孕妇产前血型不规则抗体分布及其与非ABO-HDN发生率的相关性研究
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摘要
目的分析孕妇产前不规则抗体阳性率、类型及其分布特征,探讨血型不规则抗体与非ABO血型系统引起的新生儿溶血病(ABO-HDN)的相关性及临床意义。方法回顾性分析2010年1月至2018年12月在深圳市宝安区沙井人民医院就诊的24 522例孕妇的不规则抗体筛选、鉴定结果及非ABO-HDN与血清总胆红素水平,分析不规则抗体阳性孕妇的同种抗体特征及其与非ABO-HDN发生率和严重程度的相关性。结果该院24 522例孕妇产前不规则抗体阳性共177例,不规则抗体阳性率为0.59%,其中Rh血型132例(74.5%),MNS血型24例(13.6%),Kidd血型5例(2.8%),Duffy血型4例(2.3%),Diego血型1例(0.56%),Lewis血型1例(0.56%),多血型混合抗体5例[2.8%,其中抗-M合并抗-D 3例,抗-Jk(a)合并抗-E 2例],其他无法鉴定抗体5例(2.8%,包括自身抗体)。在不规则抗体阳性孕妇中,2胎及2胎以上孕妇不规则抗体阳性率(75.1%)明显高于初胎孕妇(25.9%);有输血史孕妇阳性率(55.9%)高于无输血史的孕妇(44.1%);有妊娠史孕妇阳性率(68.4%)明显高于无妊娠史孕妇(31.6%);不同孕妇之间差异均有统计学意义(P<0.05)。非ABOHDN共计28例,其中Rh血型23例(82.0%),MNS血型2例(7.1%),Kidd血型1例(3.8%),多系统混合抗体2例(7.1%)。孕妇产前不规则抗体效价与血清总胆红素无相关性(P>0.05),但确诊的非ABO-HDN患儿游离抗体效价与血清总胆红素呈正相关(P<0.05)。结论孕妇产前不规则抗体的阳性率与生育史或输血史相关,Rh血型不规则抗体阳性率占比最高,非ABO-HDN严重程度与新生儿抗体效价相关,孕妇RhCcEe配血输血及产前不规则抗体筛查与干预对预防孕妇同种免疫发生具有重要意义。
Objective To analyze the positive rate,types and distribution characteristics of prenatal irregular antibodies of pregnant women in the hospital in recent years,and to explore the correlation and clinical significance between blood group irregular antibodies and non-ABO-HDN.Methods The results of screening and identification of irregular antibodies,non-ABO-HDN and serum total bilirubin were studied retrospectively in24 522 pregnant women who visited the Shajing People′s Hospital from January 2010 to December 2018.The characteristics of alloantibodies in pregnant women with positive irregular antibodies and their correlation with the incidence and severity of non-ABO-HDN were analyzed.Results In this hospital,177 prenatal irregular antibodies were positive in 24 522 pregnant women.The positive rate of irregular antibodies was 0.59%.Among them,132(74.5%)were Rh blood,24(13.6%)were MNS blood,5(2.8%)were Kidd blood,4(2.3%)were Duffy blood,1(0.56%)was Diego blood,1(0.56%)was Lewis blood,and 5(2.8%)were mixed antibodies(3 cases anti-M combined with anti-D,2 cases anti-Jk(a)combined with anti-E),the other 5 cases(2.8%)could not be determined antibodies(including autoantibodies).In the irregular antibody positive pregnant women,the positive rate of irregular antibodies in pregnant women with 2 or more pregnancies was 75.1%,which was significantly higher than that of irregular antibodies in first-trimester pregnant women(25.9%);the positive rate of pregnant women with transfusion history(55.9%)was higher than that of pregnant women without transfusion history(44.1%);the positive rate of pregnant women with pregnancy history(68.4%)was significantly higher than that of pregnant women without pregnancy history(31.6%);there were significant differences among different pregnant women(P<0.05).There were 28 cases of non-ABO-HDN,including 23 cases of Rh blood(82.0%),2 cases of MNS blood(7.1%),1 case of Kidd blood(3.8%)and 2 cases of mixed multi-antibodies(7.1%).Prenatal irregular antibody titers of pregnant women were not correlated with serum total bilirubin(P>0.05),but the titers of free antibodies of non-ABO-HDN children were positively correlated with serum total bilirubin(P<0.05).Conclusion The positive rate of prenatal irregular antibodies in pregnant women is related to the childbirth history or transfusion history.The positive rate of Rh irregular antibodies is the highest.The severity of non-ABO-HDN is related to the effect of neonatal alloantibodies.It is of great significance to prevent the occurrence of alloimmunity in pregnant women by RhCcEe matched transfusion and screening and intervention of prenatal irregular antibodies.
Objective To analyze the positive rate,types and distribution characteristics of prenatal irregular antibodies of pregnant women in the hospital in recent years,and to explore the correlation and clinical significance between blood group irregular antibodies and non-ABO-HDN.Methods The results of screening and identification of irregular antibodies,non-ABO-HDN and serum total bilirubin were studied retrospectively in24 522 pregnant women who visited the Shajing People′s Hospital from January 2010 to December 2018.The characteristics of alloantibodies in pregnant women with positive irregular antibodies and their correlation with the incidence and severity of non-ABO-HDN were analyzed.Results In this hospital,177 prenatal irregular antibodies were positive in 24 522 pregnant women.The positive rate of irregular antibodies was 0.59%.Among them,132(74.5%)were Rh blood,24(13.6%)were MNS blood,5(2.8%)were Kidd blood,4(2.3%)were Duffy blood,1(0.56%)was Diego blood,1(0.56%)was Lewis blood,and 5(2.8%)were mixed antibodies(3 cases anti-M combined with anti-D,2 cases anti-Jk(a)combined with anti-E),the other 5 cases(2.8%)could not be determined antibodies(including autoantibodies).In the irregular antibody positive pregnant women,the positive rate of irregular antibodies in pregnant women with 2 or more pregnancies was 75.1%,which was significantly higher than that of irregular antibodies in first-trimester pregnant women(25.9%);the positive rate of pregnant women with transfusion history(55.9%)was higher than that of pregnant women without transfusion history(44.1%);the positive rate of pregnant women with pregnancy history(68.4%)was significantly higher than that of pregnant women without pregnancy history(31.6%);there were significant differences among different pregnant women(P<0.05).There were 28 cases of non-ABO-HDN,including 23 cases of Rh blood(82.0%),2 cases of MNS blood(7.1%),1 case of Kidd blood(3.8%)and 2 cases of mixed multi-antibodies(7.1%).Prenatal irregular antibody titers of pregnant women were not correlated with serum total bilirubin(P>0.05),but the titers of free antibodies of non-ABO-HDN children were positively correlated with serum total bilirubin(P<0.05).Conclusion The positive rate of prenatal irregular antibodies in pregnant women is related to the childbirth history or transfusion history.The positive rate of Rh irregular antibodies is the highest.The severity of non-ABO-HDN is related to the effect of neonatal alloantibodies.It is of great significance to prevent the occurrence of alloimmunity in pregnant women by RhCcEe matched transfusion and screening and intervention of prenatal irregular antibodies.
引文
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[11]JAKOBSEN M A,NIELSEN C,SPROGE U.A case of high-titer anti-D hemolytic disease of the newborn in which late onset and mild course is associated with the Dvariant,RHD-CE(9)-D[J].Transfusion,2014,54(10):2463-2467.
[12]ELHENCE P,SACHAN D,VERMA A,et al.Late onset neonatal anaemia due to maternal anti-Kp(b)induced haemolytic disease of the newborn[J].Transfus Apher Sci,2012,47(3):247-250.
[13]KIM Y A,MAKAR R S.Detection of fetomaternal hemorrhage[J].Am J Hematol,2012,87(4):417-423.
[14]THAKRAL B,MALHOTRA S,SALUJA K,et al.Hemolytic disease of newborn due to anti-Jk b in a woman with high risk pregnancy[J].Transfus Apher Sci,2010,43(1):41-43.
[15]LI B J,JIANG Y J,YUAN F,et al.Exchange transfusion of least incompatible blood for severe hemolytic disease of the newborn due to anti-Rh17[J].Transfus Med,2010,20(1):66-69.
[2]BHUVA D K,VACHHANI J H.Red cell alloimmunization in repeatedly transfused patients[J].Asian J Transfus Sci,2017,11(2):115-120.
[3]ZALPURI S,ZWAGINGA J J,LE CESSIE S,et al.Redblood-cell alloimmunization and number of red-blood-cell transfusions[J].Vox Sang,2012,102(2):144-149.
[4]袁咏梅,刘和录,何亚,等.孕期效价变化的连续监测及ABO新生儿溶血病发病各因素的相关性研究[J].中国输血杂志,2014,27(3):291-293.
[5]SIDHU M,BALA R,AKHTAR N,et al.Prevalence,specificity and titration of red cell alloantibodies in multiparous antenatal females at a tertiary care centre from north india[J].Indian J Hematol Blood Tran,2016,32(3):307-311.
[6]伍昌林,党鑫堂,朱奕,等.孕妇血型同种抗体特征及RhCcEe配型输血分析[J].临床检验杂志,2018,36(12):942-944.
[7]HENDRICKSON J E,TORMEY C A,SHAZ B H.Red blood cell alloimmunization mitigation strategies[J].Transfus Med Rev,2014,28(3):137-144.
[8]ISHIDA A,OHTO H,YASUDA H,et al.Anti-M antibody induced prolonged anemia following hemolytic disease of the newborn due to erythropoietic suppression in 2siblings[J].J Pediatr Hematol Oncol,2015,37(6):e375-377.
[9]GEORGE A A,SIMON C D.Anti-c(Little c)IgM:an uncommonly observed but expected phenomenon[J].Lab Med,2014,45(4):e142-145.
[10]COHEN D N,JOHNSON M S,LIANG W H,et al.Clinically significant hemolytic disease of the newborn secondary to passive transfer of anti-D from maternal RhIG[J].Transfusion,2014,54(11):2863-2866.
[11]JAKOBSEN M A,NIELSEN C,SPROGE U.A case of high-titer anti-D hemolytic disease of the newborn in which late onset and mild course is associated with the Dvariant,RHD-CE(9)-D[J].Transfusion,2014,54(10):2463-2467.
[12]ELHENCE P,SACHAN D,VERMA A,et al.Late onset neonatal anaemia due to maternal anti-Kp(b)induced haemolytic disease of the newborn[J].Transfus Apher Sci,2012,47(3):247-250.
[13]KIM Y A,MAKAR R S.Detection of fetomaternal hemorrhage[J].Am J Hematol,2012,87(4):417-423.
[14]THAKRAL B,MALHOTRA S,SALUJA K,et al.Hemolytic disease of newborn due to anti-Jk b in a woman with high risk pregnancy[J].Transfus Apher Sci,2010,43(1):41-43.
[15]LI B J,JIANG Y J,YUAN F,et al.Exchange transfusion of least incompatible blood for severe hemolytic disease of the newborn due to anti-Rh17[J].Transfus Med,2010,20(1):66-69.