A Clinical Analysis Of The Differences Between Direct Antiglobulin Test Positive With Release Antibody Positive ABO-hemolytic Disease And Direct Antiglobulin Test Negative With Release Antibody Positive ABO-hemolytic Disease Infull-term Infants

Objective:To analyze clinical characteristics of ABO-hemolytic disease with direct antiglobulin test positive in full-term infants.Methods:This is a retrospective cohort-study.We collect all the cases admitted to our hospital during January 1st 2008 to December 31st 2008 which are both satisfying the criteria of neonatal ABO-hemolytic disease and inclusion criteria described in detail in material and methods part.There are 127 cases in total and we divide them into 2 groups:Group 1 (study group) is composed of 56 cases with direct antiglobulin test positive and release antibody positive;Group 2(control group) is composed of 71 cases with direct antiglobulin test negative and release antibody positive,then analyze the differences between the 2 groups in gestation age,weight,gender,blood type,time of jaundice's appearance,initial total serum bilirubin(TSB)(detected at the admitted moment),age, maximum of TCB(transcutaneous bilirubinometer),anaemia,blood transfusion.Then we subdivide these 2 groups according to the different therapy processes.Group A didn't use Intravenous immunoglobulin G(IVIG) and Intravenous albumin(IVA); group B didn't use IVIG but use IVA;group C use IVIG but not IVA;group D use both IVIG and IVA.For example,group 1A includes all the direct antiglobulin test positive and release antibody positive cases in group A,while Group 2A includes all the cases which are negative in direct antiglobulin test and positive in release antibody test in group A.Finally,we compare initial TSB and phototherapy time between group 1A and group 2A(group 1B and group 2B,group 1C and group 2C,group 1D and group 2D). Results:There is no significant difference between the 2 groups in gestation age, weight,gender.The average age of group 1 is younger than group 2.Proportion of type A of group 1 is l'arger than group 2.37 cases(66.1%) get jaundice in group 1 and 20 cases(28.2%) do in group 2 in the first 24 hours,(p＜0.01);55 cases(98.2%) get jaundice in group 1 and 42 cases(59.2%) do in group 2 in the first 48 hours,(p＜0.01). The initial TSB values and TCB maximum between the 2 groups have no significant difference.And 119 cases(93.70%) stop increasing in TCB value as soon as admission by intervention.Both anaemia and blood transfusion occur more often in group 1 (p＜0.01,p＜0.01).There is no significant difference between group 1A and group 2A (group 1B and group 2B,group 1C and group 2C,group 1D and group 2D) in initial TSB value.Group 1A need more time phototherapy than Group 2A(p＜0.01).Group 1B need more time phototherapy than Group 2B(p＜0.01).Group 1C need more time phototherapy than Group 2C(p＜0.05).Group 1D need more time phototherapy than Group 2D(p＜0.05).Conclusion:The cases of ABO-hemotytic disease with direct antiglobulin test positive and release antibody positive in full-term infants having earlier appearance of jaundice and more incidence of both anaemia and blood transfusion, needing more time phototherapy than the ones with direct antiglobulin test negative and release antibody positive.