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01-06-2003 | Artikelen

Intraveneuze immunoglobulinen ter preventie van wisseltransfusie bij neonatale immuunhemolytische ziekte

Auteurs: Dr. P. Van de Voorde, G. Hendrickx, L. Goossens, A. Zecic, P. Vanhaesebrouck

Gepubliceerd in: Tijdschrift voor Kindergeneeskunde | Uitgave 4/2003

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Samenvatting

De conventionele behandeling van neonatale hyperbilirubinemie bestaat uit fototherapie en zo nodig wisseltransfusie (wt). Recente publicaties postuleren intraveneuze immunoglobulinen (ivig) als therapeutisch alternatief bij significante hemolytische icterus. Vanaf 1996 behandelden wij twintig patiënten met ernstige immuunhemolytische ziekte. ivig-behandeling werd ingesteld volgens de ‘klassieke’ wt-criteria (Klaus & 38; Fanaroff): navelstrengbilirubine > 85 μmol/l (1 mg/dl = 17 μmol/l) en hemoglobine < 10 g/dl of totaalserumbilirubine (tbr) > 170 μmol/l binnen de eerste 24 levensuren, > 255 μmol/l de tweede 24 uur en > 340 μmol/l nadien. Negentien patiënten voldeden uiteindelijk aan deze criteria. Eén patiënt overleed vroegtijdig. Bij twee werd een wt verricht voor ivig-toediening. Deze patiënten werden uitgesloten van de studie. Eén neonaat vertoonde, ondanks twee doses ivig, progressief oplopende tbr-waarden zodat een ‘rescue’-wt noodzakelijk werd geacht. Aldus werd bij vijftien van de zestien patiënten een wisseltransfusie vermeden. Er werden geen majeure complicaties gezien. Vijf patiënten vertoonden laattijdige anemie met bloedtransfusienood. Toediening van intraveneuze immunoglobulinen is een veilige en effectieve behandeling van immuunhemolytische icterus. Gezien de brede variatie in ernst lijkt het definiëren van criteria voor therapie obligaat.
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Metagegevens
Titel
Intraveneuze immunoglobulinen ter preventie van wisseltransfusie bij neonatale immuunhemolytische ziekte
Auteurs
Dr. P. Van de Voorde
G. Hendrickx
L. Goossens
A. Zecic
P. Vanhaesebrouck
Publicatiedatum
01-06-2003
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Tijdschrift voor Kindergeneeskunde / Uitgave 4/2003
Print ISSN: 0376-7442
Elektronisch ISSN: 1875-6840
DOI
https://doi.org/10.1007/BF03061439