Donor blood glucose 6-phosphate dehydrogenase deficiency reduces the efficacy of exchange transfusion in neonatal hyperbilirubinemia.

Abstract

OBJECTIVES:

Acute intravascular hemolysis after exchange transfusion with glucose 6-phosphate dehydrogenase-deficient blood has been reported; however, it is not routine to screen donor blood for glucose 6-phosphate dehydrogenase deficiency while performing exchange transfusion. We hypothesized that exchange transfusion with glucose 6-phosphate dehydrogenase-deficient blood would lead to a less-than-expected decrease in total serum bilirubin. The objective of this study was to evaluate the effect of exchange transfusion with glucose 6-phosphate dehydrogenase-deficient blood in neonates with idiopathic hyperbilirubinemia on postexchange total serum bilirubin levels, duration of phototherapy, and need for repeat exchange transfusions.

METHODS:

All neonates who were undergoing exchange transfusion for idiopathic hyperbilirubinemia were enrolled. A sample of donor blood was collected at the time of exchange transfusion for a glucose 6-phosphate dehydrogenase assay. The standard criteria for starting and stopping phototherapy and exchange transfusion were applied.

RESULTS:

During the 1-year study period, 21 infants underwent exchange with glucose 6-phosphate dehydrogenase-deficient blood, and 114 neonates with similar baseline characteristics underwent exchange transfusion with glucose 6-phosphate dehydrogenase-normal blood. From 6 to 60 hours after exchange transfusion, there was a significantly lesser drop in total serum bilirubin in the recipients of glucose 6-phosphate dehydrogenase-deficient donor blood compared with recipients of glucose 6-phosphate dehydrogenase-normal blood. The mean duration of phototherapy in the postexchange period and number of infants who underwent repeat exchange transfusions were significantly higher in recipients of glucose 6-phosphate dehydrogenase-deficient donor blood in comparison with control subjects. Concurrently, there was a significantly higher drop in hematocrit and rise in plasma hemoglobin in the glucose 6-phosphate dehydrogenase-deficient donor group.

CONCLUSIONS:

Exchange transfusion with glucose 6-phosphate dehydrogenase-deficient donor blood leads to a lesser drop in postexchange total serum bilirubin. It prolongs the duration of phototherapy and increases the need for repeat exchange transfusions.

• Authors: Sandip Samanta, Praveen Kumar, Sai Sunil Kishore, Gurjeewan Garewal, Anil Narang
• Journal: Pediatrics (Pediatrics) Vol. 123 Issue 1 Pg. e96-e100 (Jan 2009) ISSN: 1098-4275 [Electronic] United States
• PMID: 19103674 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Glucosephosphate Dehydrogenase
• Bilirubin

Topics

• Bilirubin (blood)
• Exchange Transfusion, Whole Blood (adverse effects, methods)
• Female
• Glucosephosphate Dehydrogenase (adverse effects, blood)
• Glucosephosphate Dehydrogenase Deficiency (blood)
• Hemolysis (physiology)
• Humans
• Hyperbilirubinemia (blood, enzymology, therapy)
• Infant, Newborn
• Male