番禺地区RhD阴性孕妇产前筛查策略的探讨

Prenatal screening strategies for RhD-negative pregnant women in Panyu area, Guangdong

目的对广州番禺地区RhD阴性的孕产妇的产前血型抗体筛查和RHD基因分型以及产后追踪进行调查分析,为临床产科医生制定科学合理的预防新生儿溶血病发生的产前筛查策略提供科学依据。方法收集2016年1月-2018年12月广州市番禺地区RhD阴性孕产妇标本42例,用间接抗球蛋白法进行RhD确认,用吸收放散实验进行放散D确认,用PCR-SSP方法进行RHD基因分型。通过查看病历或电话回访,了解孕妇生产过程和HDN发生情况。结果 42例筛查阴性标本均确定为RhD阴性,9例经吸收放散试验确定放散D表型(Del),占比21.4%,基因分型均为RHD1227A DEL型;2例血清中检出抗-D,占比4.76%,基因分型均为RHD基因缺失型。成功追踪产妇17例,均顺利产下婴儿:RhD阴性1例、RhD阳性16例,2例血清中检查抗-D孕妇所生产的婴儿均发生RHD-HDN,其余15例均未出现明显的HDN症状。结论本地区RhD阴性孕产妇中存在较高比例的RHD1227A DEL(放散D),临床产科医生适当结合吸收放散试验和基因分型结果,更能精准制定RhD阴性孕妇的产前抗-D筛查、预防性注射Rh免疫球蛋白阻断母体抗-D产生以及预防RHD-HDN发生的管理策略。

Objective To investigate the prenatal blood group antibody screening, RHD genotyping and postpartum follow-up of RhD-negative pregnant and lying-in women in Panyu, Guangzhou, so as to provide scientific basis for clinical obstetricians to formulate scientific and reasonable prenatal screening strategies to prevent the occurrence of neonatal hemolytic disease. Methods Samples from 42 RhD-negative pregnant and lying-in women from January 2016 to December 2018 in Panyu District of Guangzhou City were collected. RhD was confirmed by indirect anti-human globulin method, D was confirmed by absorption and diffusion test, and RHD genotyping was performed by PCR-SSP method. By checking the medical records or telephone calls, the pregnant women′s production process and the occurrence of HDN were investigated. Results Forty-two negative screening specimens were confirmed as RhD negative. Nine(21.4%) of them were identified as Del by absorption and diffusion test, with the genotype of RHD 1227 A DEL. Anti-D was detected in 2(4.76%) sera samples, with the genotype of RHD deletion. Seventeen pregnant women were followed up successfully and all the babies were delivered smoothly: RhD negative in 1 case, and RhD positive in 16 cases. RHD-HDN occurred in all the babies produced by anti-D pregnant women(2 cases), while no obvious HDN symptoms were found in the other 15 cases. Conclusion There is a high proportion of RHD1227 A DEL in RhD-negative pregnant women in this region. The clinical obstetricians can formulate the management strategies of anti-D screening more accurately, block the production of maternal anti-D by prophylactic injection of Rh immunoglobulin and prevent the occurrence of RHD-HDN in RhD-negative pregnant women by properly combining the results of absorption, diffusion and genotyping.