BACKGROUND:It has traditionally been considered that mother-infant ABO incompatibility only causes mild haemolytic disease of the newborn (HDN). However, this view is inconsistent with clinical practice, and large-scale population-based data are lacking to investigate its effects on neonates. METHODS:Differences in hospitalisation rates and incidence rates of neonatal hyperbilirubinaemia (NHB) and anaemia among 47 679 Chinese liveborn neonates with different mother-infant ABO combinations, differences in the incidence of ABO-incompatible HDN (ABO-HDN) among neonates with O-B versus O-A mother-infant ABO incompatibility, and the contributions of ABO-HDN to the development of NHB and neonatal anaemia were analysed. RESULTS:Of the 47 679 liveborn neonates, neonates with mother-infant ABO incompatibility had higher rates of hospitalisation and incidence of NHB and anaemia. The hierarchy of the risk of mother-infant ABO incompatibility to the neonate was O-B > O-A > non-O-A/O-B incompatibility. Among neonates with O-B and O-A mother-infant ABO incompatibility, the ABO-HDN incidence rates were 15.27% (513/3359) and 11.33% (417/3680), respectively (95% CI 1.41 (1.23 to 1.62)), and the severe ABO-HDN incidence rates were 2.05% (69/3359) and 1.14% (42/3680), respectively (95% CI 1.82 (1.23 to 2.67)). Among the 7039 neonates with O-A/O-B mother-infant ABO incompatibility, ABO-HDN was an independent aetiological factor in 41.11% (666/1620) of the neonates with NHB, 70.27% (52/74) of the neonates with severe NHB, 42.34% (163/385) of the neonates with anaemia and 18.28% (17/93) of the neonates with severe anaemia. CONCLUSIONS:Mother-infant ABO incompatibility often leads to severe HDN and is a dominant cause of NHB and neonatal anaemia, leading to significantly higher neonatal hospitalisation rates.

There are inter-population differences in the maternal-to-fetal transfer ratio of immunoglobulin G (IgG), and there is currently a lack of research on the Chinese population. In this cross-sectional observational study, the serum concentrations of total protein, albumin, and total IgG in 71 paired samples, and IgG1–4 in 50 paired maternal and cord blood samples, were measured in Chinese mothers who delivered live births at ≥ 37 gestational weeks. The results show cord and maternal serum albumin concentrations were 36.98 ± 3.16 g/L and 36.53 ± 2.33 g/L, respectively (t = -0.98, P > 0.05). The cord serum total IgG concentration was 9.00 (8.20–9.90) g/L, and the total protein concentration was 55.63 ± 5.30 g/L, whereas the maternal serum total IgG concentration was 10.80 (9.40–11.80) g/L, and the total protein concentration was 65.14 ± 4.57 g/L (z = -5.38, P < 0.0001; t = 11.45, P < 0.0001). The maternal-to-fetal transfer ratio of total IgG was 0.82 (0.76–0.93), and the hierarchy of the maternal-to-fetal transfer ratios of IgG1–4 was as follows: IgG1 (1.28 ± 0.38) > IgG4 (1.06 ± 0.41) > IgG3 (0.86 ± 0.34) ≥ IgG2 (0.75 ± 0.28). Cord and maternal serum showed similar albumin but lower total protein; IgG1–4 transfer hierarchy matched prior studies, while ratios were lower than in most populations. These findings may help to understand the immune protection mechanisms in newborns among the Chinese population.

BACKGROUND AND OBJECTIVES:There is limited knowledge regarding cefamandole-related drug-induced immune haemolytic anaemia (DIIHA). We conducted a comprehensive serological and clinical follow-up study of a case of cefamandole-induced DIIHA to improve understanding of this condition. MATERIALS AND METHODS:A patient with advanced hepatocellular carcinoma developed severe haemolytic anaemia along with significant worsening of hepatic and renal function after intravenous cefamandole was administered for a urinary tract infection. Serological testing included the direct antiglobulin tests (DATs), irregular red blood cell (RBC) antibody screening and detection of cefamandole-dependent antibodies using two standard methods for drug-dependent antibodies: 'testing in the presence of soluble drug' and 'testing drug-treated RBCs', which were performed after cefamandole discontinuation. Clinical follow-up was conducted for 41 days after drug cessation. RESULTS:The results of DAT for anti-IgG and anti-C3d were strongly positive, while irregular RBC antibody screening was negative. Plasma samples collected at different points from 13 to 38 days after cefamandole discontinuation were incubated with cefamandole-coated RBCs at 37°C, revealing both IgM and IgG cefamandole-dependent antibodies, with a maximum titre of 16. Following treatment with blood transfusion, intravenous immunoglobulin (IVIG), and methylprednisolone, anaemia and organ dysfunction showed marked improvement. Therefore, the patient was diagnosed with cefamandole-induced DIIHA. CONCLUSIONS:This study may be the second serological analysis and the first comprehensive clinical follow-up of cefamandole-induced DIIHA. It demonstrates that cefamandole-dependent antibodies can activate complement, leading to severe haemolytic anaemia and hepatic and renal impairment. The 'testing drug-treated RBCs' method is suitable for detecting cefamandole-dependent antibodies.

Due to the disruption in the supply of consumables for platelet separation on the COBE Spectra blood component separator in China, we have performed therapeutic thrombocytapheresis using its mononuclear cell collection procedure (MNC procedure) and compared it with the therapy by COM.TEC platelet donation procedure to compare the influence on patient blood cell indicators. Therapeutic thrombocytapheresis was conducted 69 and 35 times on 38 and 15 clonal thrombocytosis patients using the MNC procedure with the COBE Spectra (MNC group) and the PLT-5d C5L procedure of the COM.TEC platelet donation package (PLT-5d C5L group), respectively. In the MNC and PLT-5d C5L groups, the therapy durations and the processed blood volumes were similar: platelet removal rates, 60.56% (53.59-75.81%) and (84.95 ± 39.46)% (z = 3.017, p < 0.01); white blood cell (WBC) loss values, 2.85 (2.02-3.83) × 109/L and 0.69 (0.23-1.47) × 109/L (z = 8.307, p < 0.001); and haemoglobin (Hb) loss values, 0.75 (0.50-1.09) g/L and 0.03 (0.02-0.20) g/L (z = 8.311, p < 0.001) in the MNC and PLT-5d C5L groups, respectively. However, the WBC count decreased by 1.28 (- 0.84 to 2.49) × 109/L and (2.97 ± 3.49) × 109/L (z = 2.825, p < 0.01), and the Hb level decreased by (3.38 ± 9.36) g/L and (9.06 ± 7.05) g/L (t = - 3.158, p < 0.01) in the MNC and PLT-5d C5L groups, respectively. The results show that, compared with the COBE Spectra MNC procedure, although the COM.TEC platelet donation package PLT-5d C5L procedure demonstrated higher therapeutic thrombocytapheresis efficiency, it also resulted in a greater decrease in WBCs and Hb.

Background: There is insufficient evidence to assess the risk of the production of clinically important alloimmune irregular red blood cell (RBC) antibodies in first-time pregnant women.Methods: Using the microcolumn gel antiglobulin method, 18,010 Chinese women with a history of pregnancy and pregnant women were screened for irregular RBC antibodies, and for those with positive test results, antibody specificity was determined. The detection rate and specificity of irregular RBC antibodies in women with a history of multiple pregnancies (two or more) and first-time pregnant women were determined.Results: In addition to 25 patients who passively acquired anti-D antibodies via an intravenous anti-D immunoglobulin injection, irregular RBC antibodies were detected in 121 (0.67%) of the 18,010 women. Irregular RBC antibodies were detected in 93 (0.71%) of the 13,027 women with a history of multiple pregnancies, and antibody specificity was distributed mainly in the Rh, MNSs, Lewis, and Kidd blood group systems; irregular RBC antibodies were detected in 28 (0.56%) of the 4983 first-time pregnant women, and the antibody specificity was distributed mainly in the MNSs, Rh, and Lewis blood group systems. The difference in the percentage of patients with irregular RBC antibodies between the two groups was insignificant (χ2=1.248, P>0.05). Of the 121 women with irregular RBC antibodies, nine had anti-Mur antibodies, and one had anti-Dia antibodies; these antibodies are clinically important but easily missed because the antigenic profile of the reagent RBCs that are commonly used in antibody screens does not include the antigens that are recognized by these antibodies.Conclusion: Irregular RBC antibody detection is clinically important for both pregnant women with a history of multiple pregnancies and first-time pregnant women. Mur and Dia should be included in the antigenic profile of reagent RBCs that are used for performing antibody screens in the Chinese population.

Objective To explore the effect of recovery autologous blood transfusion combined with bilateral internal ili-ac artery presetting in high-risk patients with hemorrhage during cesarean section.Methods A total of 162 high-risk patients with hemorrhage who underwent cesarean section from January 2021 to May 2023 in our hospital were prospectively selected and divided into in Groups A,B,and C with 54 cases in each group according to the indications for the method of transfu-sion.Group A received allogeneic blood transfusion,Group B received autologous blood transfusion,Group C received autologous blood transfusion combined with bilateral internal iliac artery balloon presetting.Results Intraoperative blood loss(mL)(1 600 vs 1 500 vs 800),postoperative hospital stay(d)(7 vs 7 vs 6)and operative time(min)(107 vs 104.50 vs 77)in group C were all lower than those in group A and B(P＜0.05),with no difference between group A and B(P＞0.05);The autologous blood transfusion volume(mL)in group C was lower than that in group B(525.5 vs 261,P＜0.05).The proportion of allogeneic erythrocytes in group C was lower than that in group A(22.22%vs 100.00%,P＜0.016 7).The proportion of plasma in group C was lower than that in groups A and B(18.50%vs 66.70%/18.50%vs 44.40%,P＜0.016 7).The incidence of coagulating dysfunction in group C was lower than that in group A(7.41%vs 25.93%,P＜0.016 7).The incidence of hysterectomy in group C was lower than that in group A(1.85%vs 16.67%,P＜0.016 7),and there was no difference between group A and B(16.67%vs 11.11%,P＞0.016 7).Conclusion Recovery autologous blood transfusion combined with bilateral internal iliac artery balloon presetting in cesare-an section for high-risk patients with hemorrhage achieved ideal effects,which can significantly reduce intraoperative blood loss,intraoperative autologous blood transfusion,allogeneic red blood cells and plasma transfusion,as well as the operation time and postoperative hospital stay.In addition,it can improve the coagulation function and hysterectomy,which is condu-cive to ensuring the safety of maternal and promoting early rehabilitation,and preserving the fertility of patients to a certain extent,which is worthy of further clinical promotion.

Background Piperacillin is one of the most common drugs that cause drug-induced immune hemolytic anemia, but a complete description of the serological features and course of the disease is rare. This study completely describes the serological characteristics and course of a patient with hypertensive nephropathy who developed drug-induced immune hemolytic anemia and worsened renal function during repeated administration of piperacillin-tazobactam. Case presentation A 79-year-old male patient with hypertensive nephropathy who developed severe hemolytic anemia and worsened renal function during intravenous piperacillin-tazobactam anti-infective treatment due to lung infection. Serological tests showed that the result of the direct antiglobulin test for anti-IgG was positive (4 +) and anti-C3d was negative, and the irregular red blood cell antibody screening test was negative. Plasma samples collected at different times from 2 days before to 12 days after the discontinuation of piperacillin-tazobactam administration were incubated with piperacillin solution and red blood cells of O-type healthy blood donors at 37 °C, IgG piperacillin-dependent antibodies were detected, and the highest titer was 128. However, no tazobactam-dependent antibody was detected in any plasma samples. Therefore, the patient was diagnosed with piperacillin-induced immune hemolytic anemia. Although blood transfusion and continuous renal replacement therapy were given, the patient died of multiple organ failure 15 days after the administration of piperacillin-tazobactam was stopped. Conclusion This is the first complete description of the disease course and serological changes of piperacillin-induced immune hemolytic anemia, which is bound to help deepen the understanding of drug-induced immune hemolytic anemia and draw profound lessons from it.

OBJECTIVE:To improve the collection efficiency of leukapheresis, explore relatively scientific and objective evaluation indicators for collection effect, and observe the effect of high-volume leukapheresis on blood cells and coagulation function.METHODS:A total of 158 times of high-volume leukapheresis were performed on 93 patients with hyperleukocytic leukemia by using continuous flow centrifugal blood component separator. 1/5-1/4 of total blood volume of the patients was taken as the target value of leukocyte suspension for single treatment. In addition, the total number of white blood cells (WBCs) subtracted, value of WBCs reduction, rate of WBCs reduction, decrease value of WBCs count, decrease rate of WBCs count, amount of hemoglobin (Hb) lost, value of Hb lost, decreased value of Hb, total number of platelet (PLT) lost, the value of PLT loss, and decrease value of PLT count were used to comprehensively evaluate the collection effect of leukapheresis and influence on Hb level and PLT count of the patients. The prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT), and fibrinogen (Fib) concentration were detected before and after treatment, and the effect of leukapheresis on coagulation function of the patients was observed.RESULTS:The volume of leukocyte suspension collected in a single treatment was 793.01±214.23 ml, the total number of WBCs subtracted was 353.25 (241.99-547.28)×109, the value of WBCs reduction was 86.98 (63.05-143.43)×109/L, the rate of WBCs reduction was 44.24 (28.37-70.48)%, decrease value of WBCs count was 65.73 (37.17-103.97)×109/L, decrease rate of WBCs count was (35.67±23.08)%, the amount of Hb lost was 17.36 (12.12-24.94) g, the value of Hb lost was 4.31 (3.01-6.12) g/L, decreased value of Hb was 4.80 (-1.25-9.33) g/L, total number of PLT lost was 222.79 (67.03-578.31)×109, the value of PLT loss was 54.45 (17.29-139.08)×109/L, and decrease value of PLT count was 26.00 (8.38-62.50)×109/L. Before and after a single treatment, the PT was 14.80 (13.20-16.98) s and 15.20 (13.08-16.90) s (z=-1.520, P>0.05), the aPTT was 35.20 (28.68-39.75) s and 35.40 (28.00-39.75) s (z=-2.058, P<0.05), the TT was 17.50 (16.30-18.80) s and 17.70 (16.70-19.10) s (z=-3.928, P<0.001), and the Fib concentration was 2.87±1.13 g/L and 2.64±1.03 g/L (t=7.151, P<0.001), respectively.CONCLUSION:High-volume leukapheresis can improve the efficiency of leukapheresis while maintaining the relative stability of the patients' circulating blood volume. The degree of influence on the patients' Hb level, PLT count, Fib concentration, and comprehensive coagulation indicators reflecting the patients' intrinsic and cxtrinsic coagulation activity is within the body's compensation range.

OBJECTIVE:To explore the genetic mechanism underlying a case with para-Bombay phenotype.METHODS:The ABO and Lewis phenotype were identified with serological methods. The coding regions of exons 6 and 7 of the ABO and FUT1 genes were amplified with PCR and directly sequenced. Haploid sequence analysis was carried out on the variant sites of the FUT1 gene.RESULTS:Serological analysis confirmed that the proband has a rare para-Bombay phenotype. Direct sequencing revealed that he was a B.01/O.01.02 heterozygote for the ABO gene, and had heterozygous deletion for the 768 and 881-882 sites of the FUT1 gene. Further haploid analysis showed that the c.881_882delTT deletion has occurred in one haploid while c.768delC was present in the other haploid. The proband was therefore determined as a FUT1*01N.13/01N.20 heterozygote, which have resulted in frameshift in polypeptide chain p.Phe294Cysfs*40 and p.Val257Phefs*23, respectively.CONCLUSION:A rare bi-allelic heterozygous deletion of para-Bombay phenotype has been identified in a blood donor. The c.881_882delTT and c.768delC deletions may decrease the activity of α-1,2-fucosyltransferase.

妊娠可引起红细胞同种免疫,产生红细胞同种抗体,具有临床意义的红细胞同种抗体可引起免疫溶血性输血反应(immune hemolytic transfusion reaction,IHTR)和胎儿及新生儿免疫溶血性疾病(hemolytic disease of fetus and newborn, HDFN).

Background: Severe drug-induced immune hemolytic anaemia (DIIHA) cases leading to death are very rare. Among the reported cases of DIIHA, the serological characteristics and course of the disease are rarely described completely. Piperacillin is a semi-synthetic penicillin against pseudomonas widely used in the treatment of bacterial infections. It is one of the most common drugs that cause DIIHA. Methods: In this study, a 79-year-old male patient with hypertensive nephropathy who developed severe hemolytic anemia during intravenous piperacillin-tazobactam anti-infective treatment due to lung infection, and worsened renal function. Serological tests included direct antiglobulin test (DAT), acid elution test, irregular red blood cell (RBC) antibody detection, and the drug-dependent antibodies associated with piperacillin or tazobactam were detected by the standard methods for the detection of drug-dependent antibodies both in the presence of soluble drug and with drug-coated RBCs. Fully described the patient's course of disease and the serological changes after stopping the administration of piperacillin-tazobactam.Results: Serological tests showed that the results of DAT for anti-IgG was positive (4+) and anti-C3d was negative. The IgG piperacillin-dependent antibodies (the highest titer reached 128) were detected in the plasma incubated with O-type RBCs and 3 mg/mL piperacillin. But the plasma or the acid eluent incubated with piperacillin-coated RBCs, or the acid eluent incubated with O-type RBCs and 3 mg/mL piperacillin did not detect antibodies. The patient was diagnosed as piperacillin-induced DIIHA. Although blood transfusion and continuous renal replacement therapy were given, the patient still died of multiple organ failure 15 days after the administration of piperacillin-tazobactam was stopped.Conclusions: DIIHA caused by piperacillin exacerbated renal damage and was an important cause of the patient's eventual death from multiple organ failure. Which has helped to deepen the understanding of DIIHA and draw lessons from it.

Background ABO blood type incompatibility hemolytic disease of newborn (ABO-HDN) and drug-induced immune hemolytic anemia (DIIHA) due to non-immunologic protein adsorption (NIPA) mainly cause extravascular hemolysis. All the reported severe DIIHA were caused by drug-induced antibodies, and rare report of acute intravascular hemolysis was caused by the NIPA mechanism or ABO-HDN. Case presentation We report the first case of acute intravascular hemolysis induced by cefotaxime sodium - sulbactam sodium (CTX - SBT) in a case of ABO-HDN which resulted in death at 55 h after birth. The mother’s blood type was O and RhD-positive, and the newborn’s blood type was B and RhD-positive. No irregular red blood cell (RBC) antibodies or drug-dependent antibodies related to CTX or SBT was detected in the mother’s plasma and the plasma or the RBC acid eluent of the newborn. Before the newborn received CTX - SBT treatment, the result of direct antiglobulin test (DAT) was negative while anti-B was positive (2 +) in both plasma and acid eluent. After the newborn received CTX - SBT treatment, the results of DAT for anti-IgG and anti-C3d were both positive, while anti-B was not detected in plasma, but stronger anti-B (3 +) was detected in acid eluent. In vitro experiments confirmed that NIPA of SBT promoted the specific binding of maternal-derived IgG anti-B to B antigen on RBCs of the newborn, thereby inducing acute intravascular hemolysis. Conclusion The NIPA effect of SBT promoted the specific binding of mother-derived IgG anti-B in newborn’s plasma to the newborn’s RBC B antigens and formed an immune complex, and then activated complement, which led to acute intravascular hemolysis. Drugs such as SBT with NIPA effect should not be used for newborns with HDN.

There has previously been a report of a patient developing haemolytic anaemia following exposure to cefoperazone. Another case has been reported involving the detection of cefoperazone-dependent antibodies in the absence of immune haemolytic anaemia. To date, no serological evidence has been reported to suggest that cefoperazone can lead to drug-induced immune haemolytic anaemia (DIIHA). This report aims to fill these gaps in knowledge by describing a case of DIIHA caused by cefoperazone-dependent antibodies. A 59-year-old man developed fatal haemolytic anaemia while receiving cefoperazone-tazobactam or cefoperazone-sulbactam for the treatment of a lung infection that occurred after craniocerebral surgery. This eventually led to renal function impairment. Prior to the discontinuation of cefoperazone treatment, the patient showed strong positive (4+) results for both anti-IgG and anti-C3d direct antiglobulin test (DAT), while cefoperazone-dependent IgM and IgG antibodies were detected. The patient's plasma and O-type RBCs were incubated with tazobactam or sulbactam solution at 37°C for 3 h, the results of DAT for anti-IgG and anti-C3d were both positive. Forty-three days after the discontinuation of cefoperazone, the results of DAT for anti-IgG and anti-C3d were negative. Meanwhile incubation of the patient's fresh serum and his own RBCs with cefoperazone at 37°C, gave rise to mild haemolysis, and the results of DAT for both anti-IgG and anti-C3d were positive. It is suggested that cefoperazone-dependent antibodies can activate complement, and the non-immunologic protein adsorption effect of tazobactam or sulbactam can enhance IgG and complement binding to RBCs. This may promote the formation of immunocomplexes and complement activation, thereby aggravating haemolysis.

Previously, it was reported that multiple patients had hemolytic anemia associated with cimetidine administration, while only one patient who had received intravenous cimetidine was serologically diagnosed with drug-induced immune hemolytic anemia (DIIHA) caused by cimetidine-dependent antibodies. However, the ability of oral cimetidine intake to induce the production of antibodies has not been examined. In this study, we report a 44-year-old male patient in whom oral cimetidine administration resulted in cimetidine-dependent antibodies and drug-independent non-specific antibodies, leading to the development of DIIHA. Serological tests showed that the results of direct antiglobulin test (DAT) for anti-IgG (3+) and anti-C3d (1+) were positive. The IgM and IgG cimetidine-dependent antibodies (the highest total titer reached 4,096) were detected in the plasma incubated with O-type RBCs and 1 mg/mL cimetidine or the plasma incubated with cimetidine-coated RBCs. IgG-type drug-independent non-specific antibodies were detected in blood samples collected at days 13, 34, 41, and 82 post-drug intake. This is the first study to report that oral administration of cimetidine can elicit the production of cimetidine-dependent antibodies, leading to DIIHA, and the production of drug-independent non-specific antibodies, resulting in hemolytic anemia independent of cimetidine. Presence of pathogenic antibodies were detectable longer than 41 days. This suggests that patients with DIIHA caused by cimetidine need to be given necessary medical monitoring within 41 days after cimetidine intake.

目的 探讨品管圈活动缩短严重产后出血患者术中紧急用血等候时间的效果.方法 回顾2018年1月～2019年3月本院产后出血量≥1000 mL产妇术中紧急用血等候时间,按照品管圈活动的十大步骤,针对术中紧急用血的环节开展质量改进活动,比较品管圈活动前、后严重产后出血患者术中紧急用血等候时间和手术室对急诊用血满意度的差异.结果 品管圈活动前严重产后出血患者术中紧急用血等候时间为(53±11)min、手术室对急诊用血的满意度为70％;品管圈活动开展质量改进后术中紧急用血等候时间为(33±8)min(t=7.5,P<0.05),手术室对急诊用血的满意度为95％.结论 针对术中紧急用血环节开展品管圈活动进行质量改进,能有效缩短严重产后出血患者术中紧急用血等候时间,提高手术室对急诊用血的满意度.

To report a case of hyperhaemolysis syndrome (HHS) that occurred during perinatal blood transfusion in a pregnant Chinese woman with β‐thalassemia to deepen the understanding of HHS and the risk of transfusion therapy for patients with thalassemia.

目的 准确鉴定1例类孟买血型OHm A,明确其分子机制.方法 对1例ABO血型常规正反定型不相符的就诊者,采用IgM单克隆抗-A、抗-A1、抗-AB、抗-B、抗-H试剂检测红细胞ABH抗原;用A、B、O型标准红细胞检测血浆中的血型抗体;用吸收放散试验检测红细胞弱表达的ABO血型抗原;用PCR产物直接测序法进行FUT1基因序列分析.结果 IgM单克隆抗-A、抗-A1、抗-AB、抗-B、抗-H试剂盐水介质即刻离心法未检出红细胞A、B、H抗原,吸收放散试验检出红细胞弱表达A抗原,血浆中检出强反应的抗-B(4+)和较弱的抗-H(与A型红细胞反应为±,与O型红细胞反应为+),FUT1基因测序检出FUT1基因c.658C>T纯合突变.结论 该就诊者符合类孟买血型OHmA的血清型和基因型.

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) occurs when fetal platelets are sensitized and then phagocytized by macrophages in the reticuloendothelial system after antibodies specific for allogeneic platelets in the pregnant women cross the placenta and enter the fetus. In severe cases, intracranial hemorrhage and even fetal death may occur. This article reviews the recent progress in the following aspects: the mechanisms of pregnancy-related platelet alloimmunity, platelet destruction mechanisms in FNAIT, correlation of anti-angiogenic effects and intracranial hemorrhage, correlation between anti-GPIbα antibodies and miscarriage, and the diagnosis, treatment and prevention of FNAIT.

We report a case of a newborn baby who suffered from hemolytic disease of fetus and newborn (HDFN) caused by anti-Di a. The baby presented with worsening jaundice started at three hours after birth and was transferred to Dongguan Maternal and Child Health Care Hospital. The newborn's hemoglobin (Hb) was 82 and 76 g/L at five and nine hours after birth, and the total bilirubin (TBIL) was 243.2 and 309.8 μmol/L, respectively. Blood samples of the newborn and the parents were collected for HDFN immunohematology test twelve hours after birth. They showed that the newborn and the father's blood type was A and RhDCCee, while the mother was A and RhDCcee. Direct antiglobulin test (DAT) indicateda strong positive for the newborn and negative for the parents. The reaction of the reagent to red blood cells for antibody screening with the patient's plasma, red cells eluate, and the mother's plasma were all negative, but were positive with the father's red blood cells. The newborn was recovered after treating with phototherapy, intravenous immunoglobulins and urgent blood exchange (the exchanged blood was the same ABO and RhD blood type and cross-matched). The newborn's plasma and red cells eluate were collected before blood exchange, and the mother's plasma were used to assess the red blood cells reaction, and IgG anti-Di a was identified in each sample. Di a blood typing was positive for the newborn and the father, and negative for the mother. Therefore, the newborn was diagnosed as HDFN caused by anti-Di a.

目的:探讨连续流动离心式血液成分分离机高量减除血小板治疗对血小板增多症患者综合性凝血指标及血浆纤维蛋白原浓度的影响.方法:采用COBE Spectra连续流动离心式血液成分分离机ELP或MNC程序,以ACD-A配方血液保存液为抗凝剂,对血小板增多症患者实施减除血小板治疗,每次治疗设置处理血量为2.5～3.0倍总血容量(total blood volume,TBV),采集血小板悬液容量为20％～25％TBV,对21例患者共进行32次减除血小板治疗,观察血小板减除效果及治疗前、后凝血指标和血浆纤维蛋白原浓度的差异.结果:单次治疗运行时间(212.53±41.54) min,处理血量(8 812.63±2 087.15)mL,采集血小板悬液容量(798.84±190.77) mL;治疗前、后患者循环血液血小板计数(platelet count,Plt)分别为(1 426.46±530.23)×109个/L、(778.83±247.25)×109个/L(t=10.808,P=0.000),凝血酶原时间(prothrombin time,PT)分别为(12.82±1.53)s、(13.28±1.51)s(t=3.921,P=0.000),活化部分凝血活酶时间(activated partial thromboplastin time,aPTT)分别为35.75(29.43,37.55)s、35.40(31.20,38.20) s(Z=3.021,P=-0.003),凝血酶时间(thrombin time,TT)分别为(17.46±1.30)s、(17.88±1.41) s(t=2.783,P=0.009),纤维蛋白原浓度(fibrinogen concentration,Fbg)分别为(2.96±1.18) g/L、(2.81±1.11)g/L(t=3.433,P=0.002).结论:采用连续流动离心式血液成分分离机对血小板增多症患者实施高量减除血小板治疗,可显著降低患者体内血小板负荷;对患者PT、aPT、TT、Fbg的影响在机体正常代偿范围内.