紧急情况下RhD阴性血型育龄女性输注RhD阳性血液风险及输血策略的研究进展

Research progress on RhD-positive blood transfusion risk and blood transfusion strategy in women of childbearing age with RhD-negative blood type in emergencies

为了降低同种免疫所致胎儿/新生儿溶血病(HDFN)的风险,多数输血指南推荐RhD阴性血型育龄女性进行输血治疗时,应输注RhD阴性血液。但是大出血等紧急情况下,RhD阴性血液通常不能满足临床救治需求。越来越多的研究证据表明,大出血患者复苏效果与尽早接受输血治疗疗效呈显著正相关关系。随着近年HDFN预防措施的广泛开展和诊疗管理水平的提高,该病发生率、致残率和病死率均已降至极低水平。因此,紧急情况下RhD阴性血型育龄女性输注RhD阳性血液的临床获益可能优于HDFN所致不良影响。笔者拟就RhD阴性血型育龄女性输注RhD阳性红细胞导致HDFN的相关风险及输血策略进行综述,旨在为制定RhD阴性血型育龄女性的输血方案提供参考。

In order to reduce the risk of hemolytic disease of the fetus/neonatal(HDFN)caused by alloimmunization,most blood transfusion guidelines recommend that women of childbearing age with RhD-negative blood type should be transfused with RhD-negative blood.However,RhD-negative blood usually cannot meet needs of clinical treatment in emergencies,such as major bleeding.More and more research evidences have showed that there was a strongly positive correlation between resuscitation effect and early blood transfusion in patients with massive hemorrhage.Meanwhile,the incidence,disability and fatality rate of HDFN has dropped extremely on account of the extensive development of preventive measures and great improvement of diagnosis and treatment of this disease.Therefore,the clinical benefit of RhD positive blood transfusion for women of childbearing age with RhD negative blood type may be better than adverse effects caused by HDFN in emergency.This article reviews the risk and transfusion strategies of RhD-positive blood transfusion in RhD-negative women of childbearing age,in order to provide reference for formulating blood transfusion programs for women of childbearing age with RhD negative blood type.