Exchange transfusion (ET) treatment is effective in decreasing bilirubin levels in newborns with severe hyperbilirubinemia associated with hemolytic disease of the fetus and newborn (HDFN), regardless of the patient’s gender or the cause of the hemolysis, according to a study recently published in the International Journal of General Medicine.
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.
Hyperbilirubinemia, if left untreated, can result in severe complications, including neurodevelopmental conditions and kernicterus, a rare, serious brain disorder that is linked to the presence of too much bilirubin in an infant’s brain. ET is a frequently utilized therapeutic intervention that can rapidly decrease bilirubin levels in newborns with severe hyperbilirubinemia. Further, ET is associated with a reduction in elevated platelet counts as well.
HDFN associated with the Rhesus (Rh) blood group system is often more severe than that linked to the ABO blood group system. The researchers sought to compare treatment outcomes related to ETs for the management of HDFN, with a focus on comparing outcomes between ABO and Rh cases of incompatibility.
Read more about HDFN testing and diagnosis
A total of 125 neonates who had been diagnosed with hyperbilirubinemia were enrolled in the study, with 73 patients in the ABO group and 52 in the Rh group. All participants had been treated with ET between 2011 and 2022.
Results of the study revealed that ET was associated with a significant reduction in serum total bilirubin (STB) levels, serum indirect bilirubin (SIB) levels and platelet counts. Prior to ET, significant differences in SIB levels and platelet counts were noted between the neonates with ABO incompatibility and those with Rh incompatibility.
A pediatric cohort of patients underwent evaluation as well. There were two distinct groups noted, with 73 cases associated with ABO blood group incompatibility, which originated from the presence of ABO blood group antibodies. In contrast, there were 52 cases associated with Rh blood group incompatibility, which was attributed to the action of Rh blood group antibodies.
In the pediatric cohort, no statistically significant differences were reported in GA or in the timing of ET post-birth between the ABO and the Rh groups.
“Our study demonstrated that ET is efficacious in reducing bilirubin levels and platelet counts in neonates presenting with ABO and Rh blood group incompatibilities,” the authors noted. “Our study observation contradicts the prevalent belief that [HDFN] associated with the Rh system is inherently more severe than that linked to the ABO system,” they emphasized. “This revelation underscores the imperative for the swift implementation of ET in managing cases of severe hyperbilirubinemia.”
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