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临床输血与检验

临床输血与检验 ›› 2023, Vol. 25 ›› Issue (4): 480-483.DOI: 10.3969/j.issn.1671-2587.2023.04.009

• 临床输血 • 上一篇    下一篇

3例新生儿溶血病D抗原遮蔽现象的实验室诊断与换血治疗

王恒1, 宋琳2, 李静1, 王晓宁1   

  1. 1吉林大学第一医院输血科 130021;
    2吉林大学第一医院血液科,吉林长春 130000
  • 收稿日期:2023-06-30 出版日期:2023-08-20 发布日期:2023-09-18
  • 通讯作者: 王晓宁,主要从事临床输血与检验方面研究,（E-mail）wxiaoning@jlu.edu.cn。
  • 作者简介:王恒,主要从事临床输血与检验方面研究,（E-mail）498293934@qq.com。

Laboratory Diagnosis and Blood Exchange Therapy of D-antigen Occlusion in 3 Cases of Hemolytic Disease of the Newborn

WANG Heng, SONG Lin, LI Jing, et al   

  1. The first hospital of Jilin University 130000
  • Received:2023-06-30 Online:2023-08-20 Published:2023-09-18

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摘要： 目的 分析3例RhD新生儿溶血病（hemolytic disease of the newborn,HDN）,因D抗原遮蔽导致新生儿D抗原假阴性的现象。方法 采用血型血清学方法检测产妇及新生儿标本血型、抗体效价,进行抗体筛查及抗体鉴定。对患儿标本进行DAT、游离抗体与放散抗体实验,并送基因检测。结果 3例新生儿DAT、游离抗体、放散抗体阳性,产妇与新生儿抗体筛查与鉴定结果为抗-D抗体,效价均大于512。患儿血型检测为RhD阴性,患儿红细胞56℃热放散后为D弱阳性,基因结果3例RhD抗原均是阳性,换血治疗后效果均较好。结论 产妇抗-D抗体效价过高易形成D抗原遮蔽现象,使新生儿RhD抗原假阴性,进一步加重HDN,需尽早给予新生儿治疗,准确检测新生儿血型。

关键词: RhD新生儿溶血病, 抗原遮蔽, 高效价

Abstract: Objective To analyze a phenomenon in 3 cases of HDN, the false negative of D antigen due to D antigen masking. Methods Blood type and antibody titers of maternal and newborn specimens were detected by blood group serology, and antibody screening and identification were carried out. DAT, free antibody and released antibody tests were performed on the samples of the children, and genotyping was carried out. Results DAT, free antibody and released antibody were positive in 3 neonates. The results of maternal and neonatal antibody screening and identification were anti-D antibody, and the titers were all greater than 512. The blood type test of the child was negative for RhD, and the red blood cells of the child were weakly positive after heat release at 56℃. The gene result of the 3 cases was positive for RhD antigen, and the effect of blood exchange treatment was good. Conclusion The high titer of maternal anti-D antibody can lead to D antigen masking phenomenon, which makes the newborn RhD antigen false negative and further increases HDN. It is necessary to give newborn treatment as soon as possible and accurately detect the newborn blood type.

Key words: RhD fetal neonatal hemolysis, Antigen masking, High potency

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