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Hemolytic Jaundice Due to Anti-Mi a , Diagnosed by Management with An Hour-Specific Nomogram for Transcutaneous Bilirubin ( TcB ) Values. Jun Kunikata 1 , Takashi Kusaka 2 , Saneyuki Yasuda 2 , Shinji Nakamura 2 , Kosuke Koyano 2 , Satoshi Hamano 1 , Hitoshi Okada 1 , Susumu Itoh 1
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Hemolytic Jaundice Due to Anti-Mia, Diagnosed by Management with An Hour-Specific Nomogram for TranscutaneousBilirubin (TcB) Values Jun Kunikata1, Takashi Kusaka2, Saneyuki Yasuda2, Shinji Nakamura2, Kosuke Koyano2, Satoshi Hamano1, Hitoshi Okada1, Susumu Itoh1 1Department of Pediatrics, Faculty of Medicine, Kagawa University, Japan 2Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Japan
Introduction • Hemolytic jaundice can develop in neonates born to mothers who have irregular antibodies. • All pregnant women are recommended tohaveIrregular antibody screening test, but there are many irregular antibodies that cannot be found by routine prenatal screening tests. • It is considered that these low frequency antibodies are rarely cause of hemolytic jaundice and there are no established management for these antibodies.
Mechanism of hemolytic jaundice due to irregular antibodies （extract from「病気が見える産科」medic media, partially revised）
Transcutaneous jaundice meter (Konica Minolta, JM-103) 150 g
97.5%tile Average 2.5%tile TranscutaneousBilirubin (TcB ) Levels in the First 72 Hours in a Normal Newborn Population in JAPAN 342 TcB (mg/dL) TcB (µM) 171 0 Postnatal Age (hours)
Case Report • Patient : A male infant delivered by cesarean section at 38 weeks' gestation with a birth weight of 3148 g. • Anti-Miahad been found in his mother’s serum in a prenatal antibody screening test. • He showed no abnormal findings at birth and was admitted to a newborn nursery, but a transcutaneous jaundice meter (JM-103) showed 1.8 mg/dL one hour after birth, which were above the treatment line in our hour-specific nomogram. • So we admitted him to hospital and started treatment.
Management of jaundice and treatment progress 2 hour after birth plasma total bilirubin 6.1mg/dL 1 hour after birth transcutaneous jaundice meter (JM-103) showed 1.8 mg/dL (exceed 95 percentile line)
Management of jaundice and treatment progress administration of γ-globulin (to avoid exchange transfusion) Diagnosis: Hemolytic jaundice induced by anti-Mia antibody Jaundice was rapidly improved Starting Photo therapy Need no treatment Since Day 3
About anti-Mia antibody • Anti-Mia is one of irregular antibodies that react with the MiIII phenotype. • Several studies have reported that the MiIII phenotype has a much higher incidence among Asians than among whites (7.3% in Taiwan Chinese blood donors, 6.28% in Hong Kong Chinese blood donors, 9.7% in Thai blood donors and 0.0098% in Whites). • The frequency of Anti-Mia among Chinese patients is 0.28 percent.1) • There are only a few report of hemolytic disease caused by anti-Mia, so Mia antigen is not considered to be necessary to test red blood cells for irregular antibody screening test. 1)R.E.Broadberry and M.Lin, The incidence and significance of anti-”Mi” in Taiwan, TRANSFUSION 1994;34;349-352.
産婦人科診療ガイドライン産科編2011より抜粋産婦人科診療ガイドライン産科編2011より抜粋 文献（1）大戸斉：新生児溶血性疾患と母児免疫.輸血学(改訂第3版), 東京：中外医学社, 2004,512-521 (III)
Conclusion • It is hard to know the presence of low frequency antibodies, such as anti-Mia, we should consider about hemolytic jaundice caused by irregular antibodies when hemolytic jaundice happens without reasons. • Even if hemolytic jaundice that cannot be predicted happens, appropriate jaundice management can identify hemolytic jaundice early and prevent kernicterus or exchange transfusion. • In particular, transcutaneous jaundice meter and an hour-specific 97.5th percentile-based TcBnomogram plays an important role in the management of newborn jaundice as a non-invasive first-line examination.
