Abstract

BAPTISTA-GONZALEZ, Hector et al. Usefulness of direct antiglobulin test in neonatal screening. Bol. Med. Hosp. Infant. Mex. [online]. 2009, vol.66, n.6, pp.502-510. ISSN 1665-1146.

Background. Neonatal jaundice is a clinical event frequently present in newborns. The causes most frequently involved in hemolytic disease of newborn (HDN) are still the incompatibilities to the ABO/Rh blood system. Direct Coombs test (or direct antiglobulin test, DAT) allows identification of the presence of red blood cell antibodies (IgG isotype) coming from the maternal serum on the surface of the fetus erythrocytes. The purpose of this study is to show the results and specificity of DAT as screening in newborn infants. Methods. We studied unselected neonates in a cross-sectional design. During the early hours of life, we determined ABO/Rh and DAT with poly- and monospecific reagents (anti-IgG and C3b/C3d). Results. We included 5 007 newborns; 181 cases (3.6%) were DAT positive. Newborns with A, B or AB blood groups showed an increased association of being DAT positive than group O (OR 2.3, 95% Cl 1.7-3.1). DAT was positive in 3.5% of RhD-positive infants and 1.9% of RhD-negative infants. In six DAT-positive cases, 117 cases (64.6%) had anti-IgG bound to red cell membrane, complement in six cases (3.3%), and 52 newborns (28.8%) were polyspecific DAT positive and monospecific DAT negative. Conclusions. The high prevalence (3.6%) of DAT-positive cases in routine neonatal detection supports the indication to incorporate DAT into neonatal screening, regardless of the mother's blood group. The benefit of early intervention in neonatal jaundice remains to be established.

Keywords : direct antiglobulin test; direct Coomb's test; hemolytic disease of newborn; neonatal hyperbilirubinemia; ABO/Rh blood group; neonatal screening.

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