抗-M抗体致胎儿新生儿溶血病的实验室检测分析  

Laboratory detection and analysis of fetal and neonatal hemolytic disease induced by anti-M antibody

作　　者：郑艳玲[1] 洪强[1] 王前明[2] ZHENG Yan-Ling;HONG Qiang;WANG Qian-Ming(Department of Blood Transfusion,the First Affiliated Hospital of Xiamen University,Xiamen,Fujian 361003,China)

机构地区：[1]厦门大学附属第一医院输血科,福建厦门361003 [2]厦门大学附属第一医院检验科,福建厦门361003

出　　处：《中国妇幼保健》2022年第24期4596-4599,共4页Maternal and Child Health Care of China

基　　金：福建省自然科学基金卫生行业项目(2019J01568)。

摘　　要：目的研究抗-M抗体引起的胎儿新生儿溶血病(HDFN)的临床表现和血清学检测特点。方法对2017—2021年厦门大学附属第一医院抗-M抗体引起的胎儿新生儿溶血病进行回顾性分析,比较致病抗体在HDFN患儿与同期孕妇不规则抗体的检出率,分析致病抗体引起的HDFN临床特点、实验室血清学检测特点。结果2017-2021年厦门大学附属第一医院孕妇产前抗体筛查检出不规则抗体(IgG、IgG+IgM)138例,18例为抗-M抗体,占总抗体检出率的13.04%。同期确诊的不规则抗体致HDFN 68例,5例为抗-M抗体,占总抗体检出率的7.35%。在血清学检测方面:1例ABO系统合并MNS系统致HDFN直抗试验阳性,余4例患儿直抗试验阴性;5例患儿放散试验均阳性。临床表现:4例患儿黄疸较高,1例患儿黄疸不明显(总胆红素61.1μmol/L)只表现贫血症状。1例患儿进行换血治疗,3例患儿输血治疗,均选择NN表型ABO同型的红细胞制品。结论抗-M抗体引起的HDFN发生在母亲有多次妊娠史的胎儿,此类HDFN较为隐匿,有些患儿溶血症状不明显,实验室检测常出现假阴性。建议加强孕妇的产前不规则抗体筛查、改进实验方法,避免抗-M抗体引起HDFN的漏检。Objective To study the clinical manifestations and serological detection characteristics of hemolysis disease of fetal and newborn(HDFN)caused by anti-M antibody.Methods Fetal and neonatal hemolytic disease caused by anti-M antibody in the First Affiliated Hospital of Xiamen University from 2017 to 2021 was retrospectively analyzed,and the detection rate of pathogenic antibody in HDFN children and pregnant women of the same period was compared,and the clinical characteristics and laboratory serological detection characteristics of HDFN caused by pathogenic antibody were analyzed.Results A total of 138 cases of irregular antibodies(IgG,IgG+IgM)were detected during prenatal antibody screening in the First Affiliated Hospital of Xiamen University from 2017 to 2021,and 18 cases were anti-M antibodies,accounting for 13.04%of the total antibody detection rate.In the same period,68 cases of HDFN caused by irregular antibody were confirmed,and 5 cases were anti-M antibody,accounting for 7.35%of the total antibody detection rate.In terms of serological testing,1 case was positive in direct antibody test of HDFN caused by ABO system combined with MNS system,the other 4 cases were negative in direct antibody test,and 5 cases were positive in release test.Clinical manifestations:jaundice was high in 4 cases,jaundice was not obvious in 1 case(TBIL 61.1μmol/L)presenting only anemia symptom.Blood exchange therapy was performed in 1 case,and blood transfusion was performed in 3 cases.ABO isotype RBC products with NN phenotype were selected in all cases.Conclusion HDFN caused by anti-M antibody occurs in the fetus with a history of multiple pregnancies.Such HDFN is relatively hidden,and some children with hemolysis symptoms are not obvious,and the laboratory tests often appear false negative.It is suggested to strengthen the serological detection of antenatal antibodies in pregnant women and improve experimental methods to avoid the missed detection of HDFN caused by anti-M antibodies.

关 键 词：胎儿新生儿溶血病 抗-M抗体 高胆红素血症 换血疗法 不规则抗体筛查 

分 类 号：R722[医药卫生—儿科]