抗-M抗体引起多次宫内死胎的血型血清学及基因分析

Anti-M-induced multiple intrauterine deaths: Serological and molecular analysis

目的母婴血型不合导致的胎儿及新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)多见于ABO及Rh系统,其他系统引起的少见。文中介绍了1例罕见的由抗-M抗体引起的严重胎儿溶血导致多次宫内死胎的案例,旨在加强对IgG型抗-M抗体临床重要性的认识。方法复习该经产妇的5次妊娠史及胎儿情况,对其及其丈夫血型进行血清学及基因分型,并对其血型抗体进行筛查及效价检测。结果该经产妇为NN血型,其丈夫为MM血型;其血清中检测出抗-M抗体,多次抗体效价测定值波动范围为1∶8至1∶64。结论通过对本例血型基因的分析,确诊为抗-M抗体引起的HDFN,提示对于原因不明的多次死胎、流产等,需要考虑到抗-M抗体或其他血型抗体引起的可能性。

Objective Hemolytic disease of the fetus and newborn （HDFN） is attributed more to ABO and Rh incompatibility than other blood groups. This article presents a rare case of multiple intrauterine deaths caused by IgG anti-M, aiming at a better understanding of the clinical significance of this alloantibody.MethodsThe pregnancy history of this woman was described in detail. The blood groups of the couple were determined by serology and PCR genotyping. Antibody identification and antibody titration detection were performed for the woman.ResultsThe blood type of the woman was NN and that of her husband was MM. IgG anti-M was detected in the woman′s serum and the antibody titration ranged from 1∶8 to 1∶64.ConclusionThe case was confirmed to be HDFN caused by the IgG anti-M. The serological results were confirmed by PCR genotyping. For mothers with a history of intrauterine deaths and abortion, anti-M and other IgG type alloantibodies should be considered after excluding other possible causes.