Rh新生儿溶血病的血清抗体研究

对51例Rh血型抗体引起的新生儿溶血病进行研究，结果抗D35例，抗E12例，抗cE2例，抗CD及抗。各1例。16例患儿直接抗人球蛋白试验、游离抗体试验、抗体释放试验均为阳性。6例有高效价抗体的孕妇进行产前血浆交换及7例新生儿进行换血治疗，均取得满意效果。认为孕期夫妇血型鉴定及抗体检查有助于新生儿溶血病的诊断、预防和治疗。     

新生儿不规则抗体检测的临床意义

目的：检测新生儿红细胞血型不规则抗体,探讨不规则抗体与新生儿溶血病的关系。方法：对521例新生儿溶血病待确诊患儿通过微柱凝胶卡进行直接抗人球白试验、游离抗体测定、放散试验,不规则抗筛选阳性标本进一步进行不规则抗体鉴定,同时进行不规则抗筛选阳性患儿母亲血型鉴定及不规则抗体筛选、鉴定。结果：检测出抗-D 4例,抗-E 3例,抗-c1,抗-M 1例。结论：应重视孕妇IgG类红细胞血型不规则抗体筛查;根据不规则抗体的特性,可为患儿选择无相应抗原的血液进行综合治疗和换血。     

孕妇产前血型抗体效价与新生儿溶血病的检测结果分析

目的:探讨新生儿溶血病(HDN)产前血型抗体效价检测与HDN发病的关系。方法:采用血型血清学方法,对453例ABO及Rh血型不合的孕妇做ABO、RhD血型鉴定、抗体筛选、抗体鉴定、抗体效价测定;对135例新生儿检测ABO、RhD血型鉴定、溶血3项试验。结果:产前孕妇IgG抗-A(B)效价64的218例,占51.54%,≥64的205例,占48.46%;Rh血型不合中抗筛阴性18例,产生抗-D 12例,其中2例与ABO合并。建议效价IgG抗-A(B)≥64、IgG抗-D2的服中药治疗,定期监测抗体效价。在135例新生儿中有8例未证实HDN,其余127例确诊为ABO溶血108例,RhD溶血10例,ABO合并RhD溶血2例,RhE、c溶血5例,抗M溶血2例。结论:HDN的临床表现程度与母体内的IgG效价有一定的关系,效价越高,HDN发生率越高。建议临床医生对血型不合的孕妇进行产前血清学检测,以便早期治疗,并对患儿进行溶血病检测,以免延误病情,造成不良后果。     

Rh新生儿溶血症血清学分析

本文报告51例Rh抗体引起的新生儿溶血症,其中抗-D35例、抗-E12例、抗-(?)·E2例、抗-C·D及抗-(?)各1例。16例患儿标本做直接抗人球蛋白试验、游离抗体试验、抗体释放试验均为阳性。对6例有高效价抗体的孕妇施行产前血浆交换,对7例新生儿施行换血治疗,均取得满意效果。作者认为,孕期夫妇血型鉴定及抗体检查有助于新生儿溶血症的诊断、预防和早期治疗。     

RhD新生儿溶血致D抗原的完全遮断

目的:对RhD新生儿溶血病导致的D抗原假阴性进行鉴定。方法:采用放散试验、抗人球蛋白等试验对母亲和患儿血清抗体及D抗原进行鉴定。结果:患儿血型为O型CcDee,母亲血型为O型ccdee,新生儿直接抗人球蛋白试验阳性,游离试验和放散试验均检测出抗-D抗体,母亲体内检出抗-D抗体。结论:当患儿直接抗人球蛋白试验强阳性,D抗原检测阴性,其母体内存在抗-D抗体时应排除D抗原完全遮断引起的假阴性。     

259例新生儿溶血病的临床分析

目的：通过对ABO、Rh血型不合的新生儿溶血病患儿进行血型血清学诊断,为临床及时治疗提供依据。方法：运用血型血清学技术对海南省人民医院送检的高胆红素血症新生儿血液标本进行直接抗人球蛋白试验、游离抗体试验和抗体释放试验。结果：HDN患儿中,3项试验均为阳性的有55例,占21.2%;直接抗人球蛋白试验阴性、游离抗体试验和抗体释放试验阳性的有119例,占46.0%;直接抗人球蛋白试验、游离抗体试验为阴性而抗体释放试验阳性的有85例,占32.8%;释放试验均阳性（阳性率100%）,174例游离抗体试验阳性（阳性率67.2%）,55例直接抗人球蛋白试验阳性（阳性率21.2%）。259例HDN患儿中,共有81例患儿换血,总换血率31.3%。B型患儿换血率与A型患儿比较差异有统计学意义（x2=7.48P〈0.05）。结论：直接抗人球蛋白试验的强弱是区别ABO和Rh溶血病的重要标志;抗体释放试验是判定新生儿溶血病的最有力证据;换血疗法是新生儿溶血病的最有效的方法,可减少胆红素脑病的发生。     

9例新生儿高效价RhD抗体导致胎儿新生儿溶血病且形成RhD抗原遮蔽现象的回顾性分析与对策

目的:回顾调查新生儿高效价RhD抗体导致胎儿新生儿溶血病(HDFN)的患儿资料,了解新生儿血型鉴定和新生儿溶血病相关情况.方法:9例新生儿抗D-HDFN且抗-D抗体效价大于1∶ 256,利用全自动血型仪和盐水试管方法,检测血型、不规则抗体、抗体效价、溶血3项试验,记录新生儿溶血病发病时间、血清总胆红素、血清间接胆红素、...     

新生儿溶血病致D抗原遮蔽现象引起D抗原假阴性的鉴定与分析

目的:对3例RhD阴性产妇所育的RhD阳性新生儿因D抗原遮蔽造成假阴性现象,进一步进行血型血清学检测及分析。方法:采用血型血清学方法检测新生儿及其母亲、父亲血型抗原、抗体。结果:新生儿血型分别为O,CcDEe、B,CCDEe、A,CcDEe;其母亲分别为O,ccdee、B,ccdee、AB,ccdee;其父亲分别为:O,CcDEe、O,CCDEe、A,CcDEe;新生儿直接抗球蛋白试验分别为:3+、3+、3+。对新生儿进行RhD血型检测时,试管法观察结果未见凝集,易误判为RhD阴性。结论:通过血型血清学检测该3例患儿RhD抗原为阳性,并由Rh系统IgG抗D引起的新生儿溶血病,为新生儿能得到及时治疗提供实验室依据。     

Rh缺失型D--导致新生儿溶血病的血液免疫学分析及家系调查

目的:分析1例新生儿溶血病产生的原因,初步探讨产妇Rh缺失型D--形成的遗传背景。方法:通过血型血清学方法对产妇、患儿标本进行ABO、Rh血型鉴定,直接抗人球蛋白试验,抗体筛查与鉴定试验,抗体释放试验、游离抗体检查及抗体效价测定,并做家系血型调查。通过分子生物学方法对RHD基因和RHCE基因第1～10外显子进行测序。结果:患儿血型为A型、DCCee,直接抗人球蛋白试验、游离抗体检查、抗体释放试验均为阳性。产妇血型为A型、D--,产生了IgG性质的抗-Hr_0抗体,效价是512,家系中只有先证者为D--。产妇RHD基因完整,RHCE基因缺失2～8外显子,基因表型为D(1～10)CE(1,9,10)。结论:产妇Rh缺失型D--由RHCE基因缺失产生,多次妊娠产生抗-Hr_0抗体导致新生儿溶血病。     

Rh缺失型D--导致新生儿溶血病的血液免疫学分析及家系调查

目的:分析1例新生儿溶血病产生的原因,初步探讨产妇Rh缺失型D--形成的遗传背景。方法:通过血型血清学方法对产妇、患儿标本进行ABO、Rh血型鉴定,直接抗人球蛋白试验,抗体筛查与鉴定试验,抗体释放试验、游离抗体检查及抗体效价测定,并做家系血型调查。通过分子生物学方法对RHD基因和RHCE基因第1～10外显子进行测序。结果:患儿血型为A型、DCCee,直接抗人球蛋白试验、游离抗体检查、抗体释放试验均为阳性。产妇血型为A型、D--,产生了IgG性质的抗-Hr_0抗体,效价是512,家系中只有先证者为D--。产妇RHD基因完整,RHCE基因缺失2～8外显子,基因表型为D(1～10)CE(1,9,10)。结论:产妇Rh缺失型D--由RHCE基因缺失产生,多次妊娠产生抗-Hr_0抗体导致新生儿溶血病。     

First report from India of haemolytic disease of newborn by anti-c and anti-E in Rh (D) positive mothers

In India, at the majority of the transfusion centers, antenatal antibody screening is done only in Rh (D) negative mothers. We report here two cases of haemolytic disease of newborn (HDN) by maternal alloimmunization to anti-c in one case, and both anti-c and anti-E in the second case. Both women were Rh (D) positive mothers and HDN was detected postnatally by a positive direct antiglobulin test (DAT) in their newborns. These cases highlight the importance of routine antenatal antibody screening even in Rh (D) positive females. A close follow-up throughout pregnancy is required if irregular antibodies are present so that antigen negative, crossmatch compatible blood can be provided in a timely manner for intra-uterine or exchange transfusions.     

First report from India of haemolytic disease of newborn by anti-c and anti-E in Rh (D) positive mothers

Abstract

In India, at the majority of the transfusion centers, antenatal antibody screening is done only in Rh (D) negative mothers. We report here two cases of haemolytic disease of newborn (HDN) by maternal alloimmunization to anti-c in one case, and both anti-c and anti-E in the second case. Both women were Rh (D) positive mothers and HDN was detected postnatally by a positive direct antiglobulin test (DAT) in their newborns. These cases highlight the importance of routine antenatal antibody screening even in Rh (D) positive females. A close follow-up throughout pregnancy is required if irregular antibodies are present so that antigen negative, crossmatch compatible blood can be provided in a timely manner for intra-uterine or exchange transfusions.     

母婴血型不合导致的新生儿溶血病实验室分析

目的:对母婴血型不合导致新生儿发生溶血的实验室数据进行分析,为新生儿溶血病(HDN)的诊断提供早期数据。方法:共纳入97例HDN患者,清晨空腹抽取160例新生儿脐血及其母亲肘静脉血液,进行ABO、Rh血型鉴定及新生儿脐血直接抗人球蛋白试验、游离抗体试验、抗体释放试验。结果:160份临床疑为HDN的标本中,患儿全部为Rh阳性,1例母亲为Rh阴性,其中A型者60例,B型80例,O型18例。血型血清学检测证实的血型抗原不合引起的HDN例数为97例,总阳性率为60.6%,其中ABO-HDN 96例,Rh-HDN 1例。在被证实为ABO-HDN的96例患儿中,A型41例,占25.6%,B型55例,占34.4%。在18例O型血患儿中,直接抗人球蛋白试验和游离抗体试验检测筛查均为阴性。1例母亲为Rh阴性患儿ABO血型与其母亲同为A型,直接抗人球蛋白实验结果阳性。结论:血型抗原不合引起的HDN中,ABO-HDN明显比Rh-HDN多见,其中又以母亲为O型的B型新生儿多见。抗体释放试验比直接抗人球蛋白试验及游离抗体试验诊断HDN的准确率高。为临床上早期诊断HDN提供重要的依据,对防止胆红素脑病的发生具有重要意义。     

Flow Cytometric Analyses of the Subclasses of Red Cell IgG Antibodies

We report on flow cytometric IgG subclass determinations of red cell antibodies using polyclonal FITC-labeled antibodies. The limit of detection of this method was 1 ng anti-D per 1×10⁷ red cells. The inter- and intra-assay coefficients of variance were 8.2 and 2.3%, respectively. In 8 newborns with a positive direct antiglobulin test (DAT) in the gel centrifugation test (GCT), due to ABO antibodies, IgG1 was detected in all and IgG2 additionally in 4 of these cases. In 5 severe cases of hemolytic disease of the newborn (HDN) due to anti-D, large amounts of IgG1 were found, and in 3 of these 5, IgG3 in combination with IgG1. In 8 mild or moderate HDN cases (4 anti-D, 2 anti-E, 1 anti-Fy^a, 1 anti-Jk^a), phototherapy sufficed, and IgG1 was the only antibody. In 7 adult patients with malignant lymphoma and a positive DAT (GCT), only small amounts of IgG1 red cell autoantibodies could be demonstrated by flow cytometry. In 5 further patients with malignant lymphoma, a positive DAT, and severe hemolytic anemia, large amounts of IgG1 autoantibodies were found and IgG3 was also present in 3 of these cases. Flow-cytometric determination of IgG subclasses may be a useful tool in immunohematology, since subclass determinations were possible in all of these cases. This method is suited for clinical routine and offers the possibility of sufficient standardization.     

IgG抗-D、抗-E致新生儿溶血病1例

<正>新生儿溶血病(hemolytic disease of the newborn,HDN)是由于孕妇和新生儿之间血型不合而产生的免疫性疾病,是造成新生儿病理性黄疸的常见原因之一,最常见的是由IgG抗-D引起,IgG抗-E次之。本例Rh(D)阴性待产妇产前血型血清学检测出血清中存在IgM和IgG性质混合的抗-D抗体、IgG性质抗-E抗体,其中IgG抗-D、抗-E抗体导致新生儿发生Rh系统HDN,现报告如     

微柱凝胶法与试管法检测新生儿溶血病免疫性抗体的比较

目的：比较微柱凝胶法与试管法对母婴血型不合新生儿溶血病（HDN）免疫性抗体的检出率。方法：对临床表现为高胆红素血症、疑似HDN的患儿血标本同时用微柱凝胶法和试管法进行直接抗人球蛋白试验、抗体游离试验及抗体放散试验,并对患儿阳性血标本进行血型不规则抗体特异性鉴定及其效价测定。结果：在275例临床表现为高胆红素血症、疑似HDN的患儿血标本中,用试管法检出直接抗人球蛋白试验阳性180例（65.5%）,抗体游离试验阳性197例（71.6%）,抗体放散试验阳性210例（76.4%）;用微柱凝胶法检出直接抗人球蛋白试验阳性224例（81.5%）,抗体游离试验阳性238例（86.5%）,抗体放散试验阳性251例（91.3%）。微柱凝胶法比试管法的凝集强度高1＋～2＋。结论：微柱凝胶法的敏感性略高于试管法,具有操作简便,影响因素少,易于标准化,结果客观及保存时间长等优点。     

A prospective study of routine antenatal enzyme antibody screening demonstrates lack of clinical value in predicting haemolytic disease of the newborn

A prospective study of 7065 consecutive new pregnancies identified 230 with a positive screen, of which 27% (62/230) were 'enzyme-only' antibodies. 32 of these (52%) were potentially clinically important and were all of Rh specificity: 22 anti-E, seven anti-Cw, two anti-D and one anti-c. However, only three of these enzyme-only antibodies (one anti-D, one anti-c and one anti-E) became reactive by the indirect antiglobulin test (IAT) during the course of pregnancy, and all were detected in the routine 34-36-week maternal sample. No babies were affected, and we reaffirm that routine antibody screening by enzyme techniques is unnecessary.     

新生儿溶血病与疑难交叉配血的关系

目的:通过对新生儿科患者配血不合血样检测结果进行分析,找出导致新生儿交叉配血不合的原因并寻求有效的解决办法。方法:通过新生儿溶血病血清学检测方法,可检测患者是由母婴红细胞血型不合引起的新生儿溶血病。结果:直接抗球蛋白试验阴性,由IgG抗-A引起配血不合4例;由IgG抗-B引起配血不合6例;直接抗球蛋白试验阳性,由IgG抗-D引起配血不合3例;由IgG抗-E引起配血不合2例。结论:ABO或Rh血型系统的新生儿溶血病是导致临床疑难交叉配血不合的重要因素之一,配合性输注,可确保临床输血安全。     

Serological and Immunological Characteristics of Maternal Anti-Rh(D) Antibodies in Predicting the Severity of Haemolytic Disease of the Newborn

A number of factors were analyzed for their predictive value in indicating the severity of haemolytic disease of the newborn (HDN) in 72 infants. The factors investigated were: maternal antibody titre in the indirect antiglobulin test, the number of antibody molecules on sensitized standard red cells evaluated by a radiometric antiglobulin test, the IgG subclass specificity and the reactivity in monocyte-monolayer assay (MMA) and in the rosette assays with lymphocytes and granulocytes from healthy individuals. The results of the MMA correlate much better with the severity of HDN than the antibody titre. In clinically unaffected infants the reactivity in the MMA never exceeded 20%, while in the severe/very severe group it was always greater than 20% (in 95% of very severe cases even above 50%). The number of IgG-bound molecules was also shown to closely correlate with the clinical severity and there was a much greater proportion of severe/very severe cases exhibiting combined IgG1 and IgG3 specificity. Of all the evaluations performed the rosette assays with lymphocytes and granulocytes were found to be less useful in predicting the severity of HDN.