Abstract 1194 Poster Session IV, Tuesday, 5/4 (poster 367)

Aim: We asked whether hemolysis and jaundice associated with glucose-6-phosphate dehydrogenase deficiency (G6PD def) commence in utero, as in Rh and ABO isoimmunization. Methods: A cohort of term male neonates at risk for G6PD def, in a population subgroup in which maternal smoking is unusual, was studied. Serum total bilirubin, total hemoglobin (tHb), and carboxyhemoglobin (COHb) (a sensitive indicator of heme catabolism) were sampled within 3 hrs of delivery to reflect in utero status (1st sample), and again close to the beginning of the 3rd day (2nd). Further bilirubin determinations were performed as clinically indicated. Bilirubin was determined by spectrophotometry (Kodak Ektachem), COHb by gas chromatography and corrected for room air CO (COHbc), and G6PD status by a visual color reduction test (Sigma). G6PD defs were compared with G6PD normal controls. Results are expressed as mean ± SD. Results: Hyperbilirubinemia (bilirubin ≥15 mg/dL) was present in 34% of the G6PD defs vs. 5.4% of controls (P<0.0001). (Table) 1st COHbc did not correlate with 1st bilirubin in the G6PD def group (r=0.20, p=0.2), but there was a trend to correlation in the controls (r=0.18, p=0.06). 1st bilirubin in both G6PD def (r=0.61, p=0.00002) and controls (r=0.40, p=0.00003). Conclusions: Hemolysis and bilirubinemia were greater in utero in the G6PD def group than controls. The difference in hemolysis was more pronounced in utero than on the 3rd day. In utero bilirubin correlated with 3rd day bilirubin in both groups. Poor correlation between COHbc and 1st bilirubin in G6PD def neonates implies that forces additional to hemolysis, such as decreased bilirubin conjugation, must have contributed a more important part to their in utero bilirubinemia than in controls.

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