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Rh阴性孕妇的产前免疫血液学检查及妊娠结局分析
徐文皓;黄亚娟
0
(上海交通大学附属上海市第六人民医院)
摘要:
目的:探讨Rh阴性孕妇产前免疫血液学检查和结局分析。方法:回顾性分析2010年1月至2016年12月期间在我院孕检及分娩的22880例孕妇中有Rh阴性孕妇287例(1.25%),用血清学方法确认血型D抗原阴性、Rh系统其他抗原表现型及抗体筛选;对有抗-D抗体孕妇进一步做抗体效价及分娩后根据新生儿黄疸指数做新生儿溶血病检测。部分Rh阴性孕妇于孕37周做预存式自体备血。结果:Rh阴性孕妇287例中,有12例(4.18%)检出抗-D抗体,抗原表现型均为ccee,且均有完整生育史。90例有1胎生育史中检出抗-D抗体10例(11.11%),15例有2胎生育史中检出抗-D抗体2例(13.33%)。287例孕妇生育290个新生儿中有8个发生胎儿新生儿Rh溶血病,发生率占2.75%(8/290)。12例抗-D抗体孕妇中1例宫内有溶血,出生后治疗无效死亡,7例出生后发现新生儿黄疸,经换血等治疗后治愈,其余4例新生儿无黄疸出现。146例Rh阴性孕妇孕37周实施了预存式自体备血,剖宫产与经阴道分娩产妇比较自体备血与未自体备血者产后出血量,显示两组差异均无统计学意义(P>0.05)。结论:有完整生育史且抗原表现型为"ccee"Rh阴性孕妇发生抗-D同种免疫反应可能会加大,但新生儿结局差异很大;Rh阴性孕妇分娩前可根据自身状况做预存式自体备血。
关键词:  Rh阴性  孕妇  抗-D抗体  新生儿溶血病  自体备血
DOI:
基金项目:
XU Wenhao;HUANG Yajuan
(Shanghai Jiaotong University affliated Shanghai Sixth People’s Hospital)
Abstract:
Objective: To study antenatal immunity test and outcomes of Rh-negative pregnant women.Methods:287 cases( 1. 25% in 22880 cases) of Rh-negative pregnant women delivered in Shanghai Sixth People hospital from January 1 st,2010 to December 31,2016 were retrospectively analyzed.Rh( D) blood group was identified by a micro column gel method,and the same as serum anti-D antibody.The Rh phenotype detection was done Serology method and the hemolytic disease of the newborn was used indirect antiglobulin test,serum free antibody test,absorption and elution test. Some Rh negative pregnant women were implemented autologous blood at 37 weeks of gestation.Results: Among 287 cases of Rh-negative,12 cases had anti-D antibody and the positive rate was 4. 18%.Among the 12 cases of anti-D positive,their Rh phenotype were all ccdee and they all had history of childbearing.In 90 cases which had one history of birth,there were ten cases had anti-D antibody( 11. 11%),in 15 cases which had two history of birth,there were two cases had anti-D antibody( 13. 33%).287 Rh negative pregnant women had 290 child births,among which 8 newborn had neonatal hemolytic disease,the incidence rate was2. 75%( 8/290).In the 12 cases of anti-D positive,there were 1 case died because of fetal neonatal hemolytic disease and 7 cases were cured and 4 cases were normal with free of jaundice symptoms.There were 146 pregnant women implementation of autologous donation safely.According to the delivery way of childbirth,287 cases were divided by cesarean section and vaginal delivery,comparing postpartum haemorrhage amount with autologous donantion and unautologous donation,respectively,the result showed that they had no significant difference( P >0. 05).Conclusions: It should be pay attention to the pregnant women who had childbearing history and whose Rh phenotype is ccee,which tend to produce anti-D immune antibody.However,this does not necessarily lead to hemolytic disease.Based on maternal and fetus conditions,autologous donation is safe and valuable in Rh-negative pregnant.
Key words:  Rh-negative  Pregnantwomen  Anti-Dantibody  Newbornhadneonatalhemolyticdisease  Autologousdonantion

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