孕产妇血型同种抗体特征及RhCcEe配型输血分析

目的探讨RhCcEe配型输血预防同种抗体的意义。方法回顾性分析2013年至2017年深圳市第二人民医院15 436例孕产妇同种抗体的筛选及鉴定结果,分析孕产妇同种抗体阳性率及其特异性分布、ABO血型以外新生儿溶血病的抗体特征,对比分析孕产妇RhCcEe配型输血与随机输血同种抗体阳性率、新生儿溶血病发生率。结果孕产妇血型同种抗体阳性率0.66%(102例),其中Rh血型占72.5%(74/102),MNSs血型占11.8%(12/102),Kidd血型占4.9%(5/102),Duffy血型占1.96%(2/102),Lewis血型占1.96%(2/102),Diego血型占0.98%(1/102),其他占5.88%(6/102)。在抗体阳性孕产妇中:2胎及以上孕产妇占75.5%,高于初胎孕产妇(25.4%);有输血史者占57.8%,高于无输血史者(42.2%);有妊娠史者占68.6%,高于无妊娠史者(31.4%)。ABO血型以外的新生儿溶血病25例,Rh血型占72%(18/25),MNSs 12%(3/25),Kidd 8%(2/25),其他8%(2/25);RhCcEe配型输血组同种抗体及新生儿溶血病发生率均低于随机输血组,差异有统计学意义(P<0.05)。结论孕产妇血型同种抗体发生率与生育史(或妊娠史)、输血史密切相关,Rh抗体阳性率占比最高;Rh血型抗原C、c、E、e同型输注可有效降低HDN发生,对预防孕产妇同种免疫具有一定的意义。

Characteristics of Blood Group Alloantibodies in Pregnant Women and RhCcEe Matched Transfusion

Objective To analyze the positive rate, specificity and distribution of blood group alloantibodies of pregnant women in our hospital in the last 5 years, and to explore the clinical significance of RhCcEe matched blood transfusion for preventing from blood group alloantibodies. Methods The screening and identified results of blood group antibodies were retrospectively analyzed for 15436 pregnant women in our hospital from January,20l3 to December,2017. The distribution characteristics were analyzed for the positive rate of blood group alloantibodies and its specificity of these pregnant women, and the positive rate of blood group alloantibody and the incidence of newborn hemolytic diseases were analyzed for the pregnant women compared with RhCcEe matched transfusion group and random blood transfusion group. Results In the last 5 years, 102 cases of maternal blood group antibodies were positive (0.66%), including Rh blood group 74 cases(72.5%), MNS 12 cases (11.8%), Kidd 5 cases (4.9%), Duffy 2 cases (1.97%), Lewis 2 cases (1.97%), Diego 1 case(0.98%), and other antibody 6 cases(5.88%). In the pregnant women with the positive antibodies: The pregnant women with 2 or more children accounted for 75.5%, who obviously were higher than that of the pregnant women with only one child (25.4%), the positive rate of antibody for the women with transfusion history (57.8%) was higher than that of the pregnant women without transfusion history (42.2%). The positive rate of pregnant women with pregnancy history (68.6 %) was significantly higher than that of pregnant women without pregnancy (31.4%), there was significant difference between them(P<0.05). There were 25 cases of hemolytic disease of newborns except for ABO blood group, including Rh blood group 18 cases (72%), MNS 3 cases (12%), Kidd 2 cases (8%) and other blood groups 2 cases(8%). Besides, the statistical analysis showed that the incidence of alloantibodies and HDN in RhCcEe matched transfusion group was significantly lower than that of random infusion group, the difference was statistically significant (P<0.05). Conclusion The production of blood group antibody in pregnant women is closely related to the birth history or transfusion history, and the proportion of Rh blood group is the highest. The incidence of HDN can be reduced effectively by RhCcEe multi-antigen matched transfusion, which has clinical significance for the prevention of blood group alloimmunity.