Clinical Case Study of ABO Hemolin Different Ethnic Groups, Blood

Types and Parity

Yan Jin

Department of Neonatology, the People’s Hospital of Baise, Baise, Guangxi, China

Keywords: Newborn, ABO Hemolytic Disease, Clinical Analysis, Nation, Blood Type, Parity.

Abstract: ABO hemolytic disease of newborn (ABO-HDN) is an allogeneic passive immune disease caused by

maternal fetal blood group incompatibility. It is caused by the combination of maternal blood group

antibody and blood group antigen on the surface of fetal or neonatal red blood cells, resulting in the

destruction of fetal or neonatal red blood cells, Therefore, this disease is also known as neonatal mother

child blood group incompatible hemolytic disease(Simmons, Savage 2015). In this study, we collected

relevant clinical data by summarizing the clinical characteristics of full-term ABO-HDN, using a

retrospective study of term infants who met the diagnostic criteria for ABO-HDN, and compared the

differences in the minimum hemoglobin, age at onset (h), and incidence of anemia between different

genders, ethnic groups, blood groups, and parity of ABO-HDN.Through the analysis, it was found that there

were no significant differences in the lowest hemoglobin, age at onset (h) and incidence of anemia of

full-term ABO-HDN in the People’s Hospital of Baise (P > 0.05), which provided a reference for further

improving the clinical management of full-term ABO-HDN.

1 INTRODUCTION

Hemolytic disease of newborn (HDN) is a kind of

isoimmune hemolytic anemia(Chen, Ling 1994),

which is caused by inconsistent blood groups

between mothers and infants. Immune hemolytic

anemia caused by blood group antibodies is one of

the common causes of unconstrained

hyperbilirubinemia of newborn(Jeon, Calhoun,

Pothiawala, et al 2000)

The clinical symptoms of ABO-HDN are related

to the degree of hemolysis of newborns. Usually,

ABO-HDN reaction will appear one to two days

after birth, showing hemolysis. The main clinical

symptoms are premature jaundice, rapid increase of

indicators, increase of abnormal destruction of red

blood cells and other symptoms(Sun, Zhang 2007).

In general, ABO-HDN is usually a relatively

slow and mild hemolysis process. The degree of

hemolysis is considered to be mild to moderate.

Severe hemolysis and fetal edema rarely occur, but

there are also reports of death cases(Kim, Kim, Park,

et al 2020). Severe hemolysis and anemia require

blood exchange, leading to bilirubin encephalopathy,

https://orcid.org/0000-0002-3465-7057

affecting the intelligence level of newborns, hand

and foot movement or death. Through the

retrospective analysis of the clinical data of 127

full-term children with ABO-HDN who met the

diagnosis and treatment criteria, this study had a

more comprehensive understanding of the

occurrence and treatment of full-term ABO-HDN in

this region, so as to provide reference for clinical

judgment of the disease and formulation of treatment

plan, and provide clinical data for the related

research of full-term ABO-HDN.

2 SUBJECTS AND METHODS

Subjects 127 full-term newborns who met the

diagnostic criteria of ABO-HDN were selected.

SPSS statistics 16.0 software was used for statistical

analysis. The counting data were described by the

number of cases and percentage (n,%). The

measurement data were described by mean±standard

deviation (

SX ±

). The differences between groups

were compared by independent sample t-test,

analysis of variance and chi square test. P<0.05 was

statistically significant.

362

Jin, Y.

Clinical Case Study of ABO Hemolin Different Ethnic Groups, Blood Types and Parity.

DOI: 10.5220/0011370200003438

In Proceedings of the 1st International Conference on Health Big Data and Intelligent Healthcare (ICHIH 2022), pages 362-366

ISBN: 978-989-758-596-8

3 CLINICAL DATA ANALYSIS

A total of 127 children with full-term ABO-HDN

were selected in this study. Among them, 72

(56.7%) were male children and 55 (43.3%) were

female children; 52 (40.9%) children with blood

type A ABO-HDN and 75 (59.1%) children with

blood type B ABO-HDN; 69 (54.3%) were

cisgender and 58 (45.7%) were cesarean delivery;

Twenty two patients (17.3%) had a 1st parity, 34

patients (26.8%) had a 2nd, and 71 patients (55.9%)

had more than a 3rd parity (including the 3rd).

3.1 Differential Comparison of Term

ABO-HDN in Different Gender

Groups

They were divided into male and female groups

according to gender, and the differences in the

lowest hemoglobin, age at onset (h), and incidence

of anemia were compared between groups using

independent samples t-test, and chi square test. As

can be seen from table 1, there was no statistical

difference between males and females in the lowest

hemoglobin, age at onset (h), and incidence of

anemia (P > 0.05).

Table 1: Comparison of the incidence of lowest hemoglobin, age at onset (h) and anemia among different sexes.

class (n)

Minimum Hb (g/L)

sx ±

Age at disease

onset (h)

sx ±

Anemia

incidence2（%）

Male (n=72) 136.44±22.45 24.30±16.09 62.5%

Female (n=55) 141.13±19.13 24.51±17.09 50.9%

t value/χ2value -1.24 -0.07 1.71*

P value 0.22 0.94 0.19

Notes: * chi square test was used; 1x refers to mean and s refers to standard deviation; 2 the denominator for the incidence

of anemia was the 127 full-term abo-hdn cases enrolled.

3.2 Comparison of Differences in Term

ABO-HDN among Ethnic Groups

Based on the ethnic distribution, they were divided

into three groups: Han group, non Han group

(Zhuang and other minorities), and the independent

samples t-test was used to compare the differences

in the lowest hemoglobin, age at onset (h), and chi

square test to compare the differences in the

incidence of anemia. As can be seen from table 2,

there were no statistical differences among different

ethnic groups in the lowest hemoglobin, age at onset

(h), and incidence of anemia (P > 0.05).

Table 2: Comparison of the incidence of minimum hemoglobin, age at onset (h) and anemia among different ethnic groups.

class (n)

Minimum Hb (g / L)

sx ±

Age at disease onset (h)

sx ±

Anemia

incidence2（%）

Han nationality (n=53) 140.40±20.94 23.30±11.49 56.6%

Non-Han nationality group

(

n=74

)

137.09±21.29 25.18±19.29 58.1%

t value /χ2value 0.87 -0.63 0.03*

P value 0.39 0.53 0.87

Notes: * chi square test was used; 1x refers to mean and s refers to standard deviation; 2 the denominator for the

incidence of anemia was the 127 full-term abo-hdn cases enrolled.

3.3 Differential Comparison of Term

ABO-HDN in Different Blood

Group

Different blood groups were divided into A blood

group and B blood group. Independent sample t-test

was used to compare the differences of minimum

hemoglobin and age at onset (h), and chi square test

was used to compare the differences of anemia

incidence. It can be seen from table 3 that there was

no difference in minimum hemoglobin, age at onset

(h) and incidence of anemia among different blood

groups, and the results were not statistically

significant (P > 0.05).

Clinical Case Study of ABO Hemolin Different Ethnic Groups, Blood Types and Parity

363

Table 3: Comparison of the incidence of different blood types in the lowest hemoglobin, age (h) and anemia of different

blood types.

class (n)

Minimum Hb (g / L)

sx ±

Age at disease onset (h)

sx ±

Anemia incidence2（%）

Blood Type A (52) 138.58±20.39 24.53±14.85 51.9%

Blood Type B (75) 138.40±21.76 24.30±17.59 61.3%

t value /χ2value 0.05 0.08 1.11*

P value 0.96 0.94 0.29

Notes: * chi square test was used; 1x refers to mean and s refers to standard deviation; 2 the denominator for the incidence

of anemia was the 127 full-term abo-hdn cases enrolled.

3.4 Differential Comparison of Term

ABO-HDN in Different Parity

Groups

According to different parity groups, they were

divided into the first parity group, the second parity

group and the third and above parity groups. The

differences of minimum hemoglobin and age at

onset (h) were compared by analysis of variance,

and the difference of anemia incidence was

compared by chi square test. It can be seen from

table 4 that there was no significant difference in the

lowest hemoglobin, age at onset (h) and incidence of

anemia among different parity (P > 0.05).

Table 4: Comparison of lowest hemoglobin, age at onset (h) and incidence of anemia among different parity.

class (n)

Minimum Hb (g / L)

sx ±

Age at disease onset (h)

sx ±

Anemia incidence2（%）

First parity (n=22) 140.05±17.61 24.55±12.24 54.5%

Second child time (n=34) 140.12±22.77 28.96±24.32 55.9%

Third and above births

(n=71)

137.20±21.50 22.15±12.20 59.2%

F value/χ2value 0.29 2.00 0.20*

P value 0.75 0.14 0.91

Notes: * chi square test was used; 1x refers to mean and s refers to standard deviation; 2 the denominator for the incidence

of anemia was the 127 full-term abo-hdn cases enrolled.

4 CONCLUSIONS

In this study, children with full-term ABO-HDN

were divided into groups according to gender,

ethnicity, blood group, and parity, and the

differences in the lowest hemoglobin, age at onset

(h), and incidence of anemia were compared,

respectively. We found that there was no significant

difference (P>0.05) in the incidence of full-term

ABO-HDN among different gender, ethnic group,

blood group, and parity among the children with

ABO-HDN treated in the People’s Hospital of Baise

combined with previous studies, Specific discussion

follows:

4.1 Ethnic Differences and ABO-HDN

Ethnic differences are mainly reflected in the

differences in social culture, living habits and

regional physical environment. The selection of

ethnic groups as variables is mainly based on the

fact that Baise region is located in Guangxi Zhuang

Autonomous Region, at the junction of Yunnan,

ICHIH 2022 - International Conference on Health Big Data and Intelligent Healthcare

364

Guizhou and Guangxi, and has eight ethnic

minorities, including Miao, Yi, Tujia and Yao, In

this study, 127 cases of full-term ABO-HDN of five

nationalities (Han, Zhuang, Yi, Yao and Miao) in the

People’s Hospital of Baise of Guangxi were

counted, including 53 cases of Han nationality

(41.7%), 69 cases of Zhuang nationality (54.3%), 2

cases of Yao nationality (1.56%), 1 case of Yi

nationality (0.78%) and 2 cases of Miao nationality

(1.56%), of which Zhuang nationality accounts for

the largest proportion, and Baise is the gathering

area of Zhuang nationality, The overall composition

of Zhuang population is relatively large.In addition,

in the univariate analysis of ethnic groups, there is

no difference in the lowest hemoglobin, age at onset

(h) and incidence of anemia (P>0.05). Ethnic factors

have little effect on the occurrence of anemia and

onset time of full-term ABO-HDN, which has been

confirmed by other relevant domestic studies(Chen,

Deng, Huang, et al 2019). Relevant studies show

that Han, Hui, Uygur, Inner Mongolia There was no

significant difference in the prevalence of full-term

ABO-HDN, the degree of hemolysis and the clinical

manifestations of hemolysis among Tibetans. A

foreign study on different ethnic groups in Iraq and

India(Zhu, Wei, Zhang 2019) confirmed that there

was no significant difference in full-term

ABO-HDN in different countries. The research on

different ethnic groups showed that there were

differences in the degree of ABO hemolysis among

black, yellow and white people, but there was no

significant difference in the incidence.

To sum up, the proportion of full-term

ABO-HDN children of Zhuang Nationality in this

study is higher than that of other nationalities. The

main reason is that Baise area is the gathering place

of Zhuang nationality, and the population base of

Zhuang nationality is large. There is no significant

difference in whether ABO-HDN is anemia and

related indicators of onset time, and ethnic factors

have no significant impact on the onset and

development of ABO-HDN.

4.2 Blood Group Difference and

ABO-HDN

Of the 127 cases enrolled in this study, 52 (40.9%)

were children with blood group A ABO-HDN and

75 (59.1%) were children with blood group B

ABO-HDN.

Relevant studies have confirmed that the

incidence of ABO-HDN hemolysis in different

blood groups is different(Sun, Zhang 2007). Since

there are about 810000-1170000 A antigen binding

sites on the surface of type A red blood cells and

610000-830000 B antigen binding sites on the

surface of type B red blood cells, in theory, children

with ABO-HDN are more common in type A blood.

However, the actual incidence rate is not consistent

with this, which is related to the frequency of A

blood type and type B blood in the opulation.Studies

have shown that(Simmons, Savage 2015), the

frequency of B blood type in Asian population is

higher than that of A blood type expression, which

may be the reason that the incidence rate of

ABO-HDN in type B blood is higher than that of A

type blood. Some scholars also believe that(Leger

2002), in the hemolysis degree of ABO-HDN,

children with type B blood are heavier than those

with type A blood.

The data of this study showed that there were no

significant differences in the lowest hemoglobin, age

at onset (h) and incidence of anemia among

full-term ABO-HDN children with different blood

groups, and the results did not reach statistical

significance (P>0.05). This may produce errors on

the results because this study is a single center and

small sample study, which needs to be further

expanded in the future The number of samples

further verified whether different blood groups had

an impact on the pathogenesis and development of

ABO-HDN.

4.3 Parity Difference and ABO-HDN

Of the term ABO-HDN children selected for this

study, 22 (17.3%) had the 1st fetus, 34 (26.8%) had

the 2nd fetus, and 71 (55.9%) had the 3rd fetus and

above (including the 3rd fetus). Relevant studies at

home and abroad(Zhao Li, Huang Xinghua,2003)

showed that pregnant women with 2 or more

pregnancies carried significantly more positive IgG

antibodies against a or anti-B than those with a first

pregnancy.The main reasons are: during and at the

end of pregnancy, fetal blood will enter the mother

for many times, stimulating the mother to produce

antibodies against fetal blood group antigens. With

the increase of pregnancy times, T cells and B cells

stimulated by foreign allogeneic ABO blood group

antigens in the mother continue to proliferate and

differentiate, and the immune response continues to

strengthen, The high titer IgG antibody gradually

increases. If the maternal fetal ABO blood group is

still incompatible during pregnancy again, the

antibody IgG with high titer is transported into the

fetal circulation through the placenta, causing

sensitization, agglutination and dissolution of fetal

red blood cells, and aggravating the degree of

Clinical Case Study of ABO Hemolin Different Ethnic Groups, Blood Types and Parity

365

hemolysis(Wang 2001). On the premise of

inconsistent maternal and infant blood groups, the

more the number of pregnancies, the more

significant the clinical symptoms of ABO-HDN in

fetuses or newborns, and the more obvious the

degree of hemolysis.

The data of this study show that the composition

ratio of different parity is different, and the

proportion of full-term ABO-HDN of three parity

and above is the largest. However, there is no

significant difference in the lowest hemoglobin, age

at onset (h) and incidence of anemia among

full-term ABO-HDN children with different parity

(P > 0.05), which may be related to the widespread

existence of ABO blood group substances in nature,

and the mother may have repeated and repeated

before pregnancy Due to a long history of blood

group antigen exposure, there was no significant

difference in the lowest hemoglobin, age at onset

and incidence of anemia.

REFERENCES

Chen JY, Ling UP.（1994）.Prediction of the development

of neonatal hyperbilirubinemia in ABO

incompatibility.Journal of the Chinese

Medical,53(1):13-18.

Chen Zhuoyao, Deng Qiulian, Huang Yinghong, et al.（

2019）.The significance of the two release tests for the

diagnosis of neonatal ABO hemolysis [J].Laboratory

Medicine and Clinical Medicine, 16 (18): 2660-2662.

Jeon H, Calhoun B, Pothiawala M, et al. （ 2000 ）

.Significant ABO hemolytic disease of the newborn in

a group B infant with a group A2

mother.Immunohematology,16(3):105-108.

Kim MS, Kim JS, Park H, et al.（2000）.Fatal hemolytic

disease of the fetus and newborn caused by anti-Jra

antibody:A case report and literature

review[J].Transfusion and Apheresis

Science,59(1):102605-102608.

Leger RM.（2002）.In vitro cellular assays and other

approaches used to predict the significance of red cell

alloantibodies[J].Immunohematology,18(3): 65-70.

Simmons DP, Savage WJ.（2015）.Hemolysis from ABO

incompatibility[J].Hematol Oncol Clin North

Am.29(3):429-430.

Sun Chengjuan, Zhang Weiyuan.（2007）.Etiology and

treatment of maternal blood hemolysis [J].Chinese

Journal of Practical Gynecology and Obstetrics, 23

(12): 911-913.

Wang Xie tong.（2001）.Pathophysiology of maternal and

maternal blood type incompatibility [J].Chinese

Journal of Practical Gynecology and Obstetrics, 217

(10): 578.

Zhao Li, Huang Xinghua.（2003）.Maternal Rh blood type

incompatibility [M].Beijing: People's Health

Publishing House, 225-233.

Zhu XJ, Wei JK, Zhang CM.（2019）.Evaluation of

endothelial microparticles as a prognostic marker in

hemolytic disease of the newborn in China[J].The

Journal Of International Medical Research,

47(11):5732-573

ICHIH 2022 - International Conference on Health Big Data and Intelligent Healthcare

366