n=29)ABO uygunsuzluğu , %6,3'ünde(n=5) Rh uygunsuzluğu mevcuttu ve %1,2'sinde hem ABO hem de Rh uygunsuzluğu mevcuttu. Kan değişimiöncesi ve sonrası bilirubin, kalsiyum,hemoglobin düzeyi ve trombosit sayıları arasında anlamlı farkbulunmaktadır. (p< 0,05) Kan değişimi uygulanan 45 hastada (%56,9) komplikasyon belirlenmiştir.Komplikasyon olarak kardiyopulmoner arrest %1,2 (n=1); sepsis %2,5 (n=2); trombositopeni %25,3 (n=20);anemi %37,9 (n=30) ve hiperkalsemi %36,7 (n=29) olguda saptanmıştır.Sonuç:Kan değişimi yenidoğanın ciddi hiperbilirubinemisinin etkili tedavisinde halen altın standart olmaözelliğini korumaktadır. ABO uygunsuzluğunun daha hafif hastalık oluşturduğu bilinmektedir, ancak serimizde% 36,7 hastada ABO uygunsuzluğu olan hastalara KD uygulandığı saptandı. Bu çalışmada KD gerektiren enönemli nedenin ABO uygunsuzluğu olduğu belirlendi. Fototerapiye rağmen geç getirilen veya çok yüksek totalbilirubin düzeyi ile başvuran hastalarda KD komplikasyon riski kern ikterus gelişme riskinden düşük olduğusürece KD geciktirilmemelidir. Günümüzde KD pratiği giderek azaldığından komplikasyonları en aza indirmekiçin deneyimli merkezlerde uygulanmalıdır. Antenatal dönemde tüm gebeler ve eşlerinde kan grupları, Rh veABO uygunsuzluğu riski önceden belirlenmeli ve doğumun sağlık personeli gözetiminde gerçekleşmesisağlanmalıdır

Anahtar Kelimeler:

Yenidoğan kan değişimi, trombositopeni, hiperkalsemi, hiperbilirubinemi

Neonatal Exchange Transfusion: Experience of a State Hospital in Ankara During a Four Year Period

Purpose: We aimed to determine the etiology, complications and treatment outcome of patients who underwent exchange transfusion (ET) for neonatal hyperbilirubinemia in our hospital. Materials and Methods: This retrospective study was performed at Ankara State Hospital between January 1998 and December 2001. Among 1152 patients admitted for hyperbilirubinemia 91 exchange transfusions which were performed on 79 (6.86%) neonates were evaluated. Results: Mean age at admission was 4.1 2.7 days.ABOincompatibility was detected in 29 (36.7 %) cases andRh incompatibility in 5 (6.3%) cases and one case had bothABO and Rh incompatibility. Hemoglobin (Hb), calcium, bilirubin and platelet count before and after ET showed statistically significant difference(p<0.05). Exchange transfusion complications occurred in 45 neonates (56.9%). These were: anaemia n=30 (37.9%); hypercalcemia n=29 (36.7%); thrombocytopenia n=20 (25.3%) sepsis n=2 (2.5%); cardiopulmonary arrest n=1 (1.2%) Conclusion: ET is still the gold standard for treatment of severe neonatal hyperbilirubinemia. In our seriesABO incompatibility was found to be the most common cause of neonatal jaundice. The morbidity caused by ET is high; therefore it should be performed in clinics which were responding to these complications of ET. When the risks of hyperbilirubinemia overweigh ET complications, ET must not be delayed. All pregnancies must be investigated forABOincompatibility during the prenatal period and labour must take place in a medical centre.

Keywords:

Neonatal exchange transfusion, thrombocytopenia, hypercalcemia, hyperbilirubinemia,

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