厦门市RhD^(-)孕妇产前血型血清学联合不规则抗体筛查策略的探讨

The Blood Group Serology Combined Irregular Antibody Prenatal Screening Strategies for RhD^(-)Pregnant Women in Xiamen

目的:探讨厦门市RhD^(-)孕产妇血清学表型分布特点及不规则抗体检出以及产后追踪的情况。方法:收集2018年6月-2020年5月共313例RhD^(-)孕产妇样本,用试管盐水法进行Rh血清学表型鉴定,采用DiaMed低离子间接抗人球蛋白卡筛选和鉴定不规则抗体。通过查看病历,了解RhD^(-)孕妇生产过程和发生HDN的情况。结果:313例RhD^(-)孕产妇的Rh血清学表型分别为ccdee 180例(57.51%)、Ccdee 97例(30.99%)、ccdEe 10例(3.19%)、CCdee 21例(6.71%)、CcdEe 5例(1.60%),血清学表型以ccdee和Ccdee为主。313例RhD^(-)孕产妇检出不规则抗体11例,占总数的3.51%,分别为抗-D抗体8例、抗E抗体1例、抗-D合并抗-C抗体2例。追踪21例RhD^(-)孕产妇,顺产新生儿RhD^(-)2例、RhD+19例,其中2例发生RhD-HDN、1例发生RHE-HDN,其余18例未发生HDN。结论:厦门市RhD^(-)孕产妇的Rh血清学表型主要为ccdee,孕产史和输血史是导致RhD^(-)孕产妇不规则抗体产生的主要原因。建议临床对RhD^(-)血型孕产妇产前进行血清学表型联合不规则抗体筛查,以降低RhD-HDN发病风险,保障RhD^(-)稀有血型的输血安全。

qAbstract Objective: To investigate the distribution of Rh phenotype,irregular antibodies screenting and postpartum follow-up of RhD^(-)pregnant women in Xiamen. Methods: The samples of 313 RhD^(-)pregnant women from June 2018 to May 2020 were collected. Rh serotype phenotypes were identified by tube physiological saline method,irregular antibodies were screened and confirmed by DiaMed Low ion indirect anti-human gel card. By recording the medical, the pregnant women production process and the occurrence of HDN were investigated. Results: The Rh serological phenotypes of 313 RhD^(-)pregnant women were ccdee 180 cases( 57.51%),Ccdee 97 cases( 30.99%),ccdEe 10 cases( 3.19%),CCdee 21 cases( 6.71%),CcdEe 5 cases( 1.60%),the ccdee and ccdee were the most common in the serological phenotype. Eleven irregular antibodies were detected in 313 RhD^(-)pregnant women,accounting for 3. 51% of the total. There were 8 cases of anti-D antibody,1 case of anti-E antibody,and 2 cases of anti-D combined with anti-C antibody. The medical records of 21 RhD^(-)pregnant women were reviewed,19 cases of RhD+ and 2 RhD^(-)newborns were successfully delivered,in which 2 cases developed RhD-HDN,1 case developed RHE-HDN,and the remaining 18 cases did not develop HDN. Conclusion: The Rh serological phenotype of RhD^(-)pregnant women in Xiamen area is mainly for ccdee. Maternal history and blood transfusion history are the main causes of irregular RhD^(-)pregnant antibodies. It is recommended that serological phenotype combined with irregular antibody screening should be applied for RhD^(-)pregnant women in clinic,to reduce the risk of RhD-HDN and ensure the safety of RhD^(-)blood transfusion.