Korean J Blood Transfus.  2017 Dec;28(3):238-247. 10.17945/kjbt.2017.28.3.238.

The Clinical Significance of Implementing Concurrent Direct Antiglobulin Test and Antibody Elution Test in Diagnosing Hemolytic Disease of the Fetus and Newborn

• Nah H
• Lee E
• Song J
• Cheong JW
• Kim HO

• KMID: 2401741
• DOI: http://doi.org/10.17945/kjbt.2017.28.3.238

Abstract

BACKGROUND
Hemolytic disease of the fetus and newborn (HDFN) is a condition in which immune hemolytic anemia occurs in fetuses or newborns as a result of maternal alloimunized antibodies transfer. Antibody elution test and direct antiglobulin test (DAT) can be performed to diagnose HDFN; maternal originated antibodies cannot be confirmed if DAT is utilized alone. In this study, we analyzed the clinical significance of implementing concurrent DAT and antibody elution test in diagnosing HDFN.
METHODS
We retrospectively analyzed the DATs and antibody elution tests that were simultaneously conducted in a period of 11 years, between 2005 and 2015, in newborns that received hemoglobin, reticulocyte, and total bilirubin tests. According to the results of these tests, the number of newborns diagnosed with HDFN was measured. Furthermore, the sensitivity and specificity of DAT and antibody elution test were compared.
RESULTS
Among 325 newborns, the results of DATs and antibody elution tests were both negative in 208 (64.0%), negative and positive, respectively, in 80 (24.6%), positive and negative in 10 (3.1%), both positive in 27 (8.3%). When this was compared to the clinical diagnosis of HDFN, more sensitive and specific diagnoses were possible when implementing DAT and antibody elution test together (sensitivity of 76.9% for antibody elution test and specificity of 90.3% for DAT). Twenty-six (8.0%) newborns suspected for HDFN showed clinically significant hemolytic anemia.
CONCLUSION
It is necessary to conduct both DAT and antibody elution test when HDFN is suspected. The severity of hemolysis in HDFN can be indirectly anticipated using an antibody elution test confirming maternal originated alloantibodies.

Keyword

Direct antiglobulin test; Antibody elution test; Hemolytic disease of the fetus and newborn

MeSH Terms

Anemia, Hemolytic
Antibodies
Bilirubin
Coombs Test*
Diagnosis
Fetus*
Hemolysis
Humans
Infant, Newborn*
Isoantibodies
Reticulocytes
Retrospective Studies
Sensitivity and Specificity
Antibodies
Bilirubin
Isoantibodies