What is hemoglobinuria?
Our red blood cells (RBCs) are composed of hemoglobin (red pigment) that carries oxygen and carbon dioxide in our circulatory system. If there is excess of RBC lysis (or breakdown/turnover), then our blood will have excessive amount of hemoglobin. Hemoglobin will be filtered out from kidney along with urine and because of its colour, the urine will stain reddish to brown.
Why it is pertinent to us?
Our baby had reddish to brown urine during the first postnatal week. The nurse said that it was normal to see reddish diaper stain sometimes and that upon subsequent feeding and passing of water, the stain will go away.
However, that reddish stain later served as an indication of persistent jaundice that we experienced later on. I am blood group B+ while my wife is A+ and our baby is AB+. Fortunately, we requested that our baby's blood group be tested (it was not normal routine for our hospital to test baby's blood group and we had to explicitly ask for it), or else we wouldn't have gotten this important information that facilitated the medical staff to conclude that our baby was having ABO incompatibility (and persistent jaundice).
What is ABO incompatibility?
ABO incompatibility happens when mother's antibody recognizes and attacks baby's blood cells. It seemed that mother's antibody can traverse from the umbilical cord to the baby's blood circulation.
As an example, if mother had no antigen B in her blood cells (i.e. she is A+ or O+), she will have antibody against this antigen. If baby has antigen B on the blood cells (e.g. if baby is B+, AB+), then the maternal antibody will start attacking the baby's blood cells. This causes excessive blood cell loss and increases circulating hemoglobin and its broken-down product, bilirubin.
Update
It has been more than a month and our baby still has jaundice (indicated by higher bilirubin level). We had phototherapy for 3.5 days and it didn't help to reduce baby's jaundice. Liver function was tested normal (indicated by testing the ratio of conjugated vs unconjugated bilirubin; where normal conjugated bilirubin signifies a working liver). Regular visits to polyclinic depletes our wallet but not the jaundice problem. We got to know that some parents just stopped visiting the clinic after the repetitive tests and brief "consultations" informing them numbers ranging from 180 to 210 of bilirubin level. The consultation fee was very high as compared to the price of the test itself (almost10 fold difference!), e.g. SGD 6.00 per test as compared to SGD 45.00 per consultation. My opinion is that there shouldn't be a flat rate of SGD45 for consultation pertaining to reading to parents their babies' bilirubin test results and setting another appointment for further tests!
How I wished there was an over-the-counter test kit for measuring bilirubin at home. Alas, a spectrophotometer is required to test bilirubin and that machine is not cheap to be placed in homes.
Solution
Now, we are advised to mix formula with breast milk for our baby in order to hasten the clearing of his jaundice. Although we wanted to give complete breast milk, but under the current circumstances - breast milk alone had failed to reduce baby's jaundice and thus - we are obligated to get a tin of formula and start giving mixed milk to our baby. Hope this approach will help reduce our baby's jaundice.
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