9例新生儿高效价RhD抗体导致胎儿新生儿溶血病且形成RhD抗原遮蔽现象的回顾性分析与对策

Retrospective analysis and countermeasures of 9 neonates with high-titer RhD antibodies leading to haemolytic disease of foetus and newborn and formation of RhD antigen"Blocking"

目的:回顾调查新生儿高效价RhD抗体导致胎儿新生儿溶血病(HDFN)的患儿资料,了解新生儿血型鉴定和新生儿溶血病相关情况。方法:9例新生儿抗D-HDFN且抗-D抗体效价大于1︰256,利用全自动血型仪和盐水试管方法,检测血型、不规则抗体、抗体效价、溶血3项试验,记录新生儿溶血病发病时间、血清总胆红素、血清间接胆红素、血红蛋白的检测数据。结果:9例新生儿中A型3例、B型4例、O型2例;RhD血型初筛与复检不相符3例;不规则抗体三细胞均为阳性;抗体效价1︰512~4096;新生儿溶血3项:直接抗人球蛋白试验、游离试验、放散试验均为阳性(3+~4+);发病时间6.2 h、血清总胆红素(125.2±31.3)μmol/L、血清间接胆红素(111.7±30.2)μmol/L、血红蛋白(115.2±6.9)g/L。结论:高效价RhD抗体导致严重HDFN,可形成抗原遮蔽现象,给新生儿RhD血型鉴定带来困扰,需综合检测分析,确保试验结果可靠性。

Objective:To retrospectively investigate the medical history of the hemolytic disease of fetus and newborn(HDFN)caused by high-titer RhD antibodies in our hospital,and understand the blood type identification of neonates and the related conditions of haemolytic disease of newborn.Methods:Nine neonates with anti-D-HDFN and anti-D antibody titers greater than 1:256,using automatic blood type analyzer and saline test tube method,were detected blood group,irregular antibodies,antibody titers and hemolysis three tests,and neonatal hemolysis disease onset time,detection data of total serum bilirubin,serum indirect bilirubin and hemoglobin were recorded.Results:Among 9 newborns,there were 3 cases of ABO blood group A type,4 cases of B type,and 2 cases of O type;3 cases of RhD blood group screening and re-examination;3 cases of irregular antibodies were positive;antibody titer 1:512~4096.The three DAT,free test,and release test of neonatal hemolysis were positive(3+~4+);onset time was 6.2 h,total serum bilirubin was(125.2±31.3)μmol/L,indirect serum bilirubin was(111.7±30.2)μmol/L,and hemoglobin was(115.2±6.9)g/L.Conclusion:High titer RhD antibodies could cause severe HDFN,which could form an antigen"Blocking"phenomenon,which would cause problems for newborn RhD blood group identification.Comprehensive testing and analysis may be required to ensure the reliability of test results.