孕产妇Rh血型系统抗体检测和临床意义分析  

Correlation between the characteristics of Rh antibody and HDN in pregnant women

作　　者：周明[1] 王慧茹 陈洋[1] 王敏[1] 潘健[1] ZHOU Ming;WANG Huiru;CHEN Yang;WANG Min;PAN Jian(Department of Blood Transfusion,The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)输血科

出　　处：《安徽医药》2020年第2期252-256,共5页Anhui Medical and Pharmaceutical Journal

基　　金：安徽省自然科学青年基金资助项目(1708085QH198)

摘　　要：目的探讨产妇Rh血型系统抗体的检出特点,分析其与新生儿溶血病之间的关系并制定临床输血应对策略。方法选取2016年10月至2018年6月中国科学技术大学附属第一医院(安徽省立医院)孕产妇红细胞不规则抗体筛选试验阳性的血标本,根据抗体的Ig类型应用抗球蛋白法或微柱凝胶抗球蛋白法,鉴定受检血清(血浆)与谱细胞及自身红细胞的反应结果;检测Rh血型抗体的效价、免疫球蛋白类型及37℃反应性以明确其临床意义;孕产妇受检红细胞D、C、E、c、e抗原采用单克隆抗-D、抗-C、抗-E、抗-c、抗-e试剂鉴定其Rh血清学分型;新生儿标本进行溶血病三项试验,鉴定新生儿放散液的抗体与其母亲血清(血浆)中是否有相同,分析妊娠史、输血史与抗体产生的相关性。结果从4 680例住院孕产妇备血标本中共检出Rh血型抗体56例,检出率为1.20%,其中有妊娠史者48例,输血史者6例;Rh血型抗体的特异性为:抗-E 33例(58.92%)、抗-D 10例(17.86%)、抗-c 7例(12.50%)、抗-cE 5例(8.93%)、抗-C 1例(1.79%);血型抗体的免疫球蛋白类型主要为IgG或IgG+IgM类,间接抗球蛋白试验37℃下均可与相应抗原的红细胞凝集反应,抗体效价介于1~512;10例新生儿溶血病血清中抗体与其母亲相同。结论女性因妊娠或输血等免疫刺激是Rh血型抗体产生的主要原因,来自母体的Rh血型抗体可导致Rh-HDN,应增加孕产夫妇RhCE抗原常规检测并同型输血,可有效降低意外抗体的产生概率。Objective To analyze the screening results of Rh antibodies among pregnant patients before blood transfusion,to analyze its association with hemolytic disease of the newborn so as to developing strategies for clinical blood transfusion.Methods Blood samples tested positive in maternal red blood cell irregular antibodies screening from October 2016 to June 2018 at the First Affiliated Hospital of The University of Science and Technology of China(Anhui Provincial Hospital)were selected.Identification was performed on the reaction results of the tested serum(plasma)with spectral cells and their own red blood cells using the antiglobulin method or micro-column gel antiglobulin method according to the Ig type of the antibodies.Detection was made of the titer of Rh blood type antibodies,immunoglobulin type and activity at 37℃ to clarify its clinical significance and maternal red blood cell D,C,E,c,e antigens were identified by monoclonal anti-D,anti-C,anti-c,anti-E,and anti-e for serotyping.Neonatal specimens were tested for hemolytic disease in three items,identification was made of whether the antibodies in neonatal dispersion were identical with those in the maternal serum(plasma),and analysis was made of the correlation between the history of gestation,blood transfusion and antibody production.Results The Rh blood group antibody was detected in 56 cases(56/4680,1.20 %),including 48 cases with pregnancy history,6 cases with blood transfusion history.The specificities of antibodies to Rh blood antigens were found as follows:33 cases of anti-E(58.92%),10 cases of anti-D(17.86%),7 cases of anti-c(12.50%),5 cases of anti-e(8.93%),and 1 case of anti-C(1.79%).The immunoglobulin types of blood group antibodies were mainly IgG or IgG+IgM,and indirect antiglobulin test can react with erythrocyte agglutination of corresponding antigen at 37 ℃.The titer of antibody ranged from 1 to 512.Antibodies found in 10 cases of neonatal hemolytic serum were the same as those of their mothers.Conclusion Immune stimulation,such as preg

关 键 词：RH-HR血型系统 COOMBS试验 输血 不规则抗体 微柱凝胶抗球蛋白试验 

分 类 号：R446.6[医药卫生—诊断学] R714[医药卫生—临床医学]