Seyyed Mohammad Hassan Aletayeb, Masoud Dehdashtian, Tahereh Ziaei Kajbaf, Mehri Taheri, Mohammad-reza Aramesh, Mazyar Mortazavi, Majid Aminzadeh, Hazhir Javaherizadeh.
Determination of hematologic causes of hyperbilirubinemia in neonates undergoing exchange transfusion in southwest of Iran.
Pak Paed J Jan ;38(1):36-41.

Purpose: The aim of this study was to find G6PD, Rh incompatibility, and ABO incompatibility among neonates with severe hyperbilirubinemia who underwent underwent exchange transfusion. Materials and Methods: Records of all (131) neonates who underwent exchange transfusion between 2006 and 2009 at two hospitals in Ahvaz- Iran, were reviewed. Collected data included age, sex, weight, total and direct bilirubin levels, direct Coombs test results, haemoglobin levels, haematocrit and G6PD qualitative test findings. Patients were classified into two groups: a normal enzyme group and a group with deficient activity of G6PD. All data were analyzed with statistical tests using SPSS ver 13.0 (Chicago, IL, USA). Results: Of 1,970 neonates admitted due to jaundice, 131(6.6%) cases required exchange transfusion; the total number of exchange transfusions was 168. The factors necessitating exchange transfusion were undetermined in 51(38.9%) neonates while G6PD deficiency was the most common known cause of hyperbilirubinamia (43 neonates; 33%). Of the transfused patients, 93 (70.9%) were full term, 74 (56.4%) were male and 95% were normal weight at birth. Most exchanges (51.1%) were performed at 2–4 days of age. Hemolysis was present in 11.6% of neonates with deficient G6PD activity and in 11.3% of neonates with normal G6PD activity (P=0.981). In patients with G6PD deficiency, the mean ages at appearance of jaundice and at exchange transfusion were 3 and 4.2 days after birth, respectively; in neonates with normal enzymes, these ages were 3.2 and 4.7 days after birth, respectively. Conclusion: In this study, the most common cause of severe jaundice leading to exchange transfusion was G6PD deficiency (33%) without hemolysis.

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