高效价IgG类抗-D致新生儿体内溶血的追踪观察  

Follow up of hemolytic changes in newborns induced by high titer IgG anti-D

作　　者：刘自强 杨静[1] 杨光 陈雪龙 袁红[1] LIU Ziqiang;YANG Jing;YANG Guang;CHEN Xuelong;YUAN Hong(Department of Blood Transfusion,Sichuan Academy of Medical Sciences and Sichuan Provincial Peopled Hospital,Chengdu,610075,China)

机构地区：[1]四川省医学科学院·四川省人民医院输血科,四川成都610075

出　　处：《中国输血杂志》2021年第5期501-504,共4页Chinese Journal of Blood Transfusion

摘　　要：目的通过对产妇产前抗-D的检测和对其产后新生儿进行血清学试验并分析结果。为临床Rh阴性孕妇产前预防和产后新生儿溶血病的治疗提供依据。方法对产妇产前进行不规则抗体筛查,和抗体鉴定并检测其效价,对患儿进行血型和溶血3项等检测。监测患儿出生后至出院时1 w内体内抗体效价、血红蛋白、胆红素变化情况并进行分析。结果产妇28 w后抗-D效价升高至512,孕30 w时效价为1 024,孕妇生产时效价为512,患儿出生后RhD抗原出现遮蔽效应,血红蛋白持续降低,总胆红素和间接胆红素在出生后24 h后出现急剧升高,并在48 h内到达峰值,此后逐渐降低。抗体效价出生后逐渐降低。结论密切监测Rh阴性产妇体内不规则抗体效价变化情况,有助于新生儿溶血病的预防及早期治疗,新生儿出生后应立即监测体内血红蛋白变化,并进行对症治疗减轻患儿受累。Objective To analyze the results of maternal anti-D measured prenatally and serological tests of the newborn postnatally, so as to provide a basis for perinatal prevention and treatment of hemolytic disease of the newborn(HDN) in Rh negative pregnant women. Methods Irregular antibodies screening, antibody identification and titer determination were carried out for pregnant women prenatally. Blood group typing and 3 HDN tests were performed for the infant suspected as HDN. One-month follow up, since the delivery of the infant, concerning the changes in antibody titers, hemoglobin and bilirubin of the infant were monitored. Results The anti-D titer increased to 512 since 28 weeks in the parturient, 1 024 at 30 weeks of gestation, and decreased to 512 at the time of delivery. The masking effect on RhD antigen was observed after the birth of the child, with a sustained decrease in hemoglobin and a sharp increase in total and indirect bilirubin after 24 h of birth, which peaked within 48 h and gradually decreased thereafter.The antibody titers gradually decreased after birth. Conclusion Close monitoring of the changes of irregular antibody titer in Rh negative parturients is helpful for the prevention and early treatment of HDN, and hemoglobin changes in the newborn should be monitored immediately after birth, as well as symptomatic treatment to reduce the involvement of affected children.

关 键 词：RH血型 抗-D 新生儿溶血病 

分 类 号：R457.11[医药卫生—治疗学] R556.63[医药卫生—临床医学]