scholarly journals Use of intravenous immunoglobulin in neonates with haemolytic disease and immune thrombocytopenia

2013 ◽  
Vol 70 (11) ◽  
pp. 1029-1033
Author(s):  
Gordana Markovic-Sovtic ◽  
Borisav Jankovic ◽  
Zorica Rakonjac ◽  
Jelena Martic ◽  
Katarina Pejic
Keyword(s):  
Intravenous Immunoglobulin ◽  
Bilirubin Level ◽  
Exchange Transfusion ◽  
Immune Thrombocytopenia ◽  
Neonatal Intensive Care ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Serum Bilirubin Level ◽  
Haemolytic Disease ◽  
Platelet Number

Background/Aim. Intravenous immunoglobulin is a blood product made of human polyclonal immunoglobulin G. The mode of action of intravenous immunoglobulin is very complex. It is indicated in treatment of neonatal immune thrombocytopenia and haemolytic disease of the newborn. The aim of the study was to present our experience in the use of intravenous immunoglobulin in a group of term neonates. Methods. We analysed all relevant clinical and laboratory data of 23 neonates who recieved intravenous immunoglobulin during their hospitalization in Neonatal Intensive Care Unit of Mother and Child Health Care Institute over a five year period, from 2006. to 2010. Results. There were 11 patients with haemolytic disease of the newborn and 12 neonates with immune thrombocytopenia. All of them recieved 1-2 g/kg intravenous immunoglobulin in the course of their treatment. There was no adverse effects of intravenous immunoglobulin use. The use of intravenous immunoglobulin led to an increase in platelet number in thrombocytopenic patients, whereas in those with haemolytic disease serum bilirubin level decreased significantly, so that some patients whose bilirubin level was very close to the exchange transfusion criterion, avoided this procedure. Conclusion. The use of intravenous immunoglobulin was shown to be an effective treatment in reducing the need for exchange transfusion, duration of phototherapy and the length of hospital stay in neonates with haemolytic disease. When used in treatment of neonatal immune thrombocytopenia, it leads to an increase in the platelet number, thus decreasing the risk of serious complications of thrombocytopenia.

Comparison of Lengths of Stay for Inpatients with Immune Thrombocytopenia Treated with Anti-Rh(D), Intravenous Immunoglobulin, and Steroids

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4646-4646
Author(s):  
Hrvoje Melinscak ◽  
Ilan Shapira ◽  
Mala Varma
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Intravenous Immunoglobulin ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Onset Of Action ◽  
Lengths Of Stay

Abstract Abstract 4646 Rationale: Anti-Rh(D) is an effective treatment for acute immune thrombocytopenia [ITP]. It has a faster onset of action (1 day) vis a vis corticoids (3 days) and intravenous immunoglobulin [IVIG] (4 days). A direct comparison of length of stay for adult inpatients receiving these therapies has hitherto not been performed. We hypothesized that the length of stay would be shortest for patients treated with anti-Rh(D). Methods: A retrospective chart review was conducted to assess length of stay in relation to treatments proffered for ITP. The defining diagnosis of ITP [coded 287.31] was rendered from the computerised record at St. Luke's-Roosevelt Hospital Center and identified 303 patients, of which 147 received treatments for active ITP within a period spanning 01SEP2005 through 29FEB2012. Treatments consisted of prednisone alone, dexamethasone alone, anti-Rh(D) alone, IVIG alone, and combinations of corticoids and the latter two. An average length of stay was tabulated for each treatment regimen. Age and gender were also recorded. Results: A total of 147 hospitalisations for ITP were noted and the analysis of variance statistical calculation applied thus. The median age was 48 years and the male:female ratio was 1.1:1. Eleven groups were delineated and the means for length of hospital stay with confidence intervals derived. The groups were as follows: Prednisone, Dexamethasone, Methylprednisolone, Anti-Rh(D), IVIG, Prednisone and Anti-Rh(D), Dexamethasone and Anti-Rh(D), Prednisone and IVIG, Dexamethasone and IVIG, Methylprednisolone and IVIG, and Anti-Rh(D) and IVIG or Dexamethasone, Anti-Rh(D), and IVIG. The overall p-value for length of stay was 0.0016 (Table 1). The shortest stays were recorded for the corticoid alone groups; however, the mean stay for anti-Rh(D) was shorter than that of IVIG, both in sole and combined modality treatments. Conclusion: Anti-Rh(D) is favourable with respect to hospital stay duration. Although corticoids result in still shorter lengths of stay, anti-Rh(D) demonstrated a shorter length of stay compared with IVIG. Combined with its single dosing and relative cost savings, anti-Rh(D) is an excellent alternative to IVIG. Disclosures: No relevant conflicts of interest to declare.

STUDIES ON ERYTHROBLASTOSIS DUE TO ABO INCOMPATIBILITY

PEDIATRICS ◽  
1954 ◽  
Vol 13 (6) ◽  
pp. 503-510
Author(s):  
DAVID YI-YUNG HSIA ◽  
SYDNEY S. GELLIS
Keyword(s):  
Blood Group ◽  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Laboratory Data ◽  
Serum Bilirubin Level ◽  
Present Knowledge ◽  
Coombs Test ◽  
Abo Incompatibility ◽  
Rh Incompatibility

Detailed clinical and laboratory data have been presented on 21 infants with erythroblastosis due to ABO incompatibility. A careful survey in one newborn service over a six-month period showed that there were 11 cases of erythroblastosis due to ABO incompatibility as compared to 7 cases of erythroblastosis due to Rh incompatibility, suggesting that the disease occurs with greater frequency than has been hitherto reported. No one test is available which can in every case be absolutely diagnostic of the disease. The criteria useful in suggesting the diagnosis are listed. Practically, the presence of a major blood group incompatibility between infant and mother with a negative Coombs' test, clinical jaundice in the first 24 hours, and a serum bilirubin level of more than 10 mg./100 cc. at 24 hours or less is sufficient to make the diagnosis in the absence of manifest infection. The same criteria for treatment as applied to Rh erythroblastosis should be applied to erythroblastosis due to ABO incompatibility in the light of our present knowledge.

scholarly journals Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

2019 ◽  
Vol 6 (5) ◽  
pp. 2173
Author(s):  
Sharath S. Ghalige ◽  
Vaideeswaran M. ◽  
Mangalabharathi S.
Keyword(s):  
Observational Study ◽  
Intravenous Immunoglobulin ◽  
Exchange Transfusion ◽  
Immune Thrombocytopenia ◽  
Tertiary Care ◽  
Retrospective Observational Study ◽  
Study Cohort ◽  
Usage Pattern ◽  
Tertiary Care Centre ◽  
Drug Register

Background: Intravenous Immunoglobulin (IVIG) is a blood product manufactured from pooled plasma. With increasing availability, an increased usage in neonates is being noted, though its utilisation has not been audited thoroughly. The objectives of this study are to describe the usage pattern and indications of IVIG and its outcome in a state-run tertiary care NICU.Methods: This retrospective observational study was carried out at the inborn unit of Department of Neonatology, Madras Medical College, Chennai on a cohort of neonates who received IVIG over 3.5 years from January 2016 to June 2019. Data was collected from drug register, neonatal case records, exchange transfusion register and death register.Results: Our study cohort had 55 neonates who received IVIG over 3.5 years. Indications for IVIG usage were Rh-alloimmunisation (23), ABO-alloimmunisation (7), prophylaxis of perinatal varicella (20), and other immune thrombocytopenia (5). Among 30 neonates with ABO-/Rh-incompatibility, 11 required exchange transfusion (ET). ET rates have shown a decreasing trend during this period. 2 babies with Rh-immunisation and Hydrops expired. None of the babies given prophylaxis for perinatal varicella manifested the disease. Neonates treated for immune thrombocytopenia were successfully discharged.Conclusions: This study shows the IVIG usage pattern in a tertiary care neonatal unit. In neonates with Hemolytic disease due to Rh-/ABO-alloimmunisation treated with IVIG, a reduction in rates of exchange transfusion has been noted. IVIG is being used increasingly for prophylaxis of perinatal varicella and immune related thrombocytopenia with promising benefits. It is prudent to have SOPs for IVIG administration with standardised issue and transfusion forms for documentation to regulate its judicious use. 

scholarly journals Learning from claims: hyperbilirubinaemia and kernicterus

2018 ◽  
Vol 104 (2) ◽  
pp. F202-F204 ◽  
Author(s):  
Janet M Rennie ◽  
Jeanette Beer ◽  
Michele Upton
Keyword(s):  
Cerebral Palsy ◽  
Bilirubin Level ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Serum Bilirubin Level ◽  
Sufficient Information ◽  
Haemolytic Disease ◽  
Total Cost ◽  
Abo Incompatibility ◽  
Extremely Preterm

We examined claims made against the National Health Service (NHS) involving neonatal jaundice in order to determine whether there were lessons that could be learnt from common themes.This was a retrospective anonymised study using information from the NHS Resolution database for 2001–2011.Twenty cases (16 males) had sufficient information for analysis. Fifteen had confirmed cerebral palsy and two young children had damage to the globus pallidus without confirmed CP. In three cases, the outcome was uncertain. Two were extremely preterm, five were born at 34–36 weeks’ gestation. Jaundice was typically present very early in life; in four cases, it was noted at less than 24hours of age, and in 14 cases, it was first noted on the second to third day. There was a lag between recognition and readmission, with a range of 26–102 hours. The peak serum bilirubin level was over 600 µmol/L in all the babies born at term. An underlying diagnosis was found in all but two; six had glucose-6-phosphatase deficiency (one also had Gilbert’s syndrome); five were diagnosed with ABO incompatibility; three with Rh haemolytic disease; one with spherocytosis and three preterm. The total cost of these claims by August 2017 was almost £150.5 million. This figure is likely to rise.These data show that, in the group who litigate, babies who develop kernicterus generally have an underlying diagnosis. We recommend adherence to theNational Institute for Health and Care Excellence guideline that recommends measuring the bilirubin level within 6 hours in all babies who are visibly jaundiced.

FOLLOW-UP STUDY OF EXCHANGE TRANSFUSION FOR HYPERBILIRUBINEMIA IN INFANTS IN JAPAN

PEDIATRICS ◽  
1967 ◽  
Vol 40 (2) ◽  
pp. 196-201
Author(s):  
Toru Ose ◽  
Tsuneo Tsuruhara ◽  
Masayoshi Araki ◽  
Toshiyuki Hanaoka ◽  
Ovid B. Bush
Keyword(s):  
Cerebral Palsy ◽  
Bilirubin Level ◽  
Exchange Transfusion ◽  
Serum Bilirubin ◽  
Total Bilirubin Level ◽  
Serum Bilirubin Level ◽  
Full Term ◽  
Follow Up Study ◽  
Developmental Retardation

A follow-up study of 157 consecutive patients who had hyperbilirubinemia was undertaken by questionnaire. Parents of 153 patients answered the questionnaire. Complete examination was carried out on 131 (83.4%) patients and, if the 17 who died are included, a 94.2% follow-up was made. The relationship between the level of the serum bilirubin and the development of cerebral palsy showed that 90% of the patients who had a bilirubin level of 35 mg/100 ml and above either died or had cerebral palsy or physical retardation. Of the 131 cases followed up, there were 17 (13.0%) patients who had definite cerebral palsy, 21 (16.0%) who were physically retarded, and 93 (71.0%) who were normal. In 129 infants checked for developmental retardation, no instances were found when the serum bilirubin level was below 20 mg/100 ml. There was developmental retardation in 15 patients who had a bilirubin level of 20 mg/100 ml and above. It is felt that this shows there is a definite relation between the height of the bilirubin and the development of cerebral palsy and/or developmental retardation. In this series there were 26 infants with bilirubin levels of 30 mg/100 ml and over. Based on our results, we would suggest that the indication for exchange transfusion should be a total bilirubin level of 20 mg/100 ml for full-term, incompatible infants and for all premature infants; the level for full-term, compatible infants should be 25 mg/100 ml.

Is intravenous immunoglobulin effective to reduce exchange transfusion in Rhesus haemolytic disease of the newborn?

2011 ◽  
Vol 6 (1) ◽  
pp. 219-222
Author(s):  
M. C. P. Santos ◽  
C. A. M. Sá ◽  
S. C. Gomes ◽  
L. A. B. Camacho ◽  
M. E. L. Moreira
Keyword(s):  
Intravenous Immunoglobulin ◽  
Exchange Transfusion ◽  
Haemolytic Disease

scholarly journals Outcome of neonatal jaundice in term neonates with ABO incompatibility at tertiary level center

2020 ◽  
Vol 7 (10) ◽  
pp. 1973
Author(s):  
Amit Kumar Thakur ◽  
Mohammad Ashfaque Ansari ◽  
Atindra Mishra ◽  
Saroj Kumar Jha
Keyword(s):  
Positive Result ◽  
Exchange Transfusion ◽  
Neonatal Jaundice ◽  
Serum Bilirubin Level ◽  
Cross Sectional ◽  
Haemolytic Disease ◽  
Term Neonates ◽  
True Incidence ◽  
New Born ◽  
Abo Incompatibility

Background: Neonatal jaundice is extremely common as almost every new-born develops an unconjugated serum bilirubin level of more than 1.8 mg/dl during the first seven days of life. ABO incompatibility is associated in about 20% of all pregnancies but manifestations of ABO haemolytic disease of new-born occurs in <10% of these cases. True incidence of ABO incompatibility, particularly in developing countries like Nepal, is not understood sufficiently. Furthermore, the confirmation of severe ABO incompatibility cannot be made accurately using only a single test. Hence, this study was done to know the outcome of jaundice in ABO incompatibility patients.Methods: This was a descriptive cross-sectional study done at Department of Paediatrics, between August 2018 to July 2019. All term neonates born to ‘O’ positive mother, with blood group A or B positive, and fulfilling the selection criteria were included in the study. Sample size was calculated to be 114 with confidence level at 95% and prevalence of ABO haemolytic disease as 11.4% with margin of error 5%.Results: Severe ABO incompatibility as evident by presence of jaundice within 24 hours of life, a positive result on direct coomb’s test and haemolytic picture on peripheral blood smear was observed in 12% of the total enrolled 200 neonates. Modalities of treatment showed significant relation with severe ABO incompatibility indicating increased need for double volume exchange transfusion in neonates with severe ABO incompatibility.Conclusions: Phototherapy was found to be effective in the management of most of the cases of neonatal jaundice in term ABO incompatible neonates but some cases, requiring exchange transfusion can occur, mostly in presence of positive result on direct Coomb’s test.

scholarly journals Neonatal hyperbilirubinaemia necessitating exchange transfusion due to maternal sickle cell crisis

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Hemant Ambulkar ◽  
Ravindra Bhat ◽  
Anne Greenough
Keyword(s):  
Sickle Cell ◽  
Bilirubin Level ◽  
Exchange Transfusion ◽  
Neonatal Intensive Care ◽  
Unconjugated Bilirubin ◽  
Maternal Circulation ◽  
Mortality And Morbidity ◽  
Sickle Cell Crisis ◽  
Uterine Growth ◽  
Fetal Complications

Abstract Background Pregnancy in women with sickle cell disease (SCD) is associated with a number of fetal complications such as intra-uterine death, intra-uterine growth restriction (IUGR), preterm birth, low birth weight and an increased perinatal mortality and morbidity. Hyperbilirubinaemia necessitating exchange transfusion in an infant of a mother with SCD, to the best of our knowledge, has not been previously described. Case presentation An infant was delivered at 33 weeks and 5 days of gestation due to a maternal sickle cell crisis. The infant had an unconjugated bilirubin level of 153 μmol/L on admission to the neonatal intensive care unit at 30 min of age. Phototherapy was immediately commenced, intravenous immunoglobulin administered and then a double-volume exchange transfusion was performed. There was, however, no evidence of haemolysis in the infant and the infant’s haemoglobin level remained stable following the exchange. No further exchange transfusions were required. The mother had a high unconjugated bilirubin level (151 μmol/L) prior to delivery. Conclusion High neonatal unconjugated bilirubin levels necessitating exchange transfusion can occur due to haemolysis in the maternal circulation, in this case due to SCD.

scholarly journals Well Neonate Due For Discharge In Low Resource Setting Must Be Screened For Significant Hyperbilirubinemia

2020 ◽  
Author(s):  
Nasuna Carolyn ◽  
Yaser Abdallah ◽  
Karamagi Charles ◽  
Mugalu Jamiru
Keyword(s):  
Bilirubin Level ◽  
Exchange Transfusion ◽  
Serum Bilirubin Level ◽  
P Value ◽  
Mulago Hospital ◽  
Transfusion Threshold ◽  
Cross Sectional ◽  
Predictive Values ◽  
Low Resource ◽  
Resource Setting

Abstract Background: Due to lack of comprehensive postnatal care; neonates in low resource settings are at high risk for significant hyperbilirubinemia (SHB) and its complications. We conducted a study to determine the prevalence of SHB, factors associated with it and performance of transcutaneous bilirubin (TCB) measurement compared to visual inspection in identifying these neonates.Methods: We conducted a cross sectional study over a one month period involving 235 neonates 24 to 72 hours of age who were due for discharge in the postnatal ward of Mulago Hospital. Relevant data was captured. Neonates with SHB were referred for treatment. Data was entered in to Epi-data version 3.0 then exported to STAT 14.0 software and analyzed. P-value of <0.05 was considered significant with confidence interval of 95%.Results: Thirty two (13.6%) of the participants had SHB and Three (1.3%) had bilirubin levels at/above exchange transfusion threshold. The means serum bilirubin level among neonates with SHB was 240µmol/l (range 132-481.4µmol/l). Possible causes for SHB included; ABO/Rhesus discordance 11 (34.4%), possible sepsis 8 (25%) due to high CRP without any explanation, significant weight loss 2 (6.25%), cephalohematoma 2 (6.25%) and twelve (37.5%) no immediate cause was identified. Significant hyperbilirubinemia was independently associated with CRP ≥ 10mg/l (AOR 3.96, CI 1.23-12.73, p 0.021), ABO discordance (AOR 3.67, CI 1.28-10.49, p 0.015), jaundice in a previous baby (AOR 3.565, CI 1.10-11.51, p 0.034) and time of initiation of feeds > 1 hour (AOR 2.74, CI 1.10-6.90, p 0.007). The sensitivity, specificity, positive and negative predictive values of TCB were 96.5%, 84.6%, 47.5% and 99.4% respectively compared to 31.2%, 98.5%, 76.9% and 90% respectively for visual assessment.Conclusions: Among well neonates in the post natal ward approximately 1 in 10 have SHB and 1 in 100 have bilirubin level at exchange transfusion threshold between 24 and 72 hours of age hence screening for SHB among such neonates should be emphasized. Transcutaneous bilirubinometry is a suitable screening tool since it identified majority of neonates with SHB. Early initiation of feeding should be promoted. Screening for possible sepsis in neonates with significant hyperbilirubinemia without identifiable reason should be considered.

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