Iron status in infants with alloimmune haemolytic disease in the first three months of life.

BACKGROUND AND OBJECTIVES: Ferritin levels are often highly elevated at birth in neonates with alloimmune haemolytic disease of the fetus and newborn (HDFN). Data on ferritin levels in these infants in the first 3 months of life are lacking. Objective of this study was to examine the course of iron status and incidence of iron deficiency and overload in neonates with alloimmune HDFN up to 3 months of age. Secondary objective was to analyse bilirubin levels, liver enzymes and red-blood-cell indices in the same time period and the association with intrauterine transfusion (IUT). MATERIALS AND METHODS: Observational study of neonates with alloimmune HDFN admitted to our centre between November 2010 and March 2012. Data on iron status, bilirubin levels, liver enzymes and red-blood-cell indices up to 3 months of age were routinely collected and compared between neonates treated with and without IUT. RESULTS: Thirty-five infants with alloimmune HDFN were included. Iron overload occurred in 70% of neonates at birth and in 50% and 18% at the age of 1 and 3 months, respectively. No cases of iron deficiency at birth and only one case of iron deficiency at 3 months of age were found. No infants received iron therapy. Infants who received IUT had a significantly lower haemoglobin level and reticulocyte count and higher ferritin level at birth. CONCLUSION: The vast majority of neonates with alloimmune HDFN have iron overload at birth. Incidence of iron overload gradually decreases within the first 3 months without iron supplementation.

Thrombocytopenia at birth in neonates with red cell alloimmune haemolytic disease.

OBJECTIVE: To evaluate the incidence and severity of and risk factors for thrombocytopenia at birth in neonates with red cell alloimmunization. STUDY DESIGN: All neonates with haemolytic disease of the foetus/newborn (HDFN) due to red cell alloimmunization admitted to our centre between January 2000 and September 2010 were included in this retrospective study. We measured platelet counts at birth and determined the incidence of thrombocytopenia (platelet count<150×10(9)/l) and severe thrombocytopenia (platelet count<50×10(9)/l). Risk factors for thrombocytopenia at birth were evaluated. RESULTS: Thrombocytopenia was present in 26% (94/362) of included neonates with HDFN at birth. Severe thrombocytopenia was found in 6% (20/362) of neonates. Three risk factors were found to be independently associated with thrombocytopenia at birth: treatment with intrauterine red cell transfusion (IUT) (OR 3·32, 95% CI 1·67-6·60, P=0·001), small for gestational age (SGA) below the 10th percentile (OR 3·32, 95% CI 1·25-8·80, P=0·016) and lower gestational age at birth (OR 1·22/week, 95% CI 1·02-1·44, P=0·025). CONCLUSIONS: Thrombocytopenia at birth occurs in 26% of neonates with HDFN due to red cell alloimmunization and is independently associated with IUT treatment, SGA and lower gestational age at birth.

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

OBJECTIVE: To evaluate neonatal outcome in Kell haemolytic disease compared to Rh D haemolytic disease. STUDY DESIGN: Retrospective study of all (near)-term neonates with Kell (n=34) and Rh D haemolytic disease (n=157) admitted to our centre between January 2000 and December 2008. We recorded the need for exchange transfusion and top-up transfusions up to 3 months of age. RESULTS: Neonates in the Kell group required less days of phototherapy than neonates in the Rh D group [2.4 vs. 4.1 days, respectively (P<0.01)]. The percentage of neonates requiring an exchange transfusion was lower in the Kell group than in the Rh D group [6% (2/34) and 62% (98/157), respectively (P<0.01)]. The percentage of neonates in the Kell group and Rh D group requiring a top-up transfusion was 62% (21/34) and 72% (113/157), respectively (P=0.20). The median number of top-up transfusions per neonate in the Kell group and Rh D group was 1 [interquartile range (IQR) 0-2] and 2(IQR 0-2), respectively (P=0.07). CONCLUSION: Neonates with Kell haemolytic disease require less phototherapy and less exchange transfusions compared to neonates with Rh D haemolytic disease, but an equal number of top-up transfusions.

Top-up transfusions in neonates with Rh hemolytic disease in relation to exchange transfusions.

OBJECTIVE: To study the effect of a restrictive guideline for exchange transfusion (ET) on the number of top-up transfusions in neonates with Rh hemolytic disease. STUDY DESIGN: Retrospective study of all (near)-term neonates with Rh hemolytic disease admitted to our center between 2000 and 2008. In December 2005, policy changed from using liberal ET criteria to more restrictive ET criteria. We recorded the number of ETs and the number of top-up transfusions in the group of neonates before (group I, n = 156) and after (group II, n = 27) the guideline change. RESULTS: The percentage of neonates requiring an ET decreased from 66% (103/156) in group I to 26% (7/27) in group II (P < 0.01). The percentage of neonates receiving a top-up transfusion increased from 68% (105/154) in group I to 81% (22/27) in group II (P = 0.25). The median number of top-up transfusions increased from 1 (interquartile range 0-2) in group I to 2 (interquartile range 1-3) in group II (P = 0.01). CONCLUSION: In this study, restrictive ET criteria in neonates with Rh hemolytic disease lead to a reduction of the rate of ET but an increase in the number of top-up transfusions for neonatal anemia.