PubMed · 14426401
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N NEIMANN, M PIERSON. 1960. [Nuclear icterus].. https://pubmed.ncbi.nlm.nih.gov/14426401/
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OBJECTIVE: To evaluate the role of intravenous immunoglobulins in Rh hemolytic disease of newborn. METHODS: The study included all DCT positive Rh isoimmunized babies admitted in the unit from August 2000 to February 2001. Intravenous immunoglobulins in the dose of 500 mg/kg on day 1 and day 2 of life in addition to the standard therapy. Babies who received IVIG were compared with those who did not receive IVIG for the peak bilirubin levels, duration of phototherapy, number of exchange transfusions, discharge PCV and the need for blood transfusions for late anemia till 1 months of age. RESULTS: A total of 34 babies were eligible for the study. 8 babies received IVIG and 26 babies only standard treatment. The mean maximum bilirubin levels were significantly lower in the IVIG group compared to the group who received NO IVIG (16.52 +/- 2.96 Vs 22.72 +/- 8.84, p=0.004). Five babies in the IVIG group (62.5%) and 23 babies in the NO IVIG group required exchange transfusions (88.5%, p=0.014). 12 of the 26 babies in the NO IVIG group required multiple exchange transfusions while none of the babies in IVIG group required more one exchange transfusion (p=0.03). The mean duration of phototherapy was 165 +/- 109 hours in the IVIG group as against 119 +/- 56 hours in the NO IVIG group (p=0.29). Blood transfusion for anemia was more common in the IVIG group (37.5% Vs 11.5% p=0.126) though the packed cell volumes at discharge were similar in both the groups (39.5 +/- 11 Vs 40 +/- 5.1, P=0.92). CONCLUSION: Intravenous immunoglobulins is effective in decreasing the maximum bilirubin levels and the need for repeated exchange transfusions in Rh hemolytic disease of newborn. There is however an increased need for blood transfusions for late anemia in the babies treated with IVIG.
Immunohaematological tests used in antenatal patients have come a long way. However, despite a great deal of progress, we should not loose sight of the fact that these tests give only an indirect measurement and will only help the obstetrician, in conjunction with other fetal parameters, to assess the severity of the haemolytic disease (HD) of the fetus and newborn. The best method to assess the severity is the direct determination of foetal blood group hemoglobin after foetal blood sampling but this procedure is not without risk. Since 10 years ago, it is possible to determine the RHD genotype of the fetus using amniocytes and, today, maternal plasma directly. All pregnant women should be grouped for ABO-RH-KEL1 and the sera tested for clinically irregular antibodies (anti-RH are still the most frequent). The trend in anti-RH levels is more important than the level itself. The perfect technique for anti-RH quantitation has not been developed. Manual titration is simple but only provides rough, semiquantitatives estimates of anti-RH concentration. Quantitative haemagglutination methods, using auto-analyzers and appropriate anti-RH1 standards, measure in microg/ml, are sensitive, rapid and have acceptable intra-laboratory reproductibility.
A recently developed immunocytochemical technique in HbF-cell counting was assessed by an objective evaluation method. The basic principle of this method is the preparation of aliquots with predetermined HbF-cell (target) values. These aliquots serve as control samples to standardize the HbF-cell measurements by the new immunocytochemical technique, which uses the StreptABComplex/AP staining procedure (SAP) and visualization under white light. Immunofluorescence optical counts (IF) were performed in parallel with the new technique. A trend of inaccuracy was observed in low target values for both methods. As the level of target values increased, deviations became insignificant (relative accuracy < 8%) with SAP having slightly better results. Linear regression data of the estimated %HbF-cell rates by the two methods versus the target values were very satisfactory for both methods with SAP being slightly better. SAP seems to provide an accurate and reliable alternative for HbF-cell estimation comparable with the classical IF optical count.