| 周明,王慧茹,陈洋,等.孕产妇 Rh血型系统抗体检测和临床意义分析[J].安徽医药,2020,24(2):252-256. |
| 孕产妇 Rh血型系统抗体检测和临床意义分析 |
| Correlation between the characteristics of Rh antibody and HDN in pregnant women |
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| DOI：10.3969/j.issn.1009?6469.2020.02.010 |
| 中文关键词: Rh?Hr血型系统 Coombs试验 输血 不规则抗体 微柱凝胶抗球蛋白试验 |
| 英文关键词: Rh?Hr blood?group system Coombs’test Blood transfusion Irregular antibody Microcolumn gel anti?globulin test |
| 基金项目:安徽省自然科学青年基金资助项目(1708085QH198) |
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| 中文摘要: |
| 目的探讨产妇 Rh血型系统抗体的检出特点，分析其与新生儿溶血病之间的关系并制定临床输血应对策略。方法选取 2016年 10月至 2018年 6月中国科学技术大学附属第一医院(安徽省立医院)孕产妇红细胞不规则抗体筛选试验阳性的血标本，根据抗体的 Ig类型应用抗球蛋白法或微柱凝胶抗球蛋白法，鉴定受检血清(血浆)与谱细胞及自身红细胞的反应结果；检测 Rh血型抗体的效价、免疫球蛋白类型及 37 ℃反应性以明确其临床意义；孕产妇受检红细胞 D、C、E、c、e抗原采用单克隆抗 ?D、抗?C、抗?E、抗?c、抗?e试剂鉴定其 Rh血清学分型；新生儿标本进行溶血病三项试验，鉴定新生儿放散液的抗体与其母亲血清(血浆)中是否有相同，分析妊娠史、输血史与抗体产生的相关性。结果从 4 680例住院孕产妇备血标本中共检出 Rh血型抗体 56例，检出率为 1.20%，其中有妊娠史者 48例，输血史者 6例； Rh血型抗体的特异性为:抗?E 33例( 58.92%)、抗?D 10例(17.86%)、抗?c 7例( 12.50%)、抗?cE 5例( 8.93%)、抗?C 1例( 1.79%)；血型抗体的免疫球蛋白类型主要为 IgG或 IgG+IgM类，间接抗球蛋白试验 37℃下均可与相应抗原的红细胞凝集反应，抗体效价介于 1~512；10例新生儿溶血病血清中抗体与其母亲相同。结论女性因妊娠或输血等免疫刺激是 Rh血型抗体产生的主要原因，来自母体的 Rh血型抗体可导致 Rh?HDN，应增加孕产夫妇 RhCE抗原常规检测并同型输血，可有效降低意外抗体的产生概率。 |
| 英文摘要: |
| Objective To analyze the screening results of Rh antibodies among pregnant patients before blood transfusion，to ana? lyze its association with hemolytic disease of the newborn so as to developing strategies for clinical blood transfusion. Methods Blood samples tested positive in maternal red blood cell irregular antibodies screening from October 2016 to June 2018 at the FirstAffiliated Hospital of The University of Science and Technology of China(Anhui Provincial Hospital)were selected.Identification was performed on the reaction results of the tested serum(plasma)with spectral cells and their own red blood cells using the anti?globulin method or micro?column gel antiglobulin method according to the Ig type of the antibodies.Detection was made of the titerof Rh blood type antibodies，immunoglobulin type and activity at 37℃ to clarify its clinical significance and maternal red blood cell D，C，E，c，e antigens were identified by monoclonal anti?D，anti?C，anti?c，anti?E，and anti?e for serotyping.Neonatal specimens were tested for hemolytic disease in three items，identification was made of whether the antibodies in neonatal dispersion were identical with those in the maternal serum(plasma)，and analysis was made of the correlation between the history of gestation，blood transfu? sion and antibody production.Results The Rh blood group antibody was detected in 56 cases(56/4680，1.20 %)，including 48 cas? es with pregnancy history，6 cases with blood transfusion history.The specificities of antibodies to Rh blood antigens were found as follows:33 cases of anti?E(58.92%)10 cases of anti?D(17.86%)7 cases of anti?c(12.50%)，5 cases of anti?e(8.93%)，and 1 caseofanti?C(1.79%).Theimmunoglob，ulintypesofbloodgroupantib，odies were mainly IgG or IgG+IgM，and indirect antiglobulin test can react with erythrocyte agglutination of corresponding antigen at 37 ℃.The titer of antibody ranged from 1 to 512.Antibodiesfound in 10 cases of neonatal hemolytic serum were the same as those of their mothers.Conclusion Immune stimulation，such as pregnancy or blood transfusion，is the main cause of antibody production of Rh blood group in women.Antibodies to Rh blood from mothers can cause Rh?HDN，therefore，routine detection of RhCE antigen in pregnant couples and blood transfusion of the sametype should be enhanced to effectively reduce the incidence of accidental antibody production. |
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