毛细管离心术在胎母血型不一致的临床大量FMH综合征的诊断价值*

doi:10.3969/j.issn.1671-2587.2022.05.006

临床输血与检验 ›› 2022, Vol. 24 ›› Issue (5): 582-587.DOI: 10.3969/j.issn.1671-2587.2022.05.006

毛细管离心术在胎母血型不一致的临床大量FMH综合征的诊断价值^*

张源秦, 徐璐, 马怡然, 杨融辉, 郝一文, 程大也, 丛桂敏

110001 中国医科大学附属第一医院（张源秦,马怡然,杨融辉,程大也,郝一文）,沈阳市妇婴医院（徐璐,丛桂敏）

收稿日期:2022-05-12 出版日期:2022-10-20 发布日期:2022-10-31
通讯作者: 郝一文,主任医师,博士,主要从事临床输血与治疗方面的研究,（E-mail）hyw82666@163.com。共同通信作者：程大也,主任技师,博士,主要从事临床输血研究,（E-mail）chengdy@cmu1h.com。共同通信作者：丛桂敏,主任技师,主要从事妇产科及婴幼儿领域相关疾病的试验诊断技术及临床运用,（E-mail）gmcong1963@163.com。
作者简介:张源秦（1994-）,女,医师,硕士,主要从事孕产妇的血液安全技术研究,（E-mail）1814089858@qq.com。并列第一作者：徐璐（1991-）,女,主管输血技师,主要从事母胎领域相关疾病的实验室诊断技术及输血治疗方面研究,（E-mail）luca_xu26660@163.com。
基金资助:
^*本课题受辽宁省自然科学基金计划重点项目（NO.20180530022）

Massive Fetomaternal Hemorrhage Caused by Maternal-fetal Blood Type Inconsistency:Diagnostic Value of Capillary Centrifugation

ZHANG Yuan-qin, XU Lu, MA Yi-ran, et al

Department of Blood Transfusion the First Affiliated Hospital of China Medical University, Shenyang 110000

Received:2022-05-12 Online:2022-10-20 Published:2022-10-31

摘要/Abstract

摘要： 目的探讨毛细管离心术对胎母血型不一致的大量FMH综合征高危孕产妇的辅助诊断价值和临床适用性。方法 25例临床高度怀疑发生胎母血型不一致的大量FMH综合征的妊娠中晚期孕产妇,以流式细胞术结果为金标准评价毛细管离心术对临床大量FMH综合征的诊断效能。结果在出现典型FMH综合征临床表现的25例孕妇中,有15例经流式细胞术证实发生了大量胎母输血,有11例用毛细管离心术成功分离出血型不一致的胎儿红细胞血型。毛细管离心术诊断临床大量FMH综合征的敏感度为73.3%、特异度60%、阳性预测值73.3%、符合率68%。结论毛细管离心术对胎母血型不一致的大量FMH具有辅助实验诊断价值,因其简便易行可作为遗传学上可能有胎母血型不一致的大量FMH 综合征的辅助诊断实验。

关键词: 胎母输血综合征, 毛细管离心术, 诊断价值

Abstract: Objective To discuss the auxiliary diagnostic value of and clinical applicability of Capillary centrifugation in high-risk pregnant women with massive fetomaternal hemorrhage（FMH）caused by maternal-fetal blood type inconsistency. Methods Twenty-five pregnant women in the second- and third-trimester pregnancy suspected of massive FMH caused by maternal-fetal blood type inconsistency were enrolled. The results of flow cytometry were used as the gold standard to evaluate the diagnostic performance of capillary centrifugation. Results In the 25 pregnant women, 15 cases were confirmed by flow cytometry to have undergone massive FMH, and 11 of them were successfully separated by Capillary centrifugation. The sensitivity, specificity, positive predictive value and coincidence rate of Capillary centrifugation for the diagnosis of massive FMH were 73.3%, 60%, 73.3% and 68%, respectively. Conclusion Capillary centrifugation has auxiliary experimental diagnostic value for massive FMH with maternal-fetal blood group incompatibility because it is simple and easy to operate.

Key words: Fetomaternal hemorrhage syndrome, Capillary centrifugation, Diagnostic value

中图分类号:

R457.1R714.5

张源秦, 徐璐, 马怡然, 杨融辉, 郝一文, 程大也, 丛桂敏. 毛细管离心术在胎母血型不一致的临床大量FMH综合征的诊断价值^*[J]. 临床输血与检验, 2022, 24(5): 582-587.

ZHANG Yuan-qin, XU Lu, MA Yi-ran, et al. Massive Fetomaternal Hemorrhage Caused by Maternal-fetal Blood Type Inconsistency:Diagnostic Value of Capillary Centrifugation[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2022, 24(5): 582-587.

参考文献

[1] BOWMAN J M,POLLOCK J M,PENSTON L E.Fetomaternal transplacental hemorrhage during pregnancy and after delivery[J]. Vox Sang,1986,51(2):117-121.
[2] TROÌA L,AL-KOUATLY H B,MCCURDY R,et al. The recurrence risk of fetomaternal hemorrhage[J]. Fetal Diagn Ther,2019,45(1):1-12.
[3] AYENEW A A.Prevalence of rhesus D-negative blood type and the challenges of rhesus D immunoprophylaxis among obstetric population in Ethiopia:a systematic review and meta-analysis[J]. Matern Health Neonatol Perinatol,2021,7(1):8.
[4] TNEH S Y,BAIDYA S,DALY J.Clinical practices and outcomes of RhD immunoglobulin prophylaxis following large-volume fetomaternal haemorrhage in Queensland,Australia[J]. Aust N Z J Obstet Gynaecol,2021,61(2):205-212.
[5] 张源秦,马怡然,郝一文,等.胎母输血综合征辅助诊断与治疗进展[J]. 临床输血与检验,2021,23(3):395-399.
[6] MAIER J T,SCHALINSKI E,SCHNEIDER W,et al.Fetomaternal hemorrhage (FMH),an update:review of literature and an illustrative case[J]. Arch Gynecol Obstet,2015,292(3):595-602.
[7] 张源秦,王美茹,徐璐,等. 毛细管超速离心技术在体外预测大量胎母输血综合征的研究[J]. 临床输血与检验,2021,23(3):301-305.
[8] Mark K.Fung,PhD Brenda J. Grossman, et al.美国血库协会技术手册(第18版)[M]. 长沙:中南大学出版社,2019:507.
[9] 汪德清. 输血技术操作规程(输血科部分)[M].北京:人民卫生出版社,2016.
[10] CAMPBELL T A,WARE R E,MASON M.Detection of hemoglobin variants in erythrocytes by flow cytometry[J]. Cytometry,1999,35(3):242-248.
[11] LEWIS N E,MARSZALEK L,ERNST L M.Placental pathologic features in fetomaternal hemorrhage detected by flow cytometry[J]. Pediatr Dev Pathol,2017,20(2):142-151.
[12] CHEN J C,DAVIS B H,WOOD B,et al.Multicenter clinical experience with flow cytometric method for fetomaternal hemorrhage detection[J]. Cytometry,2002,50(6):285-290.
[13] PELIKAN D M,SCHERJON S A,MESKER W E,et al.Quantification of fetomaternal hemorrhage:a comparative study of the manual and automated microscopic Kleihauer-Betke tests and flow cytometry in clinical samples[J].Am J Obstet Gynecol,2004,191(2):551-557.
[14] 高珊珊,俞君,吴小花.脐血胆红素对ABO溶血病新生儿高胆红素血症的预测意义[J].中国妇幼保健,2020,35(14):2623-2625.
[15] 种靖慧,李彤彤,解金辉,等.天津地区RhD阴性孕妇胎母出血的研究[J].国际生物医学工程杂志,2019,42(2):139-142.
[16] Tao E,Ye D,Long G,et al. Severe neonatal Anemia affected by massive fetomaternal hemorrhage:a single-center retrospective observational study[J]. J Matern Fetal Neonatal Med,2020:2020 Nov 12;1-2020 Nov 12;7.
[17] ZWIERS C,SCHEFFER-RATH M E,LOPRIORE E,et al. Immunoglobulin for alloimmune hemolytic disease in neonates[J].Cochrane Database Syst Rev,2018,3(3):CD003313.
[18] LE PICHON J B,RIORDAN S M,WATCHKO J,et al.The neurological sequelae of neonatal hyperbilirubinemia:definitions,diagnosis and treatment of the kernicterus spectrum disorders (KSDs)[J]. Curr Pediatr Rev,2017,13(3):199-209.
[19] WATCHKO J F.Neonatal indirect hyperbilirubinemia and kernicterus[M]//Avery's Diseases of the Newborn. Amsterdam:Elsevier,2018:1198-1218.e5.
[20] USMAN F,DIALA U,SHAPIRO S,et al.Acute bilirubin encephalopathy and its progression to kernicterus:current perspectives[J]. Res Rep Neonatol,2018,8:33-44.
[21] PENG H H,NG Z P,TANG Y H,et al.Term pregnancy with choriocarcinoma presenting as severe fetal Anemia and postpartum hemorrhage[J]. Taiwan J Obstet Gynecol,2016,55(3):430-433.

毛细管离心术在胎母血型不一致的临床大量FMH综合征的诊断价值^*

Massive Fetomaternal Hemorrhage Caused by Maternal-fetal Blood Type Inconsistency:Diagnostic Value of Capillary Centrifugation

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