孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN的意义

目的探讨孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN的意义。方法筛查4200份孕妇血清中红细胞血型不规则抗体,阳性者检测抗体特异性、免疫球蛋白类型及效价;对检测出IgG类不规则抗体者,分娩时取脐血(或新生儿血)检测血清(浆)游离抗体,并进行红细胞直接抗球蛋白试验和红细胞放散试验,以诊断其是否发生HDN。结果4200份孕妇血清中检出红细胞血型不规则抗体44份(阳性率为1.05%),其中20份孕妇血清的抗体为IgG类或IgG及IgM混合抗体,脐血(或新生儿血)检测结果,10名婴儿发生了Non-ABO-HDN,1名发生了宫内死胎。致病的抗体特异性分布为:抗-D2例、抗-c1例、抗-E2例、抗-cE1例、抗-M4例(其中1例并有抗-A)。结论孕妇体内IgG类的Rh血型系统的抗体及抗-M易引起non-ABO-HDN,检测孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN、鉴别引发HDN的抗体型别、评估HDN的严重程度及制定治疗方案均具有重要意义。

Significance of Irregular Red Blood Cell IgG of Pregnant Women in Early Diagnosis of Non-ABO-HDN

Objective To explore the significance of irregular red blood cell(RBC)IgG of pregnant women in the early diagnosis of non-ABO-HDN.Methods Screen irregular RBC antibody in 4 200 pregnant women.The women positive for irregular RBC antibody were tested for specificity of antibody as well as type and titer of Ig.The umbilical cord blood or the blood of newborns from pregnant women positive for irregular RBC IgG were collected after parturition for diagnosis of HDN by test for free antibody in sera as well as direct RBC antiglobulin test and RBC antibody release test.Results Of the 4 200 pregnant women,44(1.05%)were positive for irregular RBC antibody,of which 20 were positive for IgG or IgG and IgM mixed antibody.The fetus of one pregnant woman positive for irregular RBC IgG died in uterus at the 20th weeks after pregnancy,and of the 19 newborns delivered by the other 19 pregnant women,10 were diagnosed as non-ABO-HDN.The distribution of specificity of pathogenic antibody in the dead fetus and the newborns with non-ABO-HDN was as follows:2 cases of anti-D,1 case of anti-c,2 cases of anti-E,1 case of anti-cE and 4 cases of anti-M(including 1 case complicated with anti-A).Conclusion The IgG and anti-IgM of Rh blood group system in pregnant women may cause HDN in newborn.The detection of irregular RBC antibody is of important significance in early diagnosis of non-ABO-HDN,differentiation of antibody type causing HDN,evaluation of severity of HDN and selection of therapeutic protocol.