Haemolytic Disease of the Newborn: A Retrospective Analysis of Aetiology, Hematologic Evaluations and Treatment in a Tertiary Neonatal Centre

Background: Hemolytic disease of the newborn (HDN) results from immunologic destruction of erythrocytes (RBC), resulting in anaemia and hyperbilirubinemia. It is caused by maternal IgG antibodies that cross the placenta and in case of maternal/child blood group incompatibilities bind to RBC.

Objective: To evaluate the aetiology, hematologic findings and treatment of HDN.

Methods: All patients with HDN, admitted to the Department of Neonatology, University Children’s hospital Ljubljana between January 2007 and December 2016 were studied retrospectively. Inclusion criteria were laboratory sings of haemolysis (hyperbilirubinemia and anaemia or decrease in haemoglobin level or reticulocytosis) and positive Coombs test (DCT) or Lui elution. Medical records were reviewed and data of interest extracted. Patients with HDN due to incompatibility in: ABO blood groups (HDN-ABO), RhD (HDN-RhD) and other rarer blood antigens (HDN-other) were compered.

Results: During the study period 109 newborns with HDN were hospitalised. 92(84,5%) had HDN-ABO, 10(9%) HDN-RhD and 7(6,5%) HDN-other (Table 1). In HDN-ABO DCT was positive in 59(64%) newborns. Heamoglobin level

Conclusions: Most common cause of HDN was ABO incompatibility. 2/3 of patients with HDN-ABO had positive DCT, in others identification of antibodies was performed by Lui elution. Spherocytes were often identified in HDN-ABO and proportion of patients with erythroblastosis was higher in HDN-RhD. Since our unit is referral tertiary centre, the proportion of newborns with HDN-ABO who needed ET was high.