ABO正反定型不合发现IgM+IgG抗-E所致HDN产前漏诊1例

Hemolytic disease of the newborn due to IgG/IgM anti-E:A case Report by the Discrepancies of Forward and Reverse ABO Typing

目的对1例ABO正反定型不合发现IgM+IgG抗-E所致新生儿溶血病(HDN)产前漏诊的病例分析。方法分别用盐水法、LISS-IAT等方法检测母亲血浆、患儿血浆、患儿红细胞放散液中同种抗体特异性并测其效价。结果患儿血浆、患儿红细胞放散液中均检出IgG抗-E、母亲血浆中检出IgM+IgG抗-E,孕妇于38+5周行剖宫术,产后因患儿黄疸出现较早且胆红素值升高速度较快遂给予丙球输注及蓝光照射治疗。结论围产期应做好HDN产前预测,对于不规则抗体阳性的母亲应密切监测血清抗体水平变化及抗体分型鉴定对于高危患者及时采取有效措施干预,减少患儿受累。

Objective To report a case of IgM/IgG anti-E induced hemolytic disease of the newborn screened by the discrepancies of forward and reverse AB0 typing in prenatal diagnosis. Methods The specificities and titers of irregular an- tibodies in the serum of mother ,and infant, and the elution liquid of infant RBC, were detected by serological method. Re- sults The irregular antibody, anti-E, was detected in both baby and mother. IgG anti-E existed in both the serum and RBC elution liquid of infant, while IgM/IgG anti-E was only detected in the serum of mother. Caesarean section was operated when the mother was at 38＋5 weeks of pregnancy. IVIG and blue light phototherapy were used for the infant because of the appearance of jaundice and the elevated bilirubin. Conclusion The levels and titers of serum irregular antibody should be monitored in pregnant women with positive irregular antibody. It is important to take effective measures timely in the high risk individuals to prevent the occurrence of severe disease.