高效价抗-D抗体导致新生儿RhD抗原遮蔽的处理方法及输血策略  

Treatment method and blood transfusion strategy for neonatal RhD antigen masking caused by high titer anti-D antibody

作　　者：骆园园[1] 沈雨青[1] 苏奶助 龚君顺 符虹 卢春敬 郑艳玲[2] Luo Yuanyuan;Shen Yuqing;Su Naizhu;Gong Junshun;Fu Hong;Lu Chunjing;Zheng Yanling(Department of Blood Transfusion,Women and Children's Hospital,School of Medicine,Xiamen University,Xiamen 361003,Fujian,China;Department of Blood Transfusion,the First Affiliated Hospital of Xiamen University,Xiamen 361003,Fujian,China)

机构地区：[1]厦门大学附属妇女儿童医院(厦门市妇幼保健院)输血科,福建厦门361003 [2]厦门大学附属第一医院输血科,福建厦门361003

出　　处：《实用检验医师杂志》2023年第3期333-336,共4页Chinese Journal of Clinical Pathologist

基　　金：福建省厦门市医疗卫生指导性项目(3502Z20209206)。

摘　　要：目的分析1例RhD阴性母亲产生高效价免疫球蛋白G(IgG)抗-D抗体致新生儿RhD抗原遮蔽的血清学特点,讨论溶血病患儿的救治及输血对策。方法采用盐水法、微柱凝胶卡法、热放散及酸放散试验和基因测序等方法检测患儿血型;对患儿血液样本进行溶血病三项试验;采用试管法对母亲和患儿进行抗体鉴定和抗体效价检测;采用IgG分型试剂鉴定致病抗体IgG类型。结果患儿直接抗球蛋白试验阳性,血型初次鉴定为O、dccEe,采用酸放散试剂处理红细胞后与抗-D试剂发生凝集。患儿RhD基因检测结果为RhD^(+)/RhD^(-)杂合型(阳性),确诊母亲和患儿的血型分别为O、dccee和O、DccEe。母亲及患儿血清中均存在IgG1和IgG3抗-D抗体,抗体效价均高达2048。患儿于24 h内及时接受换血治疗,病情得到有效控制。结论高效价的IgG抗-D抗体能完全遮蔽新生儿D抗原,可采用酸放散试剂处理红细胞鉴定抗原,通过血型基因检测进行验证,避免误判血型。因此对RhD阴性孕产妇早期进行血型鉴定,纳入高危妊娠管理,并提高实验室的检测水平,对可能发生新生儿溶血病胎儿的救治具有非常重要的临床意义。Objective To analyze the serological characteristics of neonatal RhD antigen masking caused by high titer immunoglobulin G(IgG)anti-D antibody produced by RhD^(-)negative mother,and discuss the treatment of hemolytic disease and blood transfusion strategies in children.Methods The blood types of the children were detected by saline method,microcolumn gel card method,heat dissipation and acid dissipation test,and gene sequencing.Three tests of hemolytic disease were performed on blood samples of children.The antibody identification and antibody titer detection of mothers and children were carried out by the test tube method.The type of pathogenic antibody IgG was identified using IgG typing reagents.Results The child's direct antiglobulin test was positive,the initial blood type was O and dccEe,and the red blood cells were agglutinated with the anti-D reagent after treatment with acid-releasing reagent.The child's RhD gene test result was RhD^(+)/RhD^(-)heterozygous(positive),and the blood types of the mother and child were O,dccee and O,DccEe,respectively.There were IgG1 and IgG3 anti-D antibodies in the serum of mother and child,and the antibody titer was as high as 2048.The child was treated with transfusion in time within 24 hours,and the condition was effectively controlled.Conclusions The high titer of IgG anti-D antibody could completely conceal the D antigen of newborns.The red blood cells are treated with acid dispersal to identify the antigen and verified by blood group genetic testing to avoid misjudgment of blood type.Therefore,the early blood typing of RhD^(-)negative pregnant women,the inclusion of high-risk pregnancy management,and the improvement of laboratory testing levels are of very important clinical significance for the blood transfusion treatment of hemolytic disease of newborn in the fetuse.

关 键 词：新生儿溶血病 抗原遮蔽 免疫球蛋白G 酸放散试验 血型基因检测 

分 类 号：R722.18[医药卫生—儿科]