IgG亚型与新生儿ABO溶血病的关系

目的探讨IgG亚型与新生儿ABO溶血病高胆红素血症的发生及危重程度的关系。方法对实验室诊断为新生儿ABO溶血病的患儿,用德国欧盟公司的亚型试剂盒测定其血清IgG亚型,并检测胆红素水平。结果153例实验室诊断为新生儿ABO溶血病的患儿中检测出IgG1和IgG3亚型的27例,其中24例发生高胆红素血症,检出IgG3亚型的全部发生高胆红素血症且胆红素增高明显。结论测定新生儿IgG亚型抗体,可有助于诊断新生儿ABO溶血病高胆红素血症的发生并预测其严重程度。     

静脉丙种球蛋白两种方法治疗新生儿ABO溶血病的疗效研究

新生儿ABO溶血病是新生儿早期高胆红素血症的主要原因之一,严重者可发生胆红素脑病,早期需积极治疗。我院自2003年1月至2006年12月采用静脉丙种球蛋白(IVIG)1d疗法(贵阳黔峰生物制品有限责任公司生产,5%2.5g/支)治疗新生儿ABO溶血病52例,3d疗法50例,以观察其疗效并进行疗效对比。材料与方法一、临床资料选择我院2003年1月至2006年12月新生儿病房收治的102例新生儿ABO溶血病患儿,其诊断符合《实用儿科学》第7版新生儿ABO溶血病诊断标准[1],不伴其他疾病的患儿作为研究对象,将其分为两组,A组为治疗组52例,B组为对照组50例。两组临床资…     

流式法检测红细胞膜抗体含量在新生儿ABO溶血病的诊断价值

目的用流式细胞仪检测新生儿高胆红素血症患儿红细胞膜的抗体含量并进行计数,以探讨红细胞膜抗体计数对新生儿ABO溶血病的早期诊断价值。方法收集患儿静脉血标本70例,其中51例为临床确诊的新生儿溶血病,19例为临床疑似病例,采用流式细胞仪计数患儿红细胞膜被同种血型抗体致敏后的抗体含量水平。结果51例临床确诊的新生儿ABO溶血病标本均可检测到红细胞膜被同种血型抗体致敏后的相关抗体,但红细胞膜抗体含量及致敏比例有明显差异;19例临床疑似病例中,9例检测到红细胞膜相关抗体,并与临床最后诊断相符,10例结果阴性,其中6例临床排除ABO溶血所致的高胆红素血症,另4例病因不明。结论流式细胞仪可以直接检测到患儿红细胞被同种血型抗体致敏后的抗体含量,特别是对红细胞膜上结合抗体数量少,卡式法检测阴性、临床又高度怀疑的溶血病患儿有重要的临床诊断价值。     

交换输血术对高胆红素血症新生儿血清免疫球蛋白的影响

目的 评估高胆红素血症新生儿的体液免疫状态及其进行交换输血治疗(换血术)前后的血清免疫球蛋白(Ig)水平变化情况,了解换血术对新生儿血清Ig的影响.方法 对62例高胆红素血症新生儿进行换血治疗,治疗前后分别测定其血清Ig(IgG、IgA、IgM)水平,并依据病因分成ABO溶血病组、Rh溶血病组、脓毒症组和其他组进行分析.结果 1.换血术前:ABO溶血病组、Rh溶血病组IgG水平均显著高于脓毒症组及其他组(Pa＜0.01),各组间IgA、IgM水平无明显差异(Pa>0.05).2.换血术后ABO溶血病组、Rh溶血病组IgG水平均较换血前显著下降(Pa＜0.05);其他组及脓毒症组IgG水平均较换血前升高,但差异无统计学意义(P=0.387,0.091).3.换血后4组IgA水平均较换血前升高,且其他组、ABO溶血病组和Rh溶血病组治疗前后比较差异有统计学意义(Pa=0.000),脓毒症组治疗前后无统计学意义(P=0.185).4.换血后4组IgM水平均较换血前升高,其他组、ABO溶血病组和Rh溶血病组治疗前后比较均有统计学意义(Pa＜0.05),但脓毒症组治疗前后无统计学意义(P=0.081);且其他组、ABO溶血病组和Rh溶血病组各组间治疗后比较有统计学意义(P＜0.01).结论 1.新生儿溶血病患儿术前血清IgG水平较高,换血术能迅速降低溶血病患儿血IgG水平,提升患儿血IgA、IgM水平;2.换血术对脓毒症患儿血清IgG、IgA、IgM的水平无明显影响;3.换血术能提高其他高胆红素血症患儿血清IgA、IgM水平,但对血清IgG水平无明显影响.     

蓝光治疗对新生儿溶血病脑干听觉诱发电位的影响

目的 探讨蓝光治疗在降低新生儿溶血病患儿的血清胆红素浓度时能否逆转脑干听觉诱发电位结果的改变。方法 对20例新生儿ABO血型不和溶血病引起的高胆红素血症患儿光疗前后进行脑干听觉诱发电位检测，并与22例正常新生儿作对照。结果 光疗后随着胆红素浓度的下降，新生儿溶血病患儿脑干听觉诱发电位值V波潜伏期，Ⅲ-Ⅴ，Ⅰ-Ⅴ波间期较光疗前明显缩短(P＜0．01)。结论 光疗不仅能降低血清胆红素浓度，而且能逆转胆红素对脑干听觉诱发电位的影响，即光疗能逆转胆红素脑病发生。     

静脉丙种球蛋白两种方法治疗新生儿ABO溶血病的疗效研究

新生儿ABO溶血病是新生儿早期高胆红素血症的主要原因之一，严重者可发生胆红素脑病，早期需积极治疗。我院自2003年1月至2006年12月采用静脉丙种球蛋白（IVIG）1d疗法（贵阳黔峰生物制品有限责任公司生产，5％2.5g／支）治疗新生儿ABO溶血病52例，3d疗法50例，以观察其疗效并进行疗效对比。     

新生儿溶血病血清学变化特征分析

目的探讨新生儿母子血型不合溶血病血清学变化特征。方法选择我院2010年10月至2011年9月考虑母子血型不合溶血病所致新生儿高胆红素血症的患儿,回顾性分析患儿及母亲血型、新生儿溶血检测结果,并比较不同血型不合新生儿溶血病发生率、胆红素水平、Coomb’s试验、抗体弥散试验等结果。结果共收治母子血型不合的高胆红素血症患儿258例,入院日龄均≤72 h,其中O-A血型不合122例,O-B血型不合118例,Rh血型不合18例;发生溶血患儿分别为94例(77.0%)、85例(72.0%)、18例(100%);入院后最高胆红素分别为(352.0±120.2)、(383.9±116.3)、(455.9±145.4)μmol/L。Rh组胆红素水平和溶血发生率均高于O-A组和O-B组(P<0.05),O-A组和O-B组差异无统计学意义(P>0.05)。3组发生溶血患儿抗体弥散试验阳性率58.4%(115/197),Coomb’s试验阳性率19.3%(38/197)。O-A血型不合、O-B血型不合、Rh血型不合溶血病患儿Coomb’s试验阳性例数分别为18例(19.1%)、4例(4.7%),16例(88.9%),O-A血型不合、O-B血型不合溶血病患儿抗体弥散试验阳性例数分别为68例(72.3%)、47例(55.3%)。结论 Rh血型不合较ABO血型不合溶血患儿血清胆红素峰值、Coomb’s试验阳性率高,新生儿溶血病发生的严重程度与母亲血清Ig G亚型相关。     

ABO血型系统新生儿溶血病早期诊断探讨

目的 通过对脐血做免疫血清学检验,探讨新生儿溶血病的早期诊断方法.方法 按检验操作规程,对916例母/子血型O/A(B)组合的新生儿脐血进行免疫血清学检验,对红细胞被IgG抗-A(B)致敏的患儿,在出生7 d内分组调查其高胆红素血症的发生率及发病时间.结果 (1)脐血抗体释放试验阳性患儿与对照组比较,新生儿高胆红素血症发生率差异有显著性(P<0.01).不同分娩胎次患儿发生高胆红素血症的差异无显著性(P>0.05).(2)抗体释放试验阳性者血液中存在与不存在游离抗体的两组患儿,高胆红素血症发生率比较差异有显著性(P<0.01).(3)抗体释放试验阳性患儿发生高胆红素血症的高峰时间在出生后的1～3 d.结论 对脐血进行免疫血清学检验,可早期诊断新生儿溶血病,血液中存在的游离抗体有助于判断疾病的发展趋势.     

蓝光治疗对新生儿溶血病脑干听觉诱发电位的影响

目的　 探讨蓝光治疗在降低新生儿溶血病患儿的血清胆红素浓度时能否逆转脑干听觉诱发电位结果的改变。 方法 　对 2 0例新生儿ABO血型不和溶血病引起的高胆红素血症患儿光疗前后进行脑干听觉诱发电位检测 ,并与 2 2例正常新生儿作对照。 结果 　光疗后随着胆红素浓度的下降 ,新生儿溶血病患儿脑干听觉诱发电位值V波潜伏期 ,Ⅲ Ⅴ ,Ⅰ Ⅴ波间期较光疗前明显缩短 (P <0 0 1)。 结论 　光疗不仅能降低血清胆红素浓度 ,而且能逆转胆红素对脑干听觉诱发电位的影响 ,即光疗能逆转胆红素脑病发生     

新生儿高胆红素血症的病因分析

目的 对新生儿高胆红素血症的病因进行分析，探讨新生儿高胆红素的相关因素，为防治新生儿高胆红素血症提供参考。方法 2004年1月～2005年7月，我院共收治493例新生儿高胆红素血症患儿，对其病因进行分析。结果 围生因素44．2％，血液系统因素28．0％，感染因素15．6％，其他2．0％，不明原因10．1％。结论 新生儿高胆红素的病因以围产因素为首，其次是ABO型血型不合溶血病、G-6-PD缺陷症等血液系统疾病，再是感染因素。本文有助于了解本地区新生儿高胆红素血症的病因分布，从而为临床诊断与防治提供参考。     

Exchange transfusion with fresh heparinized blood is a safe procedure. Experiences from 1 069 newborns

1 069 newborns were subjected to exchange transfusion with fresh heparinized blood in the years 1968, 1971, 1974, 1977 and 1981. There were 258 infants with Rh disease, 328 with hyperbilirubinemia with ABO incompatibility, 436 with hyperbilirubinemia without ABO incompatibility and 47 infants without hyperbilirubinemia or evidence of hemolytic disease. The total annual number of infants decreased gradually from 279 in 1968 to 130 in 1981. A total of 48 infants of the 1 069 newborns died during neonatal period but the death was possibly related to exchange transfusion in four of them. There were serious complications in 14 infants during and in only five infants after the procedure. Morbidity related to exchange transfusion was the highest among newborns with serious basic disease. Using the presented bilirubin nomograms and fresh heparinized blood we have not found that the hazards of exchange transfusion would have overgone the risks of hyperbilirubinemia.     

Exchange Transfusion with Fresh Heparinized Blood is a Safe Procedure

1069 newborns were subjected to exchange transfusion with fresh heparinized blood in the years 1968, 1971, 1974, 1977 and 1981. There were 258 infants with Rh disease, 328 with hyperbilirubinemia with ABO incompatibility, 436 with hyperbilirubinemia without ABO incompatibility and 47 infants without hyperbilirubinemia or evidence of hemolytic disease. The total annual number of infants decreased gradually from 279 in 1968 to 130 in 1981. A total of 48 infants of the 1069 newborns died during neonatal period but the death was possibly related to exchange transfusion in four of them. There were serious complications in 14 infants during and in only five infants after the procedure. Morbidity related to exchange transfusion was the highest among newborns with serious basic disease. Using the presented bilirubin nomograms and fresh heparinized blood we have not found that the hazards of exchange transfusion would have overgone the risks of hyperbilirubinemia.     

足月儿高胆红素血症482例相关因素分析

目的 探讨足月儿高胆红素血症(简称高胆)的相关因素以及高胆程度.方法 对2001年7月-2006年7月收治的高胆足月儿482例进行分析.结果 482例高胆患儿中,早发型母乳性黄疸178例(36.9%,其中70.3%为剖宫产),迟发型母乳性黄疸125例(25.9%),ABO血型不合溶血60例(12.5%),围产相关因素54例(11.2%),感染相关因素49例(10.2%),其他16例(3.3%).以溶血者总血清胆红素最高(351.0±188.1)μmol/L.482例高胆患儿中轻、中、重度分别占42.5%、36.3%和21.2%.重度高胆中早发型母乳性黄疸31例(30.4%),ABO溶血20例(19.6%),迟发型母乳性黄疸25例(24.5%).482例中核黄疸4例,1例为严重酸中毒、脱水,3例为ABO溶血.结论 母乳性黄疸为住院足月儿高胆的主要原因,剖宫产可能与早发型母乳性黄疸有关;ABO溶血是导致患儿核黄疸的主要原因.     

Hemolytic disease of the newborn due to isoimmunization with anti-E antibodies: a case report

Minor blood group hemolytic disease is extremely rare, since the overall potency of minor blood groups in inducing antibodies is significantly lower when compared with that of Rh (D) antigen. We hereby report a very rare case of severe neonatal anti-E hemolytic disease due to E minor blood group incompatibility. A term newborn born to a 27-year-old, gravida 3, para 3 mother was referred due to a high and increasing serum bilirubin level despite phototherapy on the 4th day of life. On admission physical examination was normal except for the jaundice, and results of the laboratory investigation demonstrated a moderate-to-severe anemia (hemoglobin 7.8 g/dl) and a severe hemolytic hyperbilirubinemia (serum total and indirect bilirubin levels 36 mg/ dl and 32.8 mg/dl, respectively; reticulocyte count 15%; and a positive direct antiglobulin test). As there was no apparent cause of the hemolytic disease such as Rh or ABO incompatibilities, further investigation (a positive indirect antiglobulin test and a positive irregular anti-E antibody in both the patient and mother, and minor blood group antigen profiles in family members compatible with E minor blood group isoimmunization) revealed the presence of anti-E hemolytic disease due to E minor blood group incompatibility. Two exchange transfusions with a 12-hour-interval were performed with minor blood group compatible fresh whole blood, and the patient was discharged in a healthy condition on the 10th postnatal day. If the most common causes of severe neonatal hemolytic disease such as Rh and ABO incompatibilities cannot be demonstrated in a newborn with significant hemolytic hyperbilirubinemia, anti-E hemolytic disease should strongly be considered in differential diagnosis. It should be kept in mind that a very severe from of minor group antibody hemolytic disease characterized by anemia and severe hyperbilirubinemia many exchange transfusions may be encountered during the course of the disease.     

Carboxyhemoglobin Measurements in the Diagnosis of ABO Hemolytic Disease

To assess hemolysis in hyperbilirubinemic infants with ABO isoimmunization, we measured the carboxyhemoglobin (HbCO) concentrations in full-term infants with ABO isoimmunization during the first week of life. Two groups of infants, ABO compatible (n=34) and ABO incompatible (n=30), were further divided into two groups with and without hyperbilirubi-nemia. All the infants from ABO incompatible pregnancies showed a positive indirect Coombs' test. The groups with hyperbilirubinemia included infants with maximum serum total bilirubin levels about 15 mg/dL and infants treated by phototherapy or exchange transfusion. In the ABO incompatible infants, the HbCO levels in those with hyperbilirubinemia were significantly higher than in infants without hyperbilirubinemia during the first week after birth (p < 0.01 at 24, 72, 120 hours after birth, respectively). The levels of HbCO in the ABO incompatible infants with hyperbilirubinemia were significantly higher compared with the levels in the ABO compatible infants with hyperbilirubinemia (p < 0.05 at 24 hours, p < 0.01 at 72 and 120 hours after birth, respectively). HbCO measurement may facilitate the early diagnosis of hemolytic disease and the prediction of jaundice caused by ABO isoimmunization.     

Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates

Background

Neonates with ABO hemolytic disease are at greater risk for developing significant hyperbilirubinemia. We aimed to determine whether sixth hour transcutaneous bilirubin (TcB) could predict such a risk.

Methods

TcB measurements were obtained at the 6th hour of life in blood group A or B neonates born to blood group O, rhesus factor compatible mothers. Subsequent hyperbilirubinemia was monitored and considered significant if a neonate required phototherapy/exchange transfusion. The predictive role of sixth hour TcB was estimated.

Results

Of 144 ABO incompatible neonates, 41(OA, 24; O-B, 17) had significant hyperbilirubinemia. Mean sixth hour TcB was significantly higher among neonates who developed significant hyperbilirubinemia than those who did not (5.83±1.35 mg/dL vs. 3.65±0.96 mg/dL, P<0.001). Sixth hour TcB value >4 mg/dL had the highest sensitivity of 93.5% and >6 mg/dL had the highest specificity of 99%. Area under receiver operating characteristic curve was 0.898.

Conclusion

Sixth hour TcB predicts subsequent significant hyperbilirubinemia in ABO incompatible neonates.     

孕妇产前IgG抗-A(B)抗原效价与新生儿高胆红素血症发生率关系探讨

目的 探讨O型血孕妇产前IgG抗-A(B)抗原效价与A(B)型血新生儿高胆红素血症发生率的关系.方法 对夫妻ABO血型不合的O型血孕妇测定IgG抗-A(B)抗原效价,对A(B)型血新生儿脐血做血清学检查,按孕妇妊娠的次数及检验结果 分组调查其高胆红素血症发生率和发病时间.结果 (1) 第一胎与第二胎以上妊娠的孕妇IgG抗-A(B)抗原效价无显著差别,脐血检验结果 差异无显著性,新生儿高胆红素血症发生率差异无显著性(P>0.05).(2) 孕妇IgG抗-A(B)抗原效价依次增高,新生儿抗体释放试验阳性率、游离抗体阳性率、高胆红素血症发生率差异均有非常显著性(P<0.01).(3) 孕妇IgG抗-A(B)抗原效价≤1∶64、抗体释放试验阳性的新生儿高胆红素血症发生率显著高于对照组的新生儿(P<0.01).(4) 孕妇IgG抗-A(B)抗原效价依次增高,新生儿在出生3d内高胆红素血症发生率差异无显著性(P>0.05).结论 妊娠次数与孕妇IgG抗-A(B)抗原效价及新生儿高胆红素血症发生率无显著关系;孕妇IgG抗-A(B)抗原效价≥1∶32时,新生儿发生高胆红素血症的危险增加;随着孕妇IgG抗-A(B)抗原效价增高,新生儿高胆红素血症发生的概率增大,但对新生儿发病时间无显著影响.     

Newborn screening for ABO hemolytic disease

Confusion still exists regarding the true incidence of ABO hemolytic disease and the significance of the various laboratory investigations commonly employed in its evaluation. With such imprecision in diagnosis, early hospital discharge of newborns can be a potential problem. To evaluate the usefulness of more extensive screening than commonly employed and to identify possible indicators of severity, a pilot study of cord blood screening was undertaken. In the study, 1391 cord blood specimens were tested for type, Rh, direct antiglobulin test (DAT), indirect Coombs, and total and indirect bilirubin. Of the specimens, 53.3 percent were type A, B, or AB, and 19.3 percent of both A and B infants and 7 percent of AB infants had immune antibodies in their sera. DAT was neither diagnostic nor predictive of severity. DAT was negative in 48 percent of infants with serum antibody and did not correlate with cord blood or peak serum bilirubin levels. The cord blood bilirubin also was not diagnostic of hemolytic disease but was moderately predictive of peak bilirubin levels. The data do not support the use of any routine screening tests in the management of ABO hemolytic disease.