胎儿/新生儿同种免疫性血小板减少症的诊断——附1例并文献复习  

Fetal/neonatal alloimmune thrombocytopenia: a case report and literature review

作　　者：郝欣欣 邓晶[2] 丛桂敏 乔宠[1] 叶欣[2] 王秋实[1] HAO Xinxin;DENG Jing;CONG Guimin;QIAO Chong;YE Xin;WANG Qiushi(Shengjing Hospital of China Medical University,Shenyang 110004,China;Institute of Clinical Blood Transfusion,Guangzhou Blood Center;Shenyang Womenand Children's Hospital)

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004 [2]广州血液中心临床输血研究所 [3]沈阳市妇婴医院

出　　处：《中国输血杂志》2020年第11期1167-1172,共6页Chinese Journal of Blood Transfusion

基　　金：辽宁省科学技术基金(2018225088)。

摘　　要：目的探讨胎儿/新生儿同种免疫性血小板减少症(FNAIT)的发病机制、临床特点和治疗方式,辅助临床诊断,更好的预防和治疗本病。方法附1例胎儿同种免疫性血小板减少症病例报告,并对近年国内外关于胎儿/新生儿同种免疫性血小板减少症进行文献回顾。结果胎儿/新生儿同种免疫性血小板减少症并不少见,主要致病因素为母体和胎儿血小板HLA-Ⅰ和/或HPA抗原不和,或CD36抗原缺失导致产生抗体。临床症状轻重不一,其中以颅内出血最严重。HPA和CD36基因分布存在多态性,中国HPA-3杂合度最高。本文病例为抗HPA-3a引起FNAIT,伴颅内出血引起流产案例。结论血小板相关抗体检测用于FNAIT诊断和发现,并指导进一步治疗方案。Objective To investigate the pathogenesis, clinical characteristics and treatment of fetal/neonatal alloimmune thrombocytopenia(FNAIT), so as to assist clinical diagnosis and better prevent and treat this disease.Methods A case of FNAIT was reported here, and the literature on FNAIT at home and abroad in recent years was reviewed. Results FNAIT was not uncommon, and the main pathogenic factors of it were the incompatibility of maternal and fetal platelet HLAI and/or HPA antigen, or antibody production due to the lack of CD36 antigen.The clinical symptoms varied in severity, with intracranial hemorrhage being the most serious. There were polymorphisms in the distribution of HPA and CD36 genes, and the heterozygosity of HPA-3 was the highest in China. This report was a case of abortion caused by anti-HPA-3 a FNAIT, accompanied by intracranial hemorrhage.Conclusion Platelet related antibody testing is effective to diagnose and detect FNAIT, and helpful to guide further treatment.

关 键 词：血小板减少症 新生儿 HPA-3a 同种免疫 

分 类 号：R457.1[医药卫生—治疗学] R558.2[医药卫生—临床医学]