母婴ABO血型不合新生儿溶血病的临床与实验室研究

目的 对母婴ABO血型不合新生儿溶血病(HDN)的临床与实验室研究进行探讨,为临床提供更加有效的预报ABO血型不合HDN的检测方法。 方法 应用血清学方法检测2014年5月-2016年9月在瑞安市人民医院检查的600对夫妇及新生儿的ABO和RhD血型,采集产后新生儿脐血作HDN 3项试验(直接抗球蛋白实验、血清中游离抗体测定和红细胞抗体释放试验),并采用间接抗球蛋白实验测定孕妇产后血清抗A(B)IgG的效价。 结果 血清学方法检测到HDN发病例数为357例,总阳性率为59.5%;产妇-丈夫-新生儿血型为O-A-A型有168例(3项阳性49例,2项阳性7例,单项阳性49例,共105例显示为阳性,总阳性率为62.50%),O-B-B型有127例(71例均为3项阳性,总阳性率为55.90%),O-AB-A型有182例(3项阳性75例,2项阳性37例,单项阳性70例,共112例显示为阳性,总阳性率为61.54%),O-AB-B型有123例(3项阳性41例,2项阳性14例,单项阳性14例,共69例显示为阳性,总阳性率为56.10%),总阳性率按从大到小顺序排列为:O-A-A>O-AB-A>O-AB-B>O-B-B;随着孕妇产后血清抗A(B)IgG的效价的升高,HDN的发病率也逐渐增大。 结论 ABO HDN具有较高发病率,尤以母亲血型为O性,新生儿血型为A型最为常见,且抗体释放试验可有效检测ABO HDN,孕妇IgG抗A(B)抗体效价可用来评估HDN发病率,这对HDN的有效预测和诊断具有重要的临床意义。 

Clinical and laboratory studies on HDN of maternal and child blood type incompatibility

Objective The clinical and laboratory studies on hemolytic disease of newborn (HDN) of maternal and child ABO blood type incompatibility were discussed, and to provide a more effective prediction of ABO blood group incompatibility HDN detection method. Methods Serological methods were applied from May, 2014 to September, 2016 in our hospital to check the 600 couples' and newborns' ABO and RhD blood type, the postnatal neonatal umbilical cord blood was collected for HDN three trials (direct antiglobulin test, serum free antibody assay and erythrocyte antibody release test), and the indirect antiglobulin assay was used to determine the titer of anti-A (B) IgG in postpartum serum of pregnant women. Results The number of cases of HDN was 357, and the total positive rate was 59.5%; Maternal-husband-neonatal blood type which was O-A-A type had 168 cases (three positive cases in 49 cases, two positive in 7 cases, 49 cases of positive single, a total of 105 cases showed positive, the total positive rate was 62.50%), O-B-B type had 127 cases (71 cases were three positive, the total positive rate was 62.50%), O-AB-A type had 182 cases (three positive cases in 75 cases, two positive in 37 cases, 70 cases of positive single, a total of 112 cases showed positive, the total positive rate was 61.54%), O-AB-B type had 123 cases (three positive cases in 41 cases, two positive in 14 cases, 14 cases of positive single, a total of 69 cases showed positive, the total positive rate was 56.10%), and the total positive rate was O-A-A> O-AB-A> O-AB-B> O-B-B in order from large to small; The incidence of HDN was also increased as the titer of anti-A (B) IgG in postpartum serum of pregnant women increased. Conclusion ABO HDN has a higher incidence, especially when the mother's blood type is O, the most common neonatal blood type is type A, and antibody release test can effectively detect ABO HDN; maternal IgG anti-A (B) antibody titers can be used to assess the incidence of HDN, which is an important clinical significance for the effective prediction and diagnosis of HDN.