Hemolytic Jaundice due to Anti-Mi a, Diagnosed by Management with An Hour-Specific Nomogram for...

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Transcript of Hemolytic Jaundice due to Anti-Mi a, Diagnosed by Management with An Hour-Specific Nomogram for...

  • Slide 1
  • Hemolytic Jaundice due to Anti-Mi a, Diagnosed by Management with An Hour-Specific Nomogram for Transcutaneous Bilirubin (TcB) Values Jun Kunikata 1, Takashi Kusaka 2, Saneyuki Yasuda 2, Shinji Nakamura 2, Kosuke Koyano 2, Satoshi Hamano 1, Hitoshi Okada 1, Susumu Itoh 1 1 Department of Pediatrics, Faculty of Medicine, Kagawa University, Japan 2 Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Japan
  • Slide 2
  • Introduction Hemolytic jaundice can develop in neonates born to mothers who have irregular antibodies in her blood. All pregnant women are recommended to have irregular antibody screening test, but many irregular antibodies tend to be missed through routine prenatal screening tests.
  • Slide 3
  • Introduction Low frequency antibodies are rare causes of hemolytic jaundice and there are no established management methods for these antibodies. We experienced a case of hemolytic jaundice due to anti-Mi a antibody that was diagnosed early by transcutaneous jaundice meter.
  • Slide 4
  • Mechanism of hemolytic jaundice due to irregular antibodies extract from medic media, partially revised
  • Slide 5
  • Transcutaneous jaundice meter (Konica Minolta, JM-103) 150 g
  • Slide 6
  • Postnatal Age (hours) Transcutaneous Bilirubin (TcB) Levels in the First 72 Hours in a Normal Newborn Population in JAPAN 97.5%tile Average 2.5%tile 171 342 0 TcB (mg/dL) TcB (M)
  • Slide 7
  • Case Report Patient : A male infant delivered by cesarean section at 38 weeks' gestation with a birth weight of 3148 g. Anti-Mi a had been found in his mothers serum in a prenatal antibody screening test. He showed no abnormal findings at birth and was admitted to a newborn nursery. But a transcutaneous jaundice meter (JM-103) showed 1.8 mg/dL (30.8 M) one hour after birth, which were above the treatment line in our hour-specific nomogram. So we admitted him to our NICU and started treatment.
  • Slide 8
  • Clinical course and management of jaundice 2 hours after birth plasma total bilirubin 6.1mg/dL (104.3 M) 1 hour after birth transcutaneous jaundice meter (JM-103) showed 1.8 mg/dL (30.8 M)
  • Slide 9
  • Laboratory data (2 hours after birth) WBC2082 0 /l RBC373/l Ht38.1% PLT33.210 4 /l hemogram stab1.0% seg31.0% eosinophil13.5% basophil0.5% lymph41.5% mono6.5% myelo1.0% erythro3.0% reticulo7.91% Total protein5.6g/dl albumin3.8g/dl BUN8.7mg/dl creatinine0.7mg/dl uric acid5.6mg/dl total bilirubin6.3mg/dl direct bilirubin0.6mg/dl indirect bilirubin5.7mg/dl AST25U/L ALT6U/L ALP643U/L LDH422U/L -GTP179U/L Blood typeAB(+) Mothers Blood typeB(+) immunohematology test direct Coombs test(+) indirect Coombs test(+) anti-A antibody(-) anti-B antibodyNT Mi a antigen(+) Anti- Mi a antibodies were separated from his red blood cells.
  • Slide 10
  • Clinical course and management of jaundice Administration of -globulin Diagnosis: Hemolytic jaundice induced by anti-Mi a antibody Starting Photo therapy Need no further treatment after Day 3 Jaundice was swiftly improved
  • Slide 11
  • About anti-Mi a antibody Anti-Mi a is one of irregular antibodies that react with the Mi III phenotype. Several studies have reported that Asians tend to have Mi III phenotype much more than Whites: 7.3% in Taiwan Chinese blood donors, 6.28% in Hong Kong Chinese blood donors, 9.7% in Thai blood donors and 0.0098% in Whites). The frequency of Anti-Mi a antibody among Chinese patients is 0.28%. 1) There are only a few reports of hemolytic disease caused by anti-Mi a, so Mi a antigen is not considered to be necessary to test red blood cells for irregular antibody screening test. 1) R.E.Broadberry and M.Lin, The incidence and significance of anti-Mi in Taiwan, TRANSFUSION 1994;34;349-352.
  • Slide 12
  • Hitosh Ohto . ( 3 ), Tokyo, Chugai-Igakusya, 2004,512-521 (III)
  • Slide 13
  • Antigen Profile of test red blood cells
  • Slide 14
  • Discussions Difficulty in finding low frequency antibodies prevent us from predicting and treating hemolytic jaundice promptly. We can use transucutaneous jaundice meter to predict hemolytic jaundice so that kernicterus or exchange transfusion will be prevented.
  • Slide 15
  • Conclusion Transcutaneous jaundice meter and an hour-specific 97.5th percentile-based TcB nomogram is useful in the management of newborn jaundice as a non-invasive first-line examination.
  • Slide 16
  • Management of jaundice and treatment progress