母亲DⅥ-Ⅲ型致新生儿红细胞D抗原遮蔽引起HDN的鉴定与换血治疗  

Identification and exchange transfusion therapy of HDN caused by D antigen masking of neonatal erythrocytes by maternal DⅥ-Ⅲ

作　　者：万春晶 邢艳 马峰[1] 张瑜[1] 张瑞宁 徐华[2] 张薇薇 王宝燕[1] WAN Chunjing;XIN Yan;MA Feng;ZHANG Yu;ZHANG Ruining;XU Hua;ZHANG Weiwei;WANG Baoyan(Department of Blood Transfusion,the First Affiliated Hospital of Xi'an Jiao Tong University,Xi'an 710061,China;Shaanxi Blood Centre)

机构地区：[1]西安交通大学第一附属医院输血科,陕西西安710061 [2]陕西省血液中心

出　　处：《中国输血杂志》2020年第5期478-481,共4页Chinese Journal of Blood Transfusion

摘　　要：目的了解DⅥ-Ⅲ型产妇所育的RhD阳性新生儿D抗原遮蔽的血清学特征以制定和实施相应的RhD新生儿溶血病(RhD-HDN)换血治疗方案。方法采用血清学方法对1名新生儿患儿及其父母的血样做ABO与Rh血型鉴定、对患儿和母亲的血样做抗体鉴定、对患儿血样做直接抗球蛋白试验、游离和放散试验;采用PCR-SSP方法对患儿和母亲的血样做RHD基因检测;患儿经临床医师评估符合换血指征后,采用O型RhD阴性洗涤红细胞6 U和AB型RhD阳性血浆300 mL对其做经外周动静脉同步换血术,换血量为2倍新生儿血容量(150—180)mL/kg。结果患儿及其父母血型分别为:O DCcEe Jk(a+b+)、O DCCee Jk(a+b+)、A DⅥ-ⅢCcEe Jk(a-b+);患儿与母亲直接抗球蛋白试验为强阳性(4+);抗体鉴定:母亲血清中存在IgG-D合并IgG-Jk^a抗体,效价分别为512和≤1,患儿血清和放散液中存在IgG-D抗体,效价为256和512。换血治疗后患儿Hb(g)由46上升到181,TBIL(μmol/L)由240.1下降到81.4,抗体效价由512下降到128。结论采用多种实验方法可验证来自母体的高效价抗-D造成的新生儿红细胞表面D抗原遮蔽,从而避免患儿血型的误判。由RhD引起的重症HDN应尽早实施换血治疗可以得到良好的救治效果。Objective To understand the serological characteristics of D antigen masking in RhD-positive neonates born to DⅥ-Ⅲ parturients in order to formulate and implement the corresponding transfusion treatment scheme for RhD-HDN. Methods Serological methods were used to identify ABO and Rh blood groups in blood samples of a newborn infant and his parents, and to identify the antibodies of the newborn and his mother. Direct antiglobulin, dissociation and elution tests were performed on the blood samples of the newborn. Detection of RHD gene in blood samples of the newborn and his mother were performed by PCR-SSP. After conforming to the indication of exchange transfusion as assessed by the clinicians, the infant underwent peripheral arteriovenous synchronous exchange transfusion with RhD-negative washed red blood cells of type O(6 U) and RhD-positive plasma of type AB(300 mL), and the exchange volume was twice the neonatal blood volume [(150—180) mL/kg]. Results The blood groups of the newborn and his father and mother were: O DCcEe Jk(a+b+), O DCCee Jk(a+b+), and A DⅥ-Ⅲ CcEe Jk(a-b+), respectively. The direct antiglobulin test of the child and his mother presented strongly positivity(4+). Antibody identification: there were IgG-D combined with IgG-Jka antibodies in the maternal serum with titers of 512 and ≤1, respectively. IgG-D antibodies were present in the serum and the released fluid of the newborn, with titers of 256 and 512. After exchange transfusion, the newborn′s hemoglobin increased from 46 g/L to 181 g/L, total bilirubin decreased from 240.1 to 81.4 μmol/L, and antibody titer decreased from 512 to 128. Conclusion A variety of experimental methods were used to verify the masking of D antigen on the surface of neonatal red blood cells caused by high titer anti-D from the mother, thus the misjudgment of the blood group of the newborn had been avoided. Severe HDN caused by RhD should be treated with exchange transfusion as soon as possible, which can receive good treatment effect.

关 键 词：RhDⅥ-Ⅲ型 新生儿溶血病 母婴RH血型不合 D抗原遮蔽 换血治疗 

分 类 号：R457.11[医药卫生—治疗学] R722.18[医药卫生—临床医学]