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Can Exchange Transfusion Normalize Serum Levels of Copper, Zinc, and Magnesium in Severe Neonatal Hyperbilirubinemia?

Abdel Aziz, Reem, A., MD*; El-Mazary, Abdel-Azeem, M., MD*; Saidii, Ahmed, A., MD

Journal of Pediatric Hematology/Oncology: March 2018 - Volume 40 - Issue 2 - p e121–e126
doi: 10.1097/MPH.0000000000000875
Online Articles: Clinical and Laboratory Observations

Background: Neonatal hyperbilirubinemia is a frequently encountered problem. Erythrocytes, especially reticulocytes are rich in copper (Cu) and magnesium (Mg) so its serum levels increase after hemolysis. Zinc (Zn) plays an important role in synthesis of some enzymes included in the bilirubin metabolism and may cause hemolysis. Exchange transfusion is the main treatment for severe neonatal hyperbilirubinemia but can exchange transfusion affect the previous trace elements.

Materials and Methods: We measured Cu, Zn, and Mg serum levels in full-term neonates admitted to neonatal intensive care unit of Minia University hospital with severe indirect hyperbilirubinemia before and after exchange transfusion.

Results: There were significant higher serum Cu and Mg and lower Zn serum levels in neonates with hyperbilirubinemia than controls and their levels were significantly normalized after exchange transfusion. Significant positive correlations between the total bilirubin levels and hemoglobin, Cu and Mg serum levels and significant negative correlations with Zn levels were present. There were no significant correlations between maternal and neonatal serum levels of any of them.

Conclusions: Exchange transfusion can normalize the significant higher Cu and Mg and lower Zn serum levels in neonates with severe indirect hyperbilirubinemia which were not related to their maternal serum levels.

Departments of *Pediatrics

Clinical-Pathology, Faculty of Medicine, Minia University, Minya, Egypt

R.A.A.A. and A.A.M.E.M.: conceived the study, carried out its designing, coordinated the implementation, helped to perform the statistical analysis and drafted the manuscript, participated in the design of the study, analysis and interpretation of data and revised the statistics and final draft of the manuscript. A.A.S.: shared an interpretation of laboratory data and revision of the final draft of manuscript. All authors read and approved the final manuscript.

The authors declare no conflict of interest.

Reprints: Reem A. Abdel Aziz, MD, Department of Pediatrics, Faculty of Medicine, Minia University, Egypt (e-mail:

Received October 29, 2016

Accepted April 24, 2017

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