宫内输血和宫外换血治疗Rh血型不合重度溶血病并血小板减少症一例及文献复习  

Intrauterine fetal transfusions and postnatal exchange transfusion in the management of severe fetal rhesus haemolytic disease combined with fetal thrombocytopenia:case report and literature review

作　　者：黄越芳[1] 李易娟[1] 庄思齐[1] 方群[2] 杨萍[1] 陈慧卿[1] 柯志勇[1] 李晓瑜[1] 

机构地区：[1]中山大学附属第一医院儿科,广东广州510080 [2]中山大学附属第一医院妇产科胎儿医学中心,广东广州510080

出　　处：《中国优生与遗传杂志》2011年第5期119-121,共3页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨宫内输血治疗Rh胎儿溶血病的疗效、Rh重度溶血病合并严重血小板减少症以及新生儿晚期增生低下性贫血的的机制和治疗对策。方法分析我院近期成功救治的1例由IgG抗D引起的胎儿重度溶血病并发严重血小板减少症的临床资料,同时结合国外资料进行文献复习。结果本例胎儿30周时脐静脉穿刺查胎儿血红蛋白低至32g/L,血小板为73×109/L,娩出前胎儿血小板降至52×109/L,先后两次经脐静脉予以宫内输血纠正胎儿贫血,生后予以换血、光疗、输注血小板和免疫球蛋白以及输浓缩红细胞和使用促红细胞生成素纠正晚期贫血等治疗,患儿治愈,出院定期随访,生后6个月生长发育良好。结论宫内输血能明显改善Rh血型不合重度溶血病预后,但应警惕Rh重度溶血病并发少见的血小板减少症,及时输注血小板防止颅内出血,同时注意纠正新生儿晚期增生低下性贫血。Objective： To study the efficacy of intrauterine fetal transfusions in fetal rhesus haemolytic disease and the mechanisms and management of rhesus haemolytic disease combined with fetal thrombocytopenia and late hyporegenerative anemia in neonate with rhesus hemolytic disease.Methods：We report our experience in the successful management of a complex case of severe fetal hemolytic disease due to Rhesus-D incompatibility combined with fetal thrombocytopenia.A literature review was also conducted.Results： The lowest fetal hemoglobin and platelet levels were 32g/L and 73×10^9/L,respectively.Intrauterine treatment consisted of two transfusions of packed red cells into the umbilical vein to correct fetal anemia.Postnatal management included exchange transfusion,phototherapy,platelet transfusion,intravenous immunoglobulins,as well as packed red cells transfusions and erythropoietin for late anemia.The infant was cured.On regular follow-up until the age of 6 months,he was doing well and showed normal growth and development.Conclusions： Intrauterine fetal transfusions can significantly improve the outcome of fetal rhesus haemolytic disease.Caution should be exercised in severe case complicated with fetal thrombocytopenia.Platelet transfusion is required in severe thrombocytopenia in order to prevent intracranial hemorrhage.Attention should be paid to late hyporegenerative anemia in neonate with rhesus hemolytic disease.

关 键 词：RH血型不合溶血病 血小板减少症 宫内输血 换血 晚期贫血 

分 类 号：R722.1[医药卫生—儿科]