胎儿血型的产前诊断

孕早期预测胎儿血型 ,对预防新生儿溶血病及预测与ABO/Rh血型基因型连锁的遗传性疾病 ,及治疗血型不合妊娠的胎儿溶血性贫血等 ,有着重要的意义。该文概述了胎儿血型产前诊断的方法。     

胎儿血型的产前诊断

孕早期预测胎儿血型，对预防新生儿溶血病及预测与ABO／Rh血型基因型连锁的遗传性疾病，及治疗血型不合妊娠的胎儿溶血性贫血等，有着重要的意义。该文概述了胎儿血型产前诊断的方法。     

新生儿血型不合溶血病

新生儿溶血病是危害新生宝宝健康的一大杀手,是由于孕母与胎儿血型不合引起的一种同族免疫性溶血性疾病,母血中抗体进入新生儿的血液循环并进而破坏新生儿的红细胞,导致发生溶血性贫血的一类疾病。临床上主要表现为皮肤黄疸,严重者出生时就有明显的水肿、贫血。我国所见的主要是ABO血型不合溶血病,也有少数Rh血型和其他少见血型不合溶血病。     

母儿血型不合的病因、病理、诊断与治疗

<正>母儿血型不合主要是因为孕妇和胎儿之间血型不合而发生的疾病,可使胎儿红细胞凝集破坏,引起胎儿或新生儿溶血症。患儿常因严重贫血、心力衰竭而死亡,或发生严重黄疸,病死率高,即使幸存,患儿智力发育也受影响。     

胎膜早破对新生儿多器官系统的损害与临床管理

胎膜早破(PROM)是孕产期常见临床问题,可对胎儿和新生儿健康造成多方面的损害,尤其是导致其肺发育障碍和感染,甚至导致胎儿死亡或增加新生儿死亡率。本文结合本课题组在这方面的研究工作及国内外相关文献,对PROM及其对胎儿-新生儿的危害予以介绍,以加强其临床管理、改善PROM之胎儿-新生儿的预后。     

妊娠期贫血

<正>贫血是妊娠期常见的合并症。研究表明,贫血对母体、胎儿和新生儿可造成近期和远期影响,如可导致孕妇抵抗力低下,妊娠期高血压、子痫发生率升高,对分娩、手术和麻醉的耐受能力差,增加感染风险,等;对胎儿而言,重度贫血会导致胎儿生长受限、胎儿窘迫、早产或死胎。妊娠期贫血的常见类型很多,包括     

Rh血型与妊娠相关问题的研究进展

Rh阴性的女性患者在输血、妊娠等免疫过程中可以产生抗体。Rh血型不合亦是我国新生儿溶血病（hemolytic disease of newborn,HDN）的主要原因之一,导致新生儿严重的黄疸、贫血,全身水肿,心衰,甚至核黄疸、智力障碍及胎儿宫内死亡。不同的Rh抗体所发生HDN的严重程度有一定差异,并且新生儿溶血的发生率及严重程度也随着母亲免疫抗体效价增高相应增加。Rh阴性妇女妊娠前,需询问患者孕产史及输血史,必要时检测Rh IgG抗体效价,妊娠期需定期进行血型抗体检测,并结合B超以早期发现胎儿溶血,合理使用抗D免疫球蛋白可以降低HDN的发生。Rh阴性孕妇输血非常慎重,输血前的检测很关键。     

妊娠期营养性贫血与不良妊娠结局的相关研究进展

营养素缺乏导致的营养性贫血是最常见的妊娠期贫血类型,主要与铁蛋白、叶酸、维生素B12缺乏有关。妊娠期的营养性贫血可能对母婴近、远期健康造成严重威胁,导致产妇早产、胎膜早破、产后出血、妊娠期高血压疾病等,致使胎儿发育不良、低出生体重儿、新生儿窒息,甚至死胎等严重后果。加强对孕妇贫血状况的监测、普及营养性贫血知识、实施个性化预防及治疗等措施,对降低营养性贫血相关不良妊娠结局有重要意义。鉴于妊娠期营养性贫血的高发病率和严重性,现对妊娠期营养性贫血与不良妊娠结局的相关研究进展予以综述。     

母子血型不合早用茵陈蒿汤ABO

母予血型不合时,由于胎儿红血球进入母体产生了免疫抗体,这种免疫抗体通过胎盘可以进入胎儿血液循环与胎儿红血球发生凝集现象而产生溶血,引起胎儿或新生儿溶血症。临床以新生儿黄疸、贫血、水肿、肝脾肿大为特征,在孕期则     

孕妇血清IgG抗体效价与新生儿溶血病的关系

新生儿溶血病(HDN)是由于母婴血型不合,母亲体内免疫系统被动激活,产生对胎儿红细胞抗原的特异性抗体,此特异性抗体主要是IgG类抗体.IgC.类抗体是唯一能通过胎盘的免疫球蛋白,从而进入胎儿血液循环,与胎儿红细胞产生免疫性溶血反应,造成胎儿早产、新生儿水肿、进行性黄疸、贫血、肝脾肿大,严重者继发胆红素脑病,导致婴儿早期死亡或使存活者留下不可逆的神经系统后遗症,故临床上不容忽视.     

新生儿ABO溶血病56例临床分析

目的分析新生儿ABO溶血病的临床表现及血清学检查特点,以提高早期诊断水平.方法对本院56例新生儿ABO溶血病患儿的临床表现、诊断及预后进行回顾性分析.结果 56例患儿之母均为O型血,子为A型血28例(50.0%),B型血28例(50.0%);生后36小时之内出现黄疸者40例(71.2%),多数黄疸程度较轻,但仍有11例(19.6%)为重度黄疸(血清胆红素超过342μmol/L);部分病例伴有贫血、惊厥等表现.三项血清学诊断试验中最有诊断意义的试验是抗体释放试验,阳性率高达100%;采用了蓝光照射加其它药物综合治疗,达到很好的效果.结论新生儿ABO溶血病以黄疸为突出症状,可伴有贫血等其他临床表现,综合治疗效果较好,抗体释放试验有助于早期诊断及减少误诊率.     

139例新生儿溶血病血清学检测结果分析

目的探讨对母婴血型不合引起新生儿溶血病进行溶血3项检测试验的重要性。方法对139例新生儿溶血病患儿进行血清学检测,包括直接抗人球蛋白试验、血清游离抗体、红细胞抗体释放试验、ABO以外抗体筛查。结果 139例患儿中被确诊为ABO溶血137例,Rh溶血2例,直接抗人球蛋白试验阳性率84%,血清游离抗体阳性率62.6%,红细胞抗体释放试验阳性率98.6%。血液标本在1~7 d内采集检测阳性率明显较>7d采集高。结论新生儿溶血病3项检测为新生儿溶血病的明确诊断,及早治疗预防提供可靠依据。尽早采集患儿的血液标本进行检验,减少漏检和误检。     

新生儿溶血病凝血功能变化的研究

目的 探讨新生儿溶血病凝血功能的变化及其临床意义.方法 以新生儿溶血病(溶血病组)、非溶血性高胆红素血症(非溶血病组)患儿各60例为研究对象,同期出生的60例正常足月儿为对照组.测定各组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数.结果 溶血病组PT、APTT明显高于非溶血病组[(28.79±4.21)s比(18.98±241)s和(58.52±313)s比(47.26±5.81)s],且两组明显高于对照组[(13.81±1.83)s和(38.10±3.00)s],差异有统计学意义(P<0.05),而血小板计数比较差异无统计学意义(P>0.05).结论 新生儿溶血病有出血倾向,与血小板计数无关,而与PT、APTT延长有关,溶血程度越重,PT、APTT升高越明显.PT、APTT可作为新生儿溶血病患儿凝血功能检测的指标和疗效评价指标.

Abstract：

Objective To investigate the clinical significance and coagulation function changes in newborn hemolytic disease. Method The newborn hemolytic disease ( 60 cases, hemolytic disease group ), non-hemolytic hyperbilirubinemia (60 cases, non-hemolytic hyperbilirubinemia group) and normal newborn (60 cases,control group) were selected as the study subjects, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured, and the blood platelet count at the same time was detected. Results PT and APTT in hemolytic disease group were higher than those in non-hemolytic hyperbilirubinemia group[(28.79 ?.21) s vs. (18.98?.41) s and (58.52?.13) s vs. (47.26?.81) s], and they were apparently higher than those in control group [(13.81 ?1.83) s and (38.10 ?3.00) s], the difference had statistic significance (P<0.05). There was no statistic significance to detect the blood platelet count (P> 0.05). Conclusions The newborn hemolytic disease has the bleeding tendency, and the bleeding tendency has no relationship with the quantity of the blood platelet, but relates to the extension of PT and APTT. The more serious the case is, the more obvious the PT and APTT rise. PT and APTT can be as the detection index and evaluating effect of the newborn hemolytic disease coagulation function.     

微柱凝胶技术在检测新生儿溶血病中的应用

新生儿溶血病（HDN）由母婴血型不合引起,是一种免疫性溶血性疾病,可导致新生儿黄疸、贫血、水肿、肝脾肿大、死胎等。本文简述了微柱凝胶技术在新生儿血型血清学检测中的应用,对于HDN的早期诊断、早期治疗、预防和降低新生儿溶血病的发生具有重要的意义。     

CHOLESTEROL-INDUCED ANEMIA IN GUINEA PIGS

The cholesterol-induced hemolytic anemia seen in guinea pigs could not be related to the protein levels of the diet or deficiencies in choline, vitamin E or vitamin C; however, variations in the level of dietary fat, which might be expected to influence plasma cholesterol levels as well, did affect the incidence of hemolytic anemia.     

微柱凝胶技术应用于ABO新生儿溶血病患儿输血前检验价值评价

目的：：总结性探讨分析微柱凝胶技术在ABO新生儿溶血病患儿输血前的检验价值。方法：采用228例疑似ABO新生儿溶血病患儿血标本,分别采用传统试管法和微柱凝胶技术进行放散实验、间接抗人球蛋白试验以及直接抗人球蛋白试验,分析比较检测结果。结果：所有疑似ABO新生儿溶血病患儿中检测出ABO新生儿溶血病患儿200例,微柱凝胶法的直接、间接抗人球蛋白试验以及放散试验阳性检出率分别为77%、91%、99%,传统试管法的直接、间接抗人球蛋白试验以及放散试验阳性检出率分别为60%、67%、79%,三个方面的差异都较为明显（P＜0.05）。结论：微柱凝胶技术相比于传统试管法的检测阳性率高,值得在临床工作中加大使用范围。     

微柱凝胶法和传统试管法在新生儿溶血病诊断中的比较研究

目的:探讨微柱凝胶技术对新生儿溶血病(HDN)的诊断价值。方法:选取128例疑似HDN的新生儿,分别用微柱凝胶法和传统试管法进行直接抗人球蛋白试验(DAT)、间接抗人球蛋白试验(IAT)和放散试验并对比结果。结果:在128例中104例诊断为HDN患儿,微柱凝胶法的阳性检出率为92.31%,传统试管法为80.77%,微柱凝胶法的敏感性高于传统试管法(χ2=5.92,P<0.05);在微柱凝胶法3项试验中,以放散试验的阳性率最高,DAT阳性率最低。结论:对于辅助诊断HDN,微柱凝胶法比传统试管法更具优势。     

PDCA管理在提高新生儿溶血病筛查阳性率中的应用

运用PDCA对新生儿溶血病筛查进行管理。针对临床提出的新生儿溶血病筛查阳性率低的问题分析原因、设定目标、拟定计划、实施计划、检查、评价总结。最终血清总胆红素>221 umol/L患儿的新生儿溶血病筛查阳性率和新生儿溶血病筛查的平均阳性率由管理前的45.8%和34.6%分别提高到了59.4%和47.7%，效果明显。     

Effect of maternal anemia on iron status of the new born

100 hospitalized parturients were studied; 50 women with a hemoglobin level of less than 10 g% comprised the controls. Serum iron and iron binding capacity estimation of all the parturients and their newborns (cord blood) was done by the standard dimethyl glyoxime method and the modified method of Davis. The hemoglobin of the baby was around 50% higher than the mother's irrespective of the presence of anemia (in the anemic group 8.5 g% mothers vs. 12.5 g% in neonates as compared to the control group, with 10.4 g% in mothers vs. 15.3 g% in neonates). The serum iron values were also much higher in the newborn as compared to the mother, however, the difference was more marked in anemic mothers (55.7 mcg% in mothers vs. 112.6 mcg% in neonates in the anemic group compared to 86.7 mcg% in mothers vs. 139.5 mcg% in neonates in the nonanemic group). The total serum iron binding capacity was less in infants as compared to the mothers. The percentage saturation of iron was much higher in infants as compared to their mothers, and the difference was much more notable in the anemic group (15.8% for mothers and 37.0% for the newborns). The mean serum iron values of the newborn were also much higher than those of the mother in both groups, however, the difference was much more marked in the anemic group, thereby suggesting the selective uptake of iron by the fetus even in anemic parturients (ratio of maternal vs. neonatal serum iron was 1:2.02 in the anemic group as compared to 1:1.6 in the nonanemic group). The selective uptake of iron by the fetus cannot prevent the development of anemia in the newborn, and thus it mandates abundant iron intake by mothers during pregnancy, both in diet and in folic acid supplementation, to prevent the birth of anemic and low birth weight children.     

Antibody-mediated cell-specific hematopoietic autoimmune disorders

Although it is clear that immunologic mechanisms play a significant role in the pathophysiology of many hematologic diseases, there are relative few situations where it is possible to gain a detailed understanding of immune damage in vivo in humans. Autoimmune hemolytic anemia, immune thrombocytopenia and immune neutropenia as antibody-mediated cell-specific disorders are of particular interest in this regard. Autoimmune hemolytic anemia represents a group of disorders in which individuals produce antibodies directed toward one or more of their own erythrocyte membrane antigens. This leads to destruction of the antibody-coated erythrocytes. The pathophysiology of the decreased erythrocyte survival has been examined with increasing sophistication for many years. This paper first discusses the underlying mechanisms responsible for autoimmune hemolytic anemias then consider immune thrombocytopenia and immune neutropenia.