少见新生儿溶血病七例临床分析

Clinical analysis of seven cases of rare hemolytic disease of the newborn

目的 总结7例少见新生儿溶血病病例的临床特点,提高对新生儿少见溶血病的认识.方法 回顾性病例总结.首都医科大学附属北京儿童医院新生儿科2007年7月至2017年6月临床诊断为新生儿MN溶血病4例、Kidd溶血病2例、Duffy溶血病1例,回顾性分析其临床资料、实验室检查、治疗及转归.结果 4例MN溶血病患儿中男2例、女2例,其中3例出现了黄疸,2例发生了高胆红素血症,其中1例发生了重度高胆红素血症,4例均出现了贫血,其中3例发生了重度贫血.2例Kidd溶血病和1例Duffy溶血病患儿均出现了黄疸和贫血,但未达到重度高胆红素血症及重度贫血的标准.MN溶血病患儿直接抗人球蛋白试验均为阴性,Kidd溶血病和Duffy溶血病患儿直接抗人球蛋白试验均为阳性.7例患儿均未换血,病情好转出院.结论 对于无ABO、Rh血型系统母子血型不合条件,生后不明原因黄疸出现早、黄疸程度重、贫血的新生儿,仍应积极完善母子抗人球蛋白试验,注意MN、Kidd、Duffy等少见的新生儿溶血病.

Objective To summarize the clinical features of 7 rare cases of hemolytic disease of newborn （HDN）,and to improve the understanding of rare HDN.Methods Data of clinical information,laboratory findings,treatments and outcomes were collected and analyzed for four cases with HDN due to anti-M,two cases due to anti-Kidd,and one case due to anti-Duffy.All of them were admitted to the Department of Neonatology,Beijing Children＇s Hospital Affiliated to Capital Medial University from July 2007 to June 2017.Results Among the four MN hemolytic babies,two were males and two were females.Jaundice was found in three cases.Two cases had hyperbilirubinemia,one of them had severe hyperbilirubinemia.All the four cases developed anemia,including severe anemia in three cases.Two cases of Kidd hemolytic disease and 1 case of Duffy hemolytic disease had jaundice and anemia,but did not reach the level of severe hyperbilirubinemia and severe anemia.MN hemolytic disease babies got negative results in direct antiglobulin test,whereas the Kidd and Duffy hemolytic disease babies had positive findings in direct antiglobulin test.None of the babies had blood transfusion,and they were discharged from the hospital.Conclusions Without maternal and fetal blood group incompatibility （ABO or Rh blood-group system）,for early onset of jaundice,severe jaundice or anemia,antiglobulin test to mother and child earlier should be administered,and MN,Kidd,Duffy and other rare hemolytic disease of the newborn should be pay attention to.