Rh-incompatible hemolytic disease of the newborn in Hefei

doi:10.12998/wjcc.v7.i20.3202

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World Journal of Clinical Cases

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Retrospective Study

World J Clin Cases. Oct 26, 2019; 7(20): 3202-3207
Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3202

Rh-incompatible hemolytic disease of the newborn in Hefei

Shao-Hua Bi, Liang-Liang Jiang, Li-Ying Dai, Hong Zheng, Jian Zhang, Li-Li Wang, Chao Wang, Qiao Jiang, Yu Liu, Yong-Li Zhang, Juan Wang, Chao Zhu, Guang-Hui Liu, Ru-Jeng Teng

Shao-Hua Bi, Li-Ying Dai, Hong Zheng, Jian Zhang, Yu Liu, Yong-Li Zhang, Juan Wang, Guang-Hui Liu, Divisions of Neonatology, Anhui Provincial Children’s Hospital, Hefei 230022, Anhui Province, China

Liang-Liang Jiang, Pediatrics Neurology, Anhui Provincial Children’s Hospital, Hefei 230022, Anhui Province, China

Li-Li Wang, Chao Zhu, Division of Neonatology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China

Chao Wang, Hefei Blood Center, Hefei 230022, Anhui Province, China

Qiao Jiang, Clinical pathology, Anhui Provincial Children’s Hospital, Hefei 230022, Anhui Province, China

Ru-Jeng Teng, Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States

Author contributions: Bi SH and Teng RJ designed the research; Bi SH, Liu GH, and Teng RJ drafted the manuscript; Bi SH, Jiang LL, Dai LY, Zheng H, Zhang J, Liu Y, Zhang YL, and Wang J obtained the informed consents reviewed the medical records; Wang C and Jiang Q performed the laboratory tests; Bi SH, Zhu C, Liu GH, and Teng RJ performed the data analysis; Wang LL, Zhu C, Liu GH, and Teng FJ revised the manuscript; Bi SH, Zhu C, Liu GH, and Teng RJ finalized the manuscript.

Institutional review board statement: See uploaded file for IRB approval in Chinese.

Conflict-of-interest statement: The authors report no relevant conflicts of interest.

Data sharing statement: Deidentified raw data can be obtained from the authors upon official request for research purpose only.

Corresponding author: Guang-Hui Liu, MD, Chief Doctor, Division of Neonatology, Anhui Provincial Children’s Hospital, Anhui Medical University, Wangjiang E. Rd, Hefei 230022, Anhui Province, China. lgh508@sina.com

Telephone: +86-551-62237807

Received: July 23, 2019
Peer-review started: July 23, 2019
First decision: September 9, 2019
Revised: September 22, 2019
Accepted: October 5, 2019
Article in press: October 5, 2019
Published online: October 26, 2019
Processing time: 94 Days and 13.6 Hours

Abstract

BACKGROUND

Anti-D antibody is not the common cause of Rh-isoimmunization in Chinese neonatal jaundice. Recent change in national population policy has followed by an increase in Rh-isoimmunization related hemolytic disease of the newborn (HDN). Unfortunately, regional status of Rh-HDN is unavailable. We hypothesize that Rh-HDN in our region is most commonly due to anti-E antibody.

AIM

To investigate the prevalence of hemolytic disease of the newborn due to Rh-isoimmunization in Hefei City.

METHODS

Retrospective review of data obtained from Children’s Hospital of Anhui and Hefei Blood Center between January 2017 and June 2019. Status of minor blood group antibody was studied in the corresponding mothers.

RESULTS

Totally 4138 newborns with HDN admitted during the study period and 116 (2.8%) received blood exchange transfusion (BET). Eighteen newborns (0.43%) with proven Rh-incompatible HDN were identified. All were not the first-born baby. Thirteen mothers were RhD (+) (72%) and five were RhD (-). The distribution of Rh-related antibodies in mothers was ten anti-E (55%), five anti-D (27%), and for one anti-C, anti-c, and anti-E/c (6%) each. Thirteen (72.2%) were qualified for BET, relative risk for BET was 28.9 as compared to other types of HDN, but only 10 received due to parenteral refusal. All (100%) RhD related HDN received BET which is not significantly different from RhE related HDN (81.8%).

CONCLUSION

As expected, all Rh-incompatible HDN newborns were not the first-born. Contrary to the Caucasian population, anti-D induced HDN is not the most common etiology. In our region, anti-E (11/18, 61%) is the most common cause of Rh-HDN.

Keywords: Rh-isoimmunization; Hemolytic disease of the newborn; Minor blood group

Core tip: Rh-hemolytic disease of the newborn (HDN) is more commonly seen after the change of national population policy in China. Different from Caucasian, the most common antibody that causes Rh-HDN in Chinese neonates is the anti-E antibody. The severity of anti-E Rh-HDN seems no less than anti-D Rh-HDN since most of our indexed cases were qualified for blood exchange transfusion. This emerging medical problem requires a nationwide collaboration of research in order to establish evidence-based guidelines for Chinese population.