Rh血型系统意外抗体致新生儿溶血病的实验室分析
|
摘要
目的:分析由Rh血型系统意外抗体引起的新生儿溶血病中,各类抗体的分布特点,从而为临床预防、诊断和治疗Rh血型不合新生儿溶血病(Rh-HDN)提供重要依据。方法:采用试管法进行ABO、Rh血型鉴定(新生儿ABO血型鉴定仅做正定型),微柱凝胶法进行新生儿溶血三项试验,微柱凝胶法和凝聚胺法进行抗体筛查、抗体鉴定。应用χ2检验进行组间比较。结果:246例夫妇ABO血型相同或相合的样本中,61例检出Rh血型系统意外抗体(24.60%),抗体特异性分别为:抗-D(32例)、抗-E(10例)、抗-c E(4例)、抗-C(3例)、抗-c(2例)、抗-Ce(4例);273例夫妇ABO血型不相合的样本中,25例检出Rh血型系统意外抗体(8.93%),抗体特异性分别为:抗-D(15例)、抗-E(2例)、抗-c E(4例)、抗-C(2例)、抗-c(1例)、抗-Ce(1例)。不存在ABO抗体组的Rh抗体的检出数明显高于存在ABO抗体组,差异具有统计学意义(P<0.05)。结论:抗-D仍是引起Rh-HDN的主要因素,但其他Rh系统意外抗体,尤其是在夫妇ABO血型相同或相合的样本中抗-E和抗-cE的检出率也较高。应重视Rh D阳性的孕妇,且夫妇ABO血型相同或相合时,Rh血型系统意外抗体的筛查,对Rh-HDN的预防和早期治疗具有重要的临床意义。
Objective: To analyze the distribution of all kinds of irregular antibodies causing hemolytic disease of the newborn(HDN) in Rh blood group system to provide important basis for clinical prevention,diagnosis and the treatment of Rh-HDN. Methods: The ABO and Rh blood group identification(neonatal ABO blood group identification was done only by positive test) by the tube method. Three tests of neonatal hemolysis were carried out by microcolumn gel method. The antibody screening and antibody identification were carried out by microcolumn gel method and polyamine method. The application of 2test were compared between the two groups. Result: In 246 cases of compatible ABO blood type of the parents,there were 61 cases of irregular antibodies detected in Rh blood group system(24.60%),and the distribution of antibodies were anti-D(32 cases),anti-E(2cases),anti-cE(4 cases),anti-C(3 cases),anti-c(2 cases) and anti-Ce(4 cases) respectively. In 273 cases of incompatible ABO blood type of the parents,there were 25 cases of irregular antibodies detected in Rh blood group system(8.93%),and the distribution of antibodies were anti-D(15 cases),anti-E(2 cases),anti-cE(4 cases),anti-C(2cases),anti-c(1case) and anti-Ce(1case) respectively. The detected number of Rh antibodies in the group without ABO antibodies was higher than the number of the group with ABO antibodies. The differences was statistically significant(P <0.05). Conclusion: Anti-D is still the main cause of Rh-HDN. However,the detection rates of anti-E and anti-c E were also high in other Rh systems,especially in the samples of the same or compatible ABO blood group. We should attach importance to the Rh D positive pregnant women. If the ABO blood group is the same or coincide,the screening of unexpected antibodies in Rh blood group system is of great clinical significance for the prevention and early treatment of Rh-HDN.
Objective: To analyze the distribution of all kinds of irregular antibodies causing hemolytic disease of the newborn(HDN) in Rh blood group system to provide important basis for clinical prevention,diagnosis and the treatment of Rh-HDN. Methods: The ABO and Rh blood group identification(neonatal ABO blood group identification was done only by positive test) by the tube method. Three tests of neonatal hemolysis were carried out by microcolumn gel method. The antibody screening and antibody identification were carried out by microcolumn gel method and polyamine method. The application of 2test were compared between the two groups. Result: In 246 cases of compatible ABO blood type of the parents,there were 61 cases of irregular antibodies detected in Rh blood group system(24.60%),and the distribution of antibodies were anti-D(32 cases),anti-E(2cases),anti-cE(4 cases),anti-C(3 cases),anti-c(2 cases) and anti-Ce(4 cases) respectively. In 273 cases of incompatible ABO blood type of the parents,there were 25 cases of irregular antibodies detected in Rh blood group system(8.93%),and the distribution of antibodies were anti-D(15 cases),anti-E(2 cases),anti-cE(4 cases),anti-C(2cases),anti-c(1case) and anti-Ce(1case) respectively. The detected number of Rh antibodies in the group without ABO antibodies was higher than the number of the group with ABO antibodies. The differences was statistically significant(P <0.05). Conclusion: Anti-D is still the main cause of Rh-HDN. However,the detection rates of anti-E and anti-c E were also high in other Rh systems,especially in the samples of the same or compatible ABO blood group. We should attach importance to the Rh D positive pregnant women. If the ABO blood group is the same or coincide,the screening of unexpected antibodies in Rh blood group system is of great clinical significance for the prevention and early treatment of Rh-HDN.
引文
[1]曾丽仪,贾金平,徐凤仪.新生儿溶血病相关性研究[J].国际医药卫生导报,2015,21(1):26~28.
[2]余灵,黄从付.新生儿高胆红素的诊断及基因研究进展[J].实用儿科临床杂志,2004,19(2):1090~1092.
[3]尚红,王毓三,申子瑜.等.全国临床检验操作规程[M].第4版.人民卫生出版社,2015.118.
[4]王憬惺,严力行,王鸿捷,等.输血技术[M].第3版.人民卫生出版社,2013.353.
[5]林甲进,朱碎永,张瑛.Rh新生儿溶血病的血清抗体分析[J].中国实验诊断学,2007,11(12):1635.
[6]娄白敏,庞桂芝,张趁利,等.不规则抗体筛查及效价对新生儿溶血病的影响[J].中国妇幼保健,2011,36(26):5720.
[7]陈妙婵,李启欣,陈活强,等.ABO以外血型抗体引起的新生儿溶血病分析[J].广州医药,2011,42(4):55.
[8]张晨光,贺志安,赵庆伟,等.Rh血型系统系统意外抗体与新生儿溶血病的相关性[J].现代预防医学,2007,34(11):2037.
[9]李勇,马学严,刘庆梅,等.实用血液免疫学:血型理论和实验技术[M].第1版.北京:科学出版社,2006.410~422.
[10]朱传福,王玫,李京.Rh(D)阴性孕产妇Ig G抗体检测分析[J].中国输血杂志,2006,19(2):128.
[2]余灵,黄从付.新生儿高胆红素的诊断及基因研究进展[J].实用儿科临床杂志,2004,19(2):1090~1092.
[3]尚红,王毓三,申子瑜.等.全国临床检验操作规程[M].第4版.人民卫生出版社,2015.118.
[4]王憬惺,严力行,王鸿捷,等.输血技术[M].第3版.人民卫生出版社,2013.353.
[5]林甲进,朱碎永,张瑛.Rh新生儿溶血病的血清抗体分析[J].中国实验诊断学,2007,11(12):1635.
[6]娄白敏,庞桂芝,张趁利,等.不规则抗体筛查及效价对新生儿溶血病的影响[J].中国妇幼保健,2011,36(26):5720.
[7]陈妙婵,李启欣,陈活强,等.ABO以外血型抗体引起的新生儿溶血病分析[J].广州医药,2011,42(4):55.
[8]张晨光,贺志安,赵庆伟,等.Rh血型系统系统意外抗体与新生儿溶血病的相关性[J].现代预防医学,2007,34(11):2037.
[9]李勇,马学严,刘庆梅,等.实用血液免疫学:血型理论和实验技术[M].第1版.北京:科学出版社,2006.410~422.
[10]朱传福,王玫,李京.Rh(D)阴性孕产妇Ig G抗体检测分析[J].中国输血杂志,2006,19(2):128.