RhD--表型引起的胎儿新生儿溶血病的免疫学分析--附1例报道

Blood immunological analysis of hemolytic disease of the fetus and newborn caused by Rh deletion type D--

目的分析1例胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)产生的原因,初步探讨产妇Rh缺失型D--形成的遗传背景。方法使用血清学方法对患儿及其母亲进行ABO血型、Rh分型,血液抗体细胞,谱细胞分析,探讨导致胎儿溶血的抗体以及Rh缺失型D--的血型血清学特点,对产妇进行RH基因序列分析。结果患儿母亲血型为O型,血清学试验结果显示Rh缺失型D--,怀疑为多次妊娠产生针对Rh高频抗原的抗-Hr0,抗体通过胎盘屏障,使患儿获得针对Rh高频抗原的抗-Hr0,导致HDFN,基因检测结果为RHCE^(*)Ce/RHCE^(*)Ce。结论对产妇开展Rh缺失型D--的形成机制进行深入研究,为HDFN换血治疗提供临床价值,也为特殊血型人群输血提供临床依据。

Objective To analyze the causes of a case of hemolytic disease of the fetus and newborn(HDFN),and investigate the genetic background of maternal Rh deletion D--formation.Methods Blood samples of maternal and fetus were collected,and ABO blood typing,Rh blood typing,antibody screening and identification test were performed to explore the blood group serological characteristics of Rh deletion type D--,and Rh gene sequence was performed on parturient.Results The maternal blood group was identified to be O type,D--,and the anti-Hr0 antibody against Rh high-frequency antigen was suspected to be caused by multiple pregnancies which passes through the placental barrier and enable fetus to obtain anti Hr0 antibody,leading to HDFN,with genetic testing result as RH RHCE^(*)Ce/RHCE^(*)Ce.Conclusion In-depth research on the formation mechanism of Rh D--in parturient should be conducted to provide clinical value for HDFN blood exchange treatment and blood transfusion in special blood group population.