The Rh problem through a retrospectroscope. Philip Levine Award presentation

Exchange transfusion for hemolytic hyperbilirubinemia: could some be averted by emergent administration of an inhibitor of bilirubin production?

OBJECTIVES

The objective of this study is to explore the hypothetical number of neonates where an exchange transfusion (ET) could be prevented by emergency administration of an inhibitor of bilirubin production.

STUDY DESIGN

We identified all neonates who received an ET in our NICUs during the past 12 years. We reviewed the indications for ET and recorded the time between ordering and beginning the exchange.

RESULTS

Forty-six neonates underwent ET, 37 (80.4%) for hemolytic hyperbilirubinemia (36.9 ± 2.9 weeks gestation and 2.5 ± 2.1 days old at ET). The mean delay period was 7.5 ± 3.5 h. Nine (19.6%) had ET not involving bilirubin.

CONCLUSIONS

A trial testing compounds that can inhibit bilirubin production would have about three eligible neonates/years in our system. Since our births are 1% of national, up to 300 neonates/years might qualify for such a study.

Phosphate compounds in the erythrocytes of newborns with haemolytic disease

The following nucleotides and phosphate compounds ADP, ATP, AXP, 2,3-DPG, HMP and hdp were estimated chromatographically in the acid-soluble fraction of erythrocytes. In each of the fractions, total phosphorus and in fraction II, inorganic phosphorus was determined. Comparison of these compounds assayed in erythrocytes of 10 newborns with haemolytic disease and in 10 healthy newborns revealed that in the affected babies, the level of the substances investigated was higher. According to the author's theory, this difference results from increased energy metabolism of the defective erythrocyte as a defense mechanism against the harmful effects of this severe disease such as chronic hypoxia, injuring antibody action or toxicity of the erythrocyte haemolysis products.