Journal article
Detection of intravascular hemolysis in newborns using urinary carbonic anhydrase I immunoreactivity
- Abstract:
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Background:
Mild hemolysis occurs physiologically in neonates, but more severe forms can lead to life-threatening anemia. Newborns in developing regions are particularly at-risk due to the higher incidence of triggers (protozoan infections, sepsis, certain genetic traits). In advanced healthcare facilities, hemolysis is monitored indirectly using resource-intensive methods that probe downstream ramifications. These approaches could potentially delay critical decisions in early-life care, and are not suitable for point-of-care testing. Rapid and cost-effective testing could be based on detecting red blood cell (RBC)-specific proteins, such as carbonic anhydrase I (CAI), in accessible fluids (e.g., urine).
Methods:
Urine was collected from 26 full-term male neonates and analyzed for CAI using immunoassays (ELISA, western blot) and proteomics (mass spectrometry). The cohort included a range of hemolytic states, including admissions with infection, ABO incompatibility, and receiving phototherapy. Data were paired with hemoglobin, serum bilirubin (SBR), and C-reactive protein (CRP) measurements.
Results:
Urine from a control cohort (CRP < 20 mg/L, SBR < 125µmol/L) had no detectable CAI, in line with results from healthy adults. CAI excretion was elevated in neonates with raised SBR (>125 µmol/L), including those qualifying for phototherapy. Newborns with low SBR (<125 µmol/L) but elevated CRP (>20 mg/L) produced urine with strong CAI immunoreactivity. Proteomics showed that CAI was the most abundant RBC-specific protein in CAI-immunopositive samples, and did not associate with other RBC-derived peptides, indicating an intravascular hemolytic source followed by CAI-selective excretion.
Conclusions:
CAI is a direct biomarker of intravascular hemolysis that can be measured routinely in urine using non-invasive methods under minimal-laboratory conditions.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Accepted manuscript, 3.3MB, Terms of use)
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- Publisher copy:
- 10.1093/jalm/jfaa051
Authors
- Publisher:
- Oxford University Press
- Journal:
- Journal of Applied Laboratory Medicine More from this journal
- Volume:
- 5
- Issue:
- 5
- Pages:
- 921–934
- Publication date:
- 2020-06-12
- Acceptance date:
- 2020-02-14
- DOI:
- EISSN:
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2475-7241
- ISSN:
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2576-9456
- Language:
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English
- Keywords:
- Pubs id:
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1087679
- Local pid:
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pubs:1087679
- Deposit date:
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2020-02-15
Terms of use
- Copyright holder:
- American Association of Clinical Chemistry
- Copyright date:
- 2020
- Rights statement:
- © American Association for Clinical Chemistry 2020. All rights reserved.
- Notes:
- This is the accepted manuscript version of the article. The final version is available online from Oxford University Press at: https://doi.org/10.1093/jalm/jfaa051
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