抗-Di^a引起的胎儿及新生儿免疫溶血性疾病一例  

Hemolytic disease of fetus and newborn caused by anti-Di^a:a case report

作　　者：吴远军 杨勇[2] 姬艳丽[3] 莫春妍[3] 谢钟莹 袁千荃 曾嘉俊 温妙珍 吴树杰 Wu Yuanjun;Yang Yong;Ji Yanli;Mo Chunyan;Xie Zhongying;Yuan Qianquan;Zeng Jiajun;Wen Miaozhen;Wu Shujie(Department of Blood Transfusion,Dongguan Maternal and Child Health Care Hospital,Dongguan 523120,China;Department of Neonatology,Dongguan Maternal and Child Health Care Hospital,Dongguan 523120,China;Institute of Clinical Blood Transfusion,Guangzhou Blood Center,Guangzhou 510095,China)

机构地区：[1]东莞市妇幼保健院输血科,523120 [2]东莞市妇幼保健院新生儿科,523120 [3]广州血液中心输血研究所,510095

出　　处：《中华围产医学杂志》2020年第11期778-781,共4页Chinese Journal of Perinatal Medicine

基　　金：2019年东莞市社会科技发展(重点)项目(201950715007214)。

摘　　要：本文报道1例抗-Di^a引起的胎儿及新生儿免疫溶血性疾病(hemolytic disease of fetus and newborn,HDFN)新生儿的诊治过程。患儿生后3 h开始出现皮肤黄染并逐渐加重,转入东莞市妇幼保健院治疗。患儿生后5、9 h血红蛋白分别为82和76 g/L,总胆红素分别为243.2和309.8μmol/L。生后12 h,采集患儿及其父母外周血标本,进行HDFN的免疫血液学检测。结果显示,患儿及其父亲血型为A型、RhDCCee,母亲为A型、RhDCcee;直接抗球蛋白试验中患儿为强阳性(++++),父母均阴性;患儿血浆、红细胞放散液及其母亲血浆与抗体筛选试剂红细胞反应均阴性,但与患儿父亲红细胞反应均阳性。对患儿采用光疗、静脉输注免疫球蛋白,以及选择ABO及RhD血型与患儿相同,交叉配血相合的血液进行紧急换血治疗后,效果良好。换血治疗后,用患儿换血前的血浆、红细胞放散液及其母亲血浆与抗体鉴定谱细胞反应,均检出了IgG抗-Di^a。鉴定患儿及其父母Dia血型,患儿及其父亲为阳性,母亲为阴性。因此患儿被诊断为抗-Di^a引起的HDFN。We report a case of a newborn baby who suffered from hemolytic disease of fetus and newborn(HDFN)caused by anti-Di^a.The baby presented with worsening jaundice started at three hours after birth and was transferred to Dongguan Maternal and Child Health Care Hospital.The newborn's hemoglobin(Hb)was 82 and 76 g/L at five and nine hours after birth,and the total bilirubin(TBIL)was 243.2 and 309.8μmol/L,respectively.Blood samples of the newborn and the parents were collected for HDFN immunohematology test twelve hours after birth.They showed that the newborn and the father's blood type was A and RhDCCee,while the mother was A and RhDCcee.Direct antiglobulin test(DAT)indicateda strong positive for the newborn and negative for the parents.The reaction of the reagent to red blood cells for antibody screening with the patient's plasma,red cells eluate,and the mother's plasma were all negative,but were positive with the father's red blood cells.The newborn was recovered after treating with phototherapy,intravenous immunoglobulins and urgent blood exchange(the exchanged blood was the same ABO and RhD blood type and cross-matched).The newborn's plasma and red cells eluate were collected before blood exchange,and the mother's plasma were used to assess the red blood cells reaction,and IgG anti-Di^a was identified in each sample.Dia blood typing was positive for the newborn and the father,and negative for the mother.Therefore,the newborn was diagnosed as HDFN caused by anti-Di^a.

关 键 词：幼红细胞增多症 胎儿 婴儿 新生 血型抗原 胎儿及新生儿免疫溶血性疾病 

分 类 号：R714.5[医药卫生—妇产科学] R722.1[医药卫生—临床医学]