罕见抗-Di^(b)致严重胎儿新生儿溶血病的实验室检测与相关研究  

Hemolytic diseases of the fetus and newborn caused by anti-Di^(b):a case report and related research

作　　者：廖志坚[1] 贾双双[1] 温机智[1] 莫春妍[1] 邵媛[1] 张润青[1] 罗广平[1] 姬艳丽[1] LIAO Zhijian;JIA Shuangshuang;WEN Jizhi;MO Chunyan;SHAO Yuan;ZHANG Runqing;LUO Guangping;JI Yanli(Institute of Clinical Blood Transfusion,Guangzhou Blood Center,Guangzhou 510095,China.)

机构地区：[1]广州血液中心临床输血研究所,广州市血液安全重点实验室,广东广州510095

出　　处：《中国输血杂志》2024年第2期158-164,共7页Chinese Journal of Blood Transfusion

基　　金：广州市科技计划项目(2023A03J0545,2023A03J0552),广州市医学重点学科(2021—2023年)项目。

摘　　要：目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行IgG分型检测,并用流式细胞术进行单核细胞体外吞噬致敏红细胞试验,以检测抗体相关的吞噬率;对患儿母亲、父亲及舅舅进行相关红细胞血型基因测序;利用稀释的母亲血浆和抗人球卡法,在献血者中进行大规模相合血液的筛选。结果产妇鉴定为Di(b-)稀有血型,产生了抗-Di b(效价512)并导致了严重的HDFN;抗-Di b亚型分型为IgG1和IgG2型,单核细胞体外吞噬效率为88.83%(74.7/84.09);产妇亲属中没有相合献血者,后续从5520名献血者中筛选到2例Di(b-)相合血液,患儿接收输血治疗后康复出院。后续在51334名献血者中筛查到17名Di(b-)献血者,该数据表明Di(b-)在广州地区献血者中的分布频率约为三千分之一(0.033%,17/51334)。结论综合利用血型血清学及分子生物学方法诊断了抗-Di b所致的严重HDFN,建立了1种有效大规模筛查Di(b-)稀有血型的方法并找到相合血液,为建立Di(b-)稀有血型库奠定了基础。Objective To identify the specificity of alloantibody against high-frequency antigens in one case suffering with severe hemolytic diseases of the fetus and newborn(HDFN)and to screen for matching blood for transfusion.Methods The HDFN test and the antibody serological identification tests in the mother were performed.Several common high frequency antigens of maternal red blood cells(RBCs)were determined.IgG subtype coated on the RBCs of the newborn was determined.The phagocytic efficiency of the antibody was tested using the monocyte phagocytosis of sensitized erythrocyte by flow cytometry in vitro.Sanger sequencing of DI gene was performed in the mother,father and mother’s brother.The diluted maternal plasma was used for large scale screening of matching blood using IAT in Coomb’s gel card.Results Di(b-)phenotype was identified in the mother of the newborn and anti-Di b(titer:512)related HDN was detected in the newborn.IgG1 and IgG2 subtypes of anti-Di b were detected and the rate of monocyte phagocytosis was 88.83%(74.7/84.09).The compatible blood was not detected in the maternal relatives.Subsequently,the newborn received the matching RBCs of two Di(b-)donors identified from 5520 blood donors and discharged from the hospital.We screened out 17 Di(b-)donors out of 51334 blood donors,indicating that the distribution frequency of Di(b-)among blood donors in Guangzhou was about 0.033%(17/51334).Conclusion By serology and molecular biology methods,the newborn was identified with HDFN caused by anti-Di b,and an effective large-scale screening method for Di(b-)rare blood types was established to find matching blood,which supported the establishment of rare Di(b-)blood database.

关 键 词：抗-Di b Di(b-)稀有血型 胎儿新生儿溶血病 

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