新生儿ABO溶血病血型血清学检测回顾性分析

Blood group serological testings of ABO hemolytic disease of newborn:A retrospective analysis

目的通过回顾性分析疑似HDN的母婴血液标本,并对发现的由不规则抗体导致的溶血病进行检测,为HDN的临床诊断和治疗提供帮助。方法收集2016年1月到2018年10月,本院产科和新生儿科的632例疑似HDN的标本,采用微柱凝胶技术对血液标本进行血型血清学检测及HDN 3项试验:直接抗球蛋白实验(DAT)、游离抗体试验和抗体释放试验检测。结果 632例标本中,HDN的阳性306例,阳性率为48.4%,疑似HDN有64例,占10.1%,不可证实为HDN有262例,占41.5%。其中A型有180例,HDN阳性占145例,阳性率达80.56%;B型有233例,HDN阳性占157例,阳性率达67.38%,O型有210例,HDN阳性占1例,阳性率达0.48%,AB型有9例,HDN阳性占3例,阳性率达33.33%,A型、B型、O型和AB型HDN阳性发生率均有统计学差异(P<0.05)。632例疑似HDN的标本中,检测出同时具有不规则抗体+免疫性抗A的9例,仅含免疫性抗-A的136例;同时具有不规则抗体+免疫性抗-B的10例,仅含免疫性抗-B的170例,同时具有不规则抗体+免疫性抗-A和抗-B的1例,仅含免疫性抗-A和抗-B的2例;仅因不规则抗体导致的HDN患儿4例,其中包括2例抗-S,2例抗-Ec。结论 ABO HDN较为常见,因此临床上比较重视,而其他系统引起的HDN较少见,易被忽视,但这些抗体可能引起中等及严重程度的HDN甚至引起胎儿严重贫血水肿和死胎。因此,孕期需做好孕妇不规则抗体筛查,对于不规则抗体筛查阳性的要鉴定,做到早发现,早治疗。

Objective To retrospectively analyze blood samples of suspected hemolytic disease of newborn(HDN)mothers and infants, and detect hemolytic disease caused by irregular antibodies, so as to provide help for the clinical diagnosis and treatment of HDN.Methods 632 suspected HDN samples from Obstetrics and Pediatrics Department of our hospital from January 2016 to October 2018 were collected, and serologically detected by microcolumn gel technique, as well as DAT, free antibody test and antibody release test.Results Among 632 samples, 306 were HDN positive, with a positive rate at 48.4%, 64 suspected HDN, accounting for 10.1%, and 262 non confirmed HDN, accounting for 41.5%. 180 samples were type A,among which 145 were HDN positive, with a positive rate at 80.56%;233 were type B, among which 157 were HDN positive, wiht a positive rate at 67.38%;210 were type O, among which 1 was HDN positive, with a positive rate at 0.48%;9 were type AB, among which 3 were HDN positive, with a positive rate at 33.33%. The positive rates of HDN differed by blood types(P<0.05). In 632 suspected HDN samples, 9 were with irregular antibody + immune anti-A, and 136 with solo immune anti-A;10 were with irregular antibody + immune anti-B, and 170 with solo immune anti-B;1 was with irregular antibody + immune anti-A and anti-B, and 2 with immune anti-A and anti-B;4 HDN cases were caused by irregular antibody, while anti-S and anti-E cconstituted 2 and 2 cases, respectively.Conclusion ABO HDN is more common and attracts more attention in clinical practice than HDN scaused by other group systems, which were rare and easy to be ignored, but also may cause moderate and severe HDN. even severe anemia, edema and stillbirth of fetus. Therefore, it is necessary to carry out irregular antibody screening during pregnancy so as to achieve early detection and treatment.