40例行换血治疗的Rh血型系统新生儿溶血病分析  

Analysis of 40 cases hemolytic disease of newborn with Rh blood group system treated by exchange transfusion

作　　者：朱加强 ZHU Jiaqiang(Linyi Blood Center,Linyi,276000,China)

机构地区：[1]临沂市中心血站,山东临沂276000

出　　处：《临床血液学杂志（输血与检验）》2020年第5期704-706,共3页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:回顾性调查临沂地区40例行换血治疗的Rh新生儿溶血病(HDN)的患儿情况,探讨抗体分布特征及换血治疗策略,为Rh HDN的治疗及预防提供支持资料。方法:选取行换血治疗的Rh HDN进行ABO血型鉴定、抗原表型鉴定,直接抗人球蛋白试验、游离抗体试验、抗体释放试验及抗体特异性鉴定,并统计相关临床资料。结果:在40例换血治疗的Rh HDN中抗-D 27例(67.5%)、抗-E 9例(22.5%)、抗-c 2(5.0%)、抗-D+E 2例(5.0%)。抗-D组与抗-E组在胎龄、出生体重、黄疸出现时间等方面差异无统计学意义(P>0.05),抗-E组换血前总胆红素和血红蛋白水平均明显高于抗-D组(P<0.05)。27例抗-D引起的HDN中,13例患儿使用5 d内的新鲜红细胞,14例患儿使用冰冻解冻去甘油红细胞进行换血治疗。换血后血清TB水平均显著下降(P<0.05)。换血前后Rh-新鲜红细胞组Hb水平显著上升(P<0.05);Rh-冰冻红细胞组换血后贫血无加重。所有患儿均痊愈出院。结论:新生儿来自母体被动获得的Rh血型抗体是Non-ABO-HDN主要的致病抗体,以抗-D为主。建议对孕妇孕检常规进行血型不规则抗体检测和鉴定,对早期诊断和预防Rh-HDN有重要意义。对于危重Rh HDN患儿,可以使用Rh阴性新鲜红细胞或者冰冻解冻去甘油红细胞换血。Objective:To investigate the characteristics of antibody distribution and the strategy of blood exchange therapy in 40 cases of Rh hemolytic disease of the newborn(HDN)in Linyi area.Method:ABO blood group identification,antigen phenotype identification,direct anti human globulin test,free antibody test,antibody release test and antibody specificity identification were carried out for Rh HDN in our center,and relevant clinical data were collected.Result:Among 40 cases of Rh HDN treated by exchange transfusion,anti-D accounted for 27 cases(67.5%),anti-E 9 cases(22.5%),anti-c 2 cases(5.0%)and anti-D+E 2 cases(5.0%).There was no significant difference between anti-D group and anti-E group in gestational age,birth weight and jaundice time(P>0.05).The level of total bilirubin and hemoglobin in anti-E group was significantly higher than those in anti-D group(P<0.05).In addition,in 27 cases of HDN caused by anti-D,13 cases were treated with fresh red blood cells in 5 days and 14 cases with frozen and unfrozen red blood cells.The results of two kinds of blood exchange were satisfactory,and the level of serum TB decreased after blood exchange(P<0.05).The Hb level of Rh-fresh group increased significantly before and after blood exchange(P<0.05);Hb level of Rh frozen group did not aggravate anemia.All the children were cured and discharged.Conclusion:The Rh blood group antibody obtained passively from the mother is the main pathogenic antibody of non ABO HDN,with anti-D as the main antibody and the most blood exchange.It is suggested that the routine detection of irregular blood group antibodies for pregnant women may be of great significance for early diagnosis and prevention of Rh HDN;for children with critical Rh HDN,if they would not get Rh negative fresh red blood cells in time,they could use frozen thawing to remove glycerine red blood cells for blood exchange.

关 键 词：RH血型 新生儿溶血病 换血 

分 类 号：R556.6[医药卫生—血液循环系统疾病]