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).

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 分析国内广泛使用的抗体筛选试剂红细胞标识的抗原谱,探讨其抗原组合的合理性.方法 收集4个国产厂家(G1、G2、G3、G4)和2个进口厂家(J1、J2)共68批次抗体筛选试剂红细胞的抗原谱,统计各个厂家不同批次抗体筛选试剂红细胞D、C、c、E、e、M、N、S、s、Fya、Fyb、Jka、Jkb、K、k、Lea、Leb、P1、Dia、Mur共20种抗原的表达率,及D、C、c、E、e、Fya、Fyb、Jka、Jkb、S、s、M、N共13种具有剂量效应抗原符合纯合子要求的比率.结果 6个厂家抗体筛选试剂红细胞的抗原谱均标识表达有D、C、c、E、e、M、N、s、Fya、Jka、Jkb、Lea、Leb;S在G2、G3分别仅有30％、67％的批次表达;Fyb在G1仅有29％的批次表达;P1在G4均未标识;K在G1、G4均未标识,在G2、G3均不表达;k在G1均未标识;Dia仅在G4所有批次表达;Mur在6个厂家所有批次的抗体筛选试剂红细胞均未标识.具有剂量效应的抗原仅在J1所有批次符合纯合子要求,其他厂家所有批次均不符合纯合子要求.结论 所分析的6个厂家抗体筛选试剂红细胞应用于中国人群,抗原组合均存在一定缺陷,主要是缺乏部分抗原(如S、Fyb、K、Dia、Mur)和部分具有剂量效应的抗原(如Fyb、Jka、Jkb、S、M、N)不是纯合子,存在漏检有临床意义红细胞抗体的风险.