The combination of predictors such as reticulocyte count (RET%), lactate dehydrogenase (LDH) and gamma-glutamyltransferase (G-GT), easily measured through blood tests, appear to accurately distinguish jaundice caused by hemolytic disease of the fetus and newborn (HDFN) from jaundice due to other causes in newborns, according to a recently published study in Frontiers in Pediatrics.
Jaundice is the yellowish coloration of the skin and whites of the eyes due to the accumulation of a toxic metabolite called bilirubin (hyperbilirubinemia). Jaundice has several causes, including red blood cell destruction (hemolysis) and liver disease.
What is bilirubin?
Bilirubin is a molecular byproduct of the breakdown of hemoglobin, the protein responsible for holding the oxygen transported in red blood cells. It is normally transported to the liver, where it undergoes a transformation called conjugation, and is then excreted from the body through the intestines. Jaundice is caused by the accumulation of bilirubin in the blood, which is known as hyperbilirubinemia.
HDFN is the most common cause of hemolysis in newborns. Traditionally, the diagnosis of hemolysis requires tests such as the direct antiglobulin test, the free antibody test and the antibody release test. However, these tests are lacking in many rural, non-specialized centers. Therefore, the authors aimed to assess whether routine blood tests could accurately distinguish jaundice due to hemolysis from jaundice due to other causes.
“It is worthwhile to explore the utilization of basic routine examinations to accurately diagnose hemolytic disease in newborns,” the authors wrote.
Learn more about HDFN testing and diagnosis
Based on previous research, the authors chose RET%, LDH, G-GT and ABO groups to determine their combined clinical value for the indirect diagnosis of hemolysis in newborn children.
The study included data from 137 hospitalized newborns with jaundice. According to the cause of jaundice, the infants were divided into two groups: a hemolytic group and a non-hemolytic group.
Results showed that the hemolytic group had significantly higher RET%, LDH, and G-GT values. Statistical analysis of the results revealed that each value was an independent risk factor for hemolysis. Regardless, the combination of the three was more accurate than each one considered by itself.
“Combined predictor L (RET% + LDH + γ-GT) demonstrates its optimal diagnostic efficacy, offering a novel approach towards diagnosing early-onset ABO hemolytic disease of the newborn, “ the authors concluded.
