Rhesus Haemolytic Disease of the Newborn

Rhesus hæmolytisk sygdom hos nyfødte

Ratnasingam, Geerthana

5. Term (Master thesis)

Medicine, Master

2015

2015-12-21

22

Rhesus-immunisering er en form for blodtype-uoverensstemmelse, der kan føre til iso-hæmolytisk sygdom hos nyfødte, hvor antistoffer nedbryder barnets røde blodlegemer. For at forebygge dette gives anti-D-profylakse til RhD-negative, ikke-immuniserede kvinder i Danmark under graviditet, efter abort og efter fødsel. Alligevel fødes nogle børn med Rhesus hæmolytisk sygdom. Formålet med dette studie var at fastslå, hvor ofte Rhesus hæmolytisk sygdom forekom, hvor mange spædbørn der blev behandlet med intrauterin transfusion (blod til fosteret), udskiftningstransfusion (udskiftning af barnets blod), supplerende erytrocyttransfusion, fototerapi (lysbehandling mod gulsot) og intravenøs immunglobulin (IVIG) i Region Nordjylland i perioden 2005–2014, samt om maksimal plasmakoncentration af bilirubin (et stof, der stiger ved nedbrydning af røde blodlegemer og giver gulsot) og varigheden af fototerapi ændrede sig over tid. I dette retrospektive kohortestudie blev ICD-10-kodesystemet brugt til at identificere spædbørn med iso-hæmolytisk sygdom i Region Nordjylland 2005–2014. Data blev indsamlet fra journaler på Børneafdelingen, Gynækologisk/Obstetrisk Afdeling og Blodbanken på Aalborg Universitetshospital. I alt blev 100 børn identificeret; 67 blev inkluderet, og 33 blev udelukket på grund af negativ direkte antiglobulintest (DAT), autoimmunisering hos moderen eller manglende oplysninger om DAT. (DAT er en test, der påviser antistoffer på barnets røde blodlegemer.) Den samlede incidens af iso-hæmolytisk sygdom var 1,22 pr. 1.000 fødsler, hvor RhD-immunisering udgjorde 0,75 pr. 1.000. Der var en tendens til fald i RhD-immunisering gennem perioden. Tilfælde med enkelt og multiple antistoffer var omtrent lige hyppige. Børn med RhD-immunisering var mere alvorligt påvirkede end børn med andre former for Rhesus-immunisering. Den maksimale plasmakoncentration af bilirubin steg signifikant, mens den gennemsnitlige varighed af fototerapi var uændret, sandsynligvis på grund af mindre aggressiv behandling. Konklusion: RhD-immuniseringens incidens havde en faldende tendens i studieperioden. Den gennemsnitlige maksimale bilirubinkoncentration steg, mens varigheden af fototerapi var uændret.

Rhesus immunization is a type of blood group incompatibility that can cause isohaemolytic disease in newborns, where antibodies break down the baby’s red blood cells. To prevent this, Denmark provides anti‑D prophylaxis to RhD‑negative, non‑immunized women during pregnancy, after abortion, and after childbirth. Even so, some babies still develop Rhesus haemolytic disease. This study aimed to determine how often Rhesus haemolytic disease occurred and how many infants received intrauterine transfusion (blood given to the fetus), exchange transfusion (replacing the newborn’s blood), top‑up red blood cell transfusion, phototherapy (light treatment for jaundice), and intravenous immunoglobulin (IVIG) in the North Denmark Region from 2005 to 2014. It also examined whether peak plasma bilirubin (a pigment that rises when red blood cells break down and causes jaundice) and the duration of phototherapy changed over time. In this retrospective cohort study, ICD‑10 codes were used to identify infants with isohaemolytic disease in the North Denmark Region during 2005–2014. Data were extracted from medical records at the Departments of Pediatrics, Gynecology and Obstetrics, and the Blood Bank at Aalborg University Hospital. In total, 100 infants were identified; 67 were included, and 33 were excluded due to a negative direct antiglobulin test (DAT), maternal autoimmunization, or missing DAT information. (DAT detects antibodies attached to the baby’s red blood cells.) The overall incidence of isohaemolytic disease was 1.22 per 1,000 births, of which RhD immunization accounted for 0.75 per 1,000. RhD immunization tended to decrease over the study period. Cases involving single antibodies were about as common as those with multiple antibodies. Infants with RhD immunization were more severely affected than those with other types of Rhesus immunization. Peak plasma bilirubin increased significantly, while the average duration of phototherapy remained unchanged, probably due to less aggressive treatment. Conclusion: The incidence of RhD immunization tended to decrease over time. Mean peak plasma bilirubin increased significantly, while the duration of phototherapy was unchanged.

[This abstract was generated with the help of AI]

rhesus hæmolytisk sygdom hos nyfødte ; immunisering ; intrauterin transfusion ; udskiftningstransfusion ; blodtransfusion ; intravenøs immunglobulin ; lysterapi

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