[New data on hemolytic jaundice. I. Investigation of lysolecithin in hemolytic jaundice].
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Isoimmune hemolytic jaundice due to ABO and Rh blood group incompatibility is an important problem in the neonatal period. Intravenous immune globulin (IVIG) treatment in isoimmune jaundice has been shown to be effective, but the response to treatment is variable. In this study, the effect of multiple doses IVIG therapy versus single dose MG therapy was investigated in 61 babies who had ABO and Rh hemolytic disease. Patients were divided into three groups. Group I received multiple dose IVIG treatment, group II received single dose MG treatment, and group III was not given any IVIG. All three groups received phototherapy. No exchange transfusion was needed in group I. The rate of exchange transfusion was 12 per cent in group II and 33 per cent in group III. Duration of phototherapy was shorter in group I than in groups II and III. It was concluded that IVIG treatment reduces the need of exchange transfusion in neonatal isoimmune hemolytic jaundice by lowering hemolysis. Multiple doses IVIG treatment appears to be better at blocking ongoing hemolysis.
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A 62-year-old man having prostate cancer presenting with hemolytic jaundice is reported. The hemolytic jaundice was cured by diethylstilbestrol diphosphate (DES-P) treatment, but the patient died one year and two months later from relapse of prostate cancer. An autopsy confirmed the diagnosis of prostate cancer with multiple metastases. Sudden anemia caused by bone metastasis might have caused the hemolytic jaundice. DES-P cured bone metastasis and then improved anemia when associated with transfusion. Consequently, hemolytic jaundice was cured.
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In order to examine the effect of intravenous immunoglobulin (IVIG) on the rate of hemolysis in immune hemolytic hyperbilirubinemia, we measured the carboxyhemoglobin levels of 5 newborn infants who were subjected to IVIG treatment. The pretreatment rate of hemolysis, in the 5 patients with isoimmune hemolytic jaundice (3 patients with Rh hemolytic disease of the newborn and 2 patients with ABO hemolytic disease of the newborn), as reflected by carboxyhemoglobin levels was higher than the rate of hemolysis in normal newborn infants. In 4 out of the 5 patients treated with IVIG, there was a rapid decline ( > 30%) of carboxyhemoglobin levels, a pattern which was different from that observed in normal newborn infants with no hemolytic jaundice and in 3 untreated patients with ABO hemolytic disease of the newborn. None of the treated patients required an exchange transfusion. Our preliminary results support the theory that the attenuation of jaundice observed following IVIG treatment in patients with immune hemolytic hyperbilirubinemia is caused, at least in part, by the reduction in hemolysis.
To study the effects of moderate non-hemolytic jaundice and phototherapy (PT) on newborn behavior, initially 29 full-term infants with serum bilirubin (SB) 12-15 mg/dl were randomly assigned to PT (n = 14) or non-PT (n = 15) group. PT was done until SB less than 12 mg/dl. One infant in the PT group was excluded because of G-6-PD deficiency and evidence of hemolysis. Four infants in the non-PT group were excluded because their serum bilirubin concentrations finally exceeded 15 mg/dl and they were put on phototherapy for ethical concern. Two more infants were then added to the non-PT group to make a total number of 13. Additional 14 infants with serum bilirubin levels less than 12 mg/dl were studied as controls. Neonatal Behavioral Assessment Scales (NBAS) were performed 4 times: just before PT, right after termination of PT, 24 hrs after termination of PT and at 2 wks of age in PT group, and at comparable ages with the non-PT and control groups. The course of jaundice was measured in terms of SB levels at entry into study, peak SB levels, duration from entry into study to the time when SB levels dropped below 12 mg/dl and age when SB levels dropped below 12 mg/dl. The values did not differ significantly between the PT and non-PT groups. Therefore, phototherapy did not change the clinical course of jaundice in the majority of infants with bilirubin levels between 12 and 15 mg/dl. The 7 cluster scores of 1st NBAS did not differ significantly among the 3 groups of infants. On the 2nd and 3rd examinations, the infants in the PT group performed poorer in some of the orientation items than the infants in the non-PT and control groups (p less than 0.05) whereas the non-PT groups showed similar performance as the control group. At 2 wks of age, no significant differences of the NBAS scores were found in 3 groups. We conclude that moderate non-hemolytic jaundice (serum bilirubin 12-15 mg/dl) does not affect the behavior of full-term infants in this study. Phototherapy has some short-term adverse effects on visual, auditory orientation and alertness of the infants which may impair infant-caregiver interaction.
The onset of spontaneous hemolytic jaundice in a young subject should lead to the search for Wilson's disease when clinical examination reveals cirrhosis. This hemolysis may evolve in the form of severe jaundice to a stage where the cirrhosis remains usually latent or well tolerated. The intervention of a toxic, allergic of infective factor liable to produce a hepatic lesion which frees a dose of copper sufficient to trigger off hemolysis, is discussed. The mechanism of the latter, that of the coagulation disorders observed, liver cell failure and widespread intravascular coagulation, are analysed in this paper and compared with data in the literature. The dramatic character of the case indicates that it is necessary to treat as a routine with penicillamine all homozygous forms of Wilson's disease.
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OBJECTIVE: The aim of this study was to determine what proportion of newborns admitted with idiopathic non-hemolytic hyperbilirubinemia exhibit severe weight loss and hypernatremia. METHODS: The prospective study involved 115 infants >48 h old who were admitted with jaundice between July 2002 and July 2003, and had unconjugated bilirubin levels >12 mg/dL. Premature babies (gestational age <37 weeks) and those with hemolytic jaundice and other pathologic causes of non-hemolytic jaundice were excluded. Postnatal age (days) at admission, bodyweight at admission, weight change since birth (percentage weight loss calculated at admission) and mode of feeding (breast-feeding, formula feeding, mixed feeding) were recorded. Severe weight loss was defined in babies who showed >10% weight loss or had not regained enough to reach birthweight by postnatal day 10. Serum Na levels and breast-milk Na levels were also measured. RESULTS: Twenty-eight (33%) of the 86 newborns with idiopathic hyperbilirubinemia in the study exhibited severe weight loss. Almost all the 86 babies were exclusively breast-fed, and 10 babies (12%) had severe weight loss combined with hypernatremia. The group with severe weight loss and hypernatremia had higher breast-milk Na levels than the other infants. CONCLUSION: The results indicate that a large proportion of babies with non-hemolytic jaundice have severe weight loss, and that breast-fed newborns with the combination of weight loss and hypernatremia may present with non-hemolytic jaundice.
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