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ABO hemolytic disease of the newborn: a need for clarity and consistency in diagnosis

Journal of Perinatology volume 43, pages 242–247 (2023)Cite this article

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Abstract

The diagnosis of ABO hemolytic disease of the newborn (ABO HDN) has been the subject of considerable debate and clinical confusion. Its use as an overarching default diagnosis for hyperbilirubinemia in all ABO incompatible neonates regardless of serological findings is problematic and lacks diagnostic precision. Data on hemolysis indexed by carbon monoxide (CO) levels in expired air (ETCOc) and blood (COHbc) support an essential role for a positive direct antiglobulin test (DAT) in making a more precise diagnosis of ABO HDN. A working definition that includes ABO incompatibility, significant neonatal hyperbilirubinemia, and a positive DAT is needed to gain clarity and consistency in the diagnosis of ABO HDN. Absent a positive DAT, the diagnosis of ABO HDN is suspect. Instead, a negative DAT in a severely hyperbilirubinemic ABO incompatible neonate should trigger an exhaustive search for an alternative cause, a search that may require the use of targeted gene panels.

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Acknowledgements

The author thanks Darrell Triulzi, M.D. for his insightful comments on an earlier draft of the paper.

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  1. Professor Emeritus, Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Jon F. Watchko

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Watchko, J.F. ABO hemolytic disease of the newborn: a need for clarity and consistency in diagnosis. J Perinatol 43, 242–247 (2023). https://doi.org/10.1038/s41372-022-01556-6

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