襄阳地区23例RH血型抗体致新生儿溶血病输血治疗探讨

Transfusion Therapy of 23 Cases of HDN Caused by RH Blood Group Antibody in Xiangyang Area

目的回顾性分析襄阳地区23例RH新生儿溶血病(hemolytic disease of the newborn,HDN)患儿情况,为该地区RHHDN的治疗及预防提供支持资料。方法收集自2009年襄阳五家医院开展新生儿溶血病的实验室检测并明确诊断23例RH溶血症患儿的相关资料,对其标本进行血型鉴定、交叉配血、RH分型、不规则抗体定型、新生儿溶血三项试验,对实验结果进行分析;对确诊的孕妇进行血浆置换,对患儿进行换血治疗,然后观察患儿的胆红素指标以及部分生命体征,对这些指标进行分析。结果 23例患儿母亲的RH(D)阴性20例(87.0%),血清学表型分布为ccdee 9例(39.1%)、Ccdee8例(34.80%)、Ccd Ee2例(8.7%)、Ccd EE1例(4.3%)。另外三例RH表型为cc Dee 2例(8.7%),cc DEe 1例(4.3%)。新生儿的血清学表型分布为cc Dee 5例(21.7%)、Cc Dee3例(13.0%)、cc DEe6例(26.1%)、CCDee2例(8.7%)、Ccd Ee 7例(30.4%)。22例患儿进行换血治疗前、后胆红素对比均有明显降低;术中患儿呼吸、心率、血压、体温及经皮血氧饱和度均稳定,未出现不良反应,未作特殊处理。术后追踪观察1个月,无并发症发生。结论对孕妇和新生儿进行及时准确的实验室检查、孕妇进行血浆置换和药物治疗,以及在及时准确RH-HDN的诊断后采取换血治疗可以有效的预防和治疗RH-HDN。

Objective To retrospectively analyze 23 children condition of RH-HDN in Xiangyang area in order to provide treatment and prevention support information of RH-HDN. Methods The related clinical laboratory diagnosed data for 23 cases of RH-HDN in Xiangyang area have been collected. The data such as blood type,cross-matching of blood,RH typing,antibody irregular shape and hemolytic three trials were analyzed. The confirmed pregnant women were carried out plasma exchange. The blood exchange transfusion treatments were carried out for children and then bilirubin index and some vital signs of children were observed and analyzed.Results Of the 23 cases,the mother’s RH（ D） negative was 20 cases（ 87. 0%）,and serological phenotype distributions were 9 cases of ccdee（ 39. 1%）,8 cases of Ccdee（ 34. 80%）,2 cases of Ccd Ee（ 8. 7%） and 1case of Ccd EE（ 4. 3%）. The other three cases were RH phenotype 2 cases of cc Dee（ 8. 7%） and 1 case of cc DEe（ 4. 3%）. The newborns serological phenotype distributions were 5 cases of cc Dee（ 21. 7%）,3 cases of Cc Dee（ 13. 0%）,6 cases of cc DEe（ 26. 1%）,2 cases of CCDee（ 8. 7%） and 7 patients of Ccd Ee（ 30. 4%）.For 22 cases of children with blood transfusion therapy,the bilirubin concentrations were significantly reduced compared with before treatment. The children ’s breath,heart rate,blood pressure,body temperature and transcutaneous oxygen saturation were stable and without any adverse event in surgery treatment. There was no complication within one month after surgery. Conclusion Timely and accurate diagnosis on RH-HDN and then blood transfusion therapy could prevent and treat RH-HDN effectively.