Association of ABO and Rh incompatibility with neonatal hyperbilirubinaemia

Abstract

Background: 60% of term new-born have clinical jaundice, in the first week of life. ABO incompatibility is the most common cause of haemolytic disease of the new-born. So early intervention, at proper time, is mandatory to prevent these sequelae.Methods: This study was done at Dhiraj Hospital in Obstetrics and Gynecology Department. It was prospective observational study. 200 new-born with ABO incompatibility and 20 new-born with Rh incompatibility, causing clinically significant neonatal hyperbilirubinemia, were recruited for the clinical study noted.Results: The incidence of ABO incompatibility in our study was 13.79% and of Rh incompatibility was 1.37%. In ABO incompatibility group, 90% new born developed clinical jaundice. In treated group, out of 88 new born, 82 were from O-A and O-B incompatibility group. In ABO incompatibility DCT was positive in only 9%, whereas in Rh incompatibility it was 25%. In ABO incompatibility group, majority, 56% did not require treatment, whereas in Rh incompatibility group 65% required treatment. In ABO incompatibility group only 1% required exchange transfusion whereas in Rh incompatibility, it was required in 10%. In ABO incompatibility, all new-born treated well except, 0.5% developed kernicterus. In Rh incompatibility group, 10% new-born developed kernicterusConclusions: In ABO incompatibility, if jaundice develops, it remains in physiological limits. In presence of some aggravating conditions may present as pathological jaundice. It results in significant morbidity but no mortality. So prevention of aggravating factors is very important, in case of ABO incompatibility.

Frequency of Antibodies in Haemolytic Disease of Foetus and Newborn

“…In treated group, out of 88 newborns, 82 were from O-A and O-B incompatibility group. 19 A study by Ashutosh Kumar et al similarly showed that ABO incompatibility was the leading cause of haemolysis (in 48%) followed by Rh incompatibility (in 22%), septicaemia in 26% and G6PD deficiency in 4%. 20 Out of 158 cases of HDFN, 110 occurred due to antibodies against antigens in ABO blood group system.…”

ABO Incompatibility in the Newborn

“…Physiological jaundice typically occurs between the second and fourth days of life. 6 With ABO incompatibility, jaundice is noted within 24 hours, which may suggest that it is pathological.…”

“…However, Patel et al 6 suggested that ABO incompatibility is a physiological condition in itself, but with aggravating factors it may become severe.…”

“…In the neonate, the placenta no longer removes IB, and the sensitized fetal RBCs are destroyed in the spleen with resultant hyperbilirubinemia. 3 According to Patel et al, 6 neonatal physiologic jaundice is a result of simultaneous occurrences. First, fetal RBCs have a shorter lifespan than adult RBCs, and the fetus also has more RBCs than adults.…”

“…Glucuronic acid binds to IB so that it can be excreted. 6 In short, more IB is present and the liver is unable to clear it quickly enough, so it accumulates in the neonate. Slightly elevated levels of IB can result in a yellow coloring of the skin and perhaps a sleepy infant, and severely elevated levels can result in irreversible neurological damage, hearing loss, and may potentially lead to death if not managed.…”