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2015 ; 3
(ä): 17-22
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Comparison of the direct antiglobulin test and the eluate technique for
diagnosing haemolytic disease of the newborn
#MMPMID28932805
van Rossum HH
; de Kraa N
; Thomas M
; Holleboom CAG
; Castel A
; van Rossum AP
Pract Lab Med
2015[Dec]; 3
(ä): 17-22
PMID28932805
show ga
OBJECTIVE: The direct antiglobulin test (DAT) is an important tool for
identification of haemolytic disease of the newborn (HDN) caused by erythrocyte
immunization. Although this test has been used for decades, accurate insights
into its diagnostic properties and optimal use in the diagnosis of HDN are
limited. We aimed to gain more insight into the diagnostic properties of the DAT
for HDN by comparing it with erythrocyte eluate screening. DESIGN AND METHODS:
DAT and erythrocyte eluate screening was performed in umbilical cord blood of
neonates obtained from 317 consecutive deliveries. Clinical jaundice was scored
4-6 days after delivery for the determination of HDN. RESULTS: In 21 neonates a
positive DAT and in 61 neonates a positive eluate screening was found, while only
4 cases of HDN were observed. For the overall population the positive predictive
value (PPV) and specificity of the DAT for HDN were 10% and 93% respectively and
in the population of neonates with abnormal post-partum jaundice population the
PPV and specificity were both 100%. The DAT missed two cases of HDN. These missed
cases were, however, positive in the erythrocyte eluate screening. CONCLUSION:
The detection of clinically irrelevant ABO immunization limits the specificity of
the DAT and eluate for HDN in ABO-incompatible pregnancies. For optimal use, the
DAT should be requested only in cases of jaundice and be interpreted in the
context of ABO-incompatibility. Finally, a negative DAT does not rule out HDN.
When clinical suspicion is high, an eluate should be added following a negative
DAT.