Exchange transfusions and top‐up transfusions in neonates with Kell haemolytic disease compared to Rh D haemolytic disease

Rath, Mirjam E.A.; Smits-Wintjens, Vivianne E.H.J.; Lindenburg, Irene T.M.; Brand, Anneke; Kamp, Inge L. van; Oepkes, Dick; Walther, Frans J.; Lopriore, Enrico

doi:10.1111/j.1423-0410.2010.01408.x

Cited by 29 publications

(27 citation statements)

References 22 publications

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“…In the IUT group, the median number of top-up transfusions was 1 (range, 0-4), compared to 0 (range, 0-2) in non-IUT group (p < 0.01) [33]. This difference can be explained by a depressed erythropoiesis and is correlated with a significantly lower reticulocyte count at birth in transfused neonates [33,62,64].…”

Section: Top-up Transfusionsmentioning

confidence: 82%

“…At least one top-up transfusion is reported to be required in 68-83% of neonates with HDFN [33,59,63]. Some neonates need up to six top-up transfusions in the first 3 months of life [62]. In neonates that were treated with IUTs, the top-up transfusion rate is significantly higher (77-89%), than in neonates that were not treated with IUTs (27-67%) [33,59,63].…”

Section: Top-up Transfusionsmentioning

confidence: 90%

“…The mean postnatal age for a first topup transfusion in HDFN is 18 days (range 1-34) [62]. At least one top-up transfusion is reported to be required in 68-83% of neonates with HDFN [33,59,63].…”

Section: Top-up Transfusionsmentioning

confidence: 99%

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Neonatal management and outcome in alloimmune hemolytic disease

Ree

Smits-Wintjens

Bom

et al. 2017

Expert Review of Hematology

103

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis.ARTICLE HISTORY

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Section: Top-up Transfusionsmentioning

confidence: 82%

Section: Top-up Transfusionsmentioning

confidence: 90%

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Neonatal management and outcome in alloimmune hemolytic disease

Ree

Smits-Wintjens

Bom

et al. 2017

Expert Review of Hematology

103

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“…The Leiden University Medical Center is the national referral center for the management and intrauterine treatment of HDFN. Neonatal outcome in part of this group was reported in previous studies [10,11,12,13,14]. In the Netherlands, no formal ethical approval by the medical ethics committee or written informed consent is necessary for retrospective studies.…”

Section: Methodsmentioning

confidence: 94%

“…Our guidelines for ET were revised in December 2005 [10,11]. Before December 2005, criteria for ET included (1) bilirubin level at birth >3.5 mg/dl and/or (2) total serum bilirubin level above ET thresholds (rise in bilirubin value >0.5 mg/dl/h despite intensive phototherapy).…”

Section: Methodsmentioning

confidence: 99%

Neonatal Morbidity after Exchange Transfusion for Red Cell Alloimmune Hemolytic Disease

Smits-Wintjens

Rath²,

Zwet³

et al. 2012

Neonatology

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Background: Exchange transfusion (ET) is a high-risk procedure. The type and rate of complications in neonatal red cell alloimmune hemolytic disease exclusively are not clear. Objectives: Our aim was to study the type and rate of complications associated with ET in a large series of neonates with hemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization. Methods: All neonates with HDFN due to red cell alloimmunization admitted to our center between January 2001 and June 2011 were eligible for this study. We recorded the number and rate of complications during admission in the group of neonates treated with ET (ET group) and not treated with ET (no-ET group). Multivariate logistic regression analysis was performed to measure the independent risk of complications of ET treatment. Results: A total of 347 infants with red cell alloimmune hemolytic disease were included; 39% (134/347) were treated with at least one ET (ET group), and 61% (213/347) did not require ET (no-ET group). Comparison between the ET group and no-ET group showed that ET treatment was independently associated with proven sepsis [8 vs. 1%, respectively; odds ratio (OR) 8.3, 95% confidence interval (CI) 1.7–40.3; p = 0.009], leukocytopenia (88 vs. 23%, respectively; OR 36.0, 95% CI 17.5–73.8; p < 0.001), severe thrombocytopenia (platelet count <50 × 10⁹/l; 63 vs. 8%, respectively; OR 31.4, 95% CI 14.0–70.4; p < 0.001), hypocalcemia (22 vs. 1%, respectively; OR 27.4, 95% CI 5.9–126.8; p < 0.001) and hypernatremia (8 vs. 0%, respectively; p < 0.001). There were no neonatal deaths in the ET group. Conclusion: ET in neonates with HDFN is associated with an increased risk of sepsis, leukocytopenia, thrombocytopenia, hypocalcemia and hypernatremia.

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