Analysis of detection rate of anti-M antibody during pregnancy and pregnancy outcome
-
摘要: 目的 探讨妊娠期不规则抗体检测中抗-M抗体的检出率及其对孕产妇妊娠结局的影响，以提高临床对抗-M抗体的认识，增加孕产妇妊娠成功率。方法 应用NEO全自动血型分析仪进行不规则抗体检测，对阳性结果进行进一步抗体鉴定，并留取脐带血或采集静脉血进行新生儿溶血病(HDN)相关检测。结果 在24 646例孕妇中，检出不规则抗体阳性77例，其中抗-M抗体16例，占不规则抗体的比率为20.78%(16/77)。16例孕妇中有1例孕中期胎死，1例未在我院分娩。新生儿中3例因无任何临床症状未行检测，其余检出抗-M抗体引起的HDN 3例，疑似2例，通过采用不同的治疗方法患儿均治愈出院。结论 检出抗-M抗体孕产妇妊娠结局迥异，从无症状到胎儿严重贫血甚至死胎。所以对于抗体筛查试验阳性的孕妇应及时对其抗体类型、特异性及效价进行鉴定，辅助临床诊断，做到早干预、早治疗。Abstract: Objective To investigate the detection rate of anti-M antibody in irregular antibody detection during pregnancy and its effect on pregnancy outcome, in order to improve the clinical understanding of anti-M antibody and increase the success rate of pregnancy.Methods The irregular antibody was detected by NEO automatic blood group analyzer, the positive results were further identified, and the umbilical cord blood or venous blood was taken for the detection of neonatal hemolytic disease(HDN).Results Among 24 646 pregnant women, 77 cases were positive for irregular antibody, including 16 cases of anti-M antibody, accounting for 20.78%(16/77). Among the 16 pregnant women, one died in the second trimester and one did not give birth in our hospital. Among the newborns, 3 cases were not tested because there were no clinical symptoms, and the remaining 3 cases of HDN caused by anti-M antibody and 2 suspected cases were cured and discharged through different treatment methods.Conclusion The pregnancy outcomes of pregnant women with anti-M antibody were very different, from asymptomatic to severe fetal anemia and even stillbirth. Therefore, pregnant women with positive antibody screening test should identify their antibody type, specificity and titer in time to assist clinical diagnosis and achieve early intervention and treatment.
-
-
表 1 77例孕产妇不规则抗体的特异性分布
血型系统 抗体类型 例数 百分率/% Rh系统 抗-D 3 3.90 抗-E 17 22.08 抗-Ec 11 14.29 抗-Ce 2 2.60 抗-DC 1 1.30 MNS系统 抗-M 16 20.78 抗-Mur 8 10.40 Kidd系统 抗-Jkb 1 1.30 Duffy系统 抗-Fyb 1 1.30 Lewis系统 抗-Lea 4 5.19 其他 未确定特异性 6 7.79 直接抗人球蛋白阳性 7 9.09 
下载: 导出CSV
表 2 16例抗-M抗体阳性孕妇临床情况及妊娠结局
病例 血型 妊娠史 抗体类型 抗体效价 效价初次检出孕周 生产孕周 宫内输血 其他 1 A+ G1P0 / / / 40 无 2 A+ G7P3 IgG+IgM 640/160 13+2 33+4 6次 既往不良孕产史 3 A+ G2P1 IgG+IgM < 1/ < 1 17 38+4 无 既往不良孕产史 4 O+ G1P0 IgM < 1 13 39 无 5 B+ G2P0 IgM 2 29 39+6 无 6 B+ G1P0 IgM < 1 35 38+5 无 7 B+ G2P0 IgG 1 10+4 39+2 无 8 O+ G2P0 IgG+IgM 8/ < 1 12 38+3 无 9 O+ G4P0 IgG+IgM < 1/ < 1 9+2 / 2次 既往胎儿水肿史 10 AB+ G2P0 IgG 2 35+2 39 无 11 B+ G1P0 IgM < 1 32 39 无 12 O+ G1P0 IgM < 1 31 40+2 无 13 A+ G1P0 IgM 1 31+4 38+2 无 14 A+ G1P0 IgM < 1 28+2 39+4 无 15 A+ G2P1 IgM < 1 11+6 40+5 无 16 AB+ G3P0 IgG < 2 12+1 / / 9号病例孕19周胎心消失引产。
下载: 导出CSV
表 3 16例HDN检测结果及新生儿情况
病例 血型 Apar评分 总胆红素/ (μmol·L-1) 年龄 DAT 游离试验① 释放试验② 治疗 1 min 5 min 1 A+ 9 10 41 12 h△ - - - / 2 O+ 9 10 141 7 d○ + + + 输血，光疗，静脉注射丙种球蛋白 3 A+ 9 10 233 1 d○ - - + 光疗，静脉注射丙种球蛋白 4 / 10 10 / / / / / 5 B+ 10 10 29 1 d△ - - - / 6 O+ 9 10 23 12 h△ - - - / 7 B+ 9 10 276 5 d○ - + - 光疗 8 A+ 9 10 22 1 h△ - + - / 9 / / / / / / / / 10 AB+ 9 10 22 16 h△ - - + / 11 B+ 9 10 23 10 h△ - - - / 12 O+ 9 9 294 5 d○ - - - / 13 AB+ 9 10 22 1 h△ - - - / 14 / 9 10 / / / / / 15 / 10 10 / / / / / 16 / / / / / / / / ①+表示新生儿血清中检出抗-M抗体，-表示未检出；②+表示放散液中检出抗-M抗体，-表示未检出；○标本类型为静脉血；△标本类型为脐血。
下载: 导出CSV
-
[1] 李翠莹, 李小薇. 胎儿新生儿溶血病实验室检测专家共识[J]. 临床输血与检验, 2021, 23(1): 20-23, 28. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202101006.htm
[2] 李翠莹. 胎儿新生儿溶血病的诊疗策略探讨[J]. 临床输血与检验, 2021, 23(1): 24-28. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202101007.htm
[3] Ferdowsi S, Mohammadi S, Ahmadnezhad M, et al. Anti-M antibody and ABO blood grouping discrepancy: a report of three cases with review of literature[J]. Hematol Transfus Cell Ther, 2022, 44(2): 288-290. doi: 10.1016/j.htct.2020.09.150
[4] 谭庆芬. MN血型系统不规则抗体对ABO血型定型困难及交叉配血不合的影响[J]. 临床血液学杂志, 2021, 34(4): 282-284. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202104016.htm
[5] Li S, He Z, Luo Y, et al. Distribution of maternal red cell antibodies and the risk of severe alloimmune haemolytic disease of the foetus in a Chinese population: a cohort study on prenatal management[J]. BMC Pregnancy Childbirth, 2020, 20(1): 539. doi: 10.1186/s12884-020-03235-w
[6] Li S, He Z, Mo C, et al. Hyporegenerative anemia in anti-M-associated hemolytic disease of the fetus[J]. Transfusion, 2021, 61(6): 1908-1915. doi: 10.1111/trf.16350
[7] 许亚莉, 刘孟, 张瑞宁, 等. 高效价抗-M抗体对血型鉴定的影响及解决策略[J]. 临床血液学杂志, 2021, 34(12): 878-881. doi: 10.13201/j.issn.1004-2806.2021.12.012
[8] 刘长利, 赵卫军. 编码MNS血型抗原的GYP基因组研究进展[J]. 中国实验血液学杂志, 2012, 20(1): 200-204. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY201201049.htm
[9] 桂嵘, 译. AABB技术手册[M]. 长沙: 中南大学出版社, 2019: 228-229.
[10] 王琛, 焦琴, 杨世明, 等. 81例抗M抗体的鉴定及其对血型血清学检测的影响[J]. 细胞与分子免疫学杂志, 2022, 38(1): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-XBFM202201011.htm
[11] Ohto H, Denomme GA, Ito S, et al. Three non-classical mechanisms for anemic disease of the fetus and newborn, based on maternal anti-Kell, anti-Ge3, anti-M, and anti-Jra cases[J]. Transfus Apher Sci, 2020, 59(5): 102949.
[12] 姚润, 杨涓, 李宁. 不同血型系统胎儿或新生儿溶血病的特点[J]. 临床血液学杂志, 2021, 34(12): 890-893. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202112016.htm
[13] Yasuda H, Ohto H, Nollet KE, et al. Hemolytic disease of the fetus and newborn with late-onset anemia due to anti-M: a case report and review of the Japanese literature[J]. Transfus Med Rev, 2014, 28(1): 1-6.
[14] Li L, Huang L, Luo G, et al. Prenatal treatment of severe fetal hemolytic disease due to anti-M alloimmunization by serial intrauterine transfusions[J]. Taiwan J Obstet Gynecol, 2017, 56(3): 379-381.
[15] 杨茹, 李刚, 何欣, 等. Rh、MNS等血型系统不规则抗体导致新生儿溶血病的实验室检测分析[J]. 临床血液学杂志, 2019, 32(2): 109-112. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201902008.htm
[16] Wikman A, Edner A, Gryfelt G, et al. Fetal hemolytic anemia and intrauterine death caused by anti-M immunization[J]. Transfusion, 2007, 47(5): 911-917.
[17] 邹昕, 虞茜, 葛平英, 等. 常州地区Rh、MNS血型不合致新生儿溶血病的试验结果分析及治疗[J]. 检验医学与临床, 2021, 18(9): 1185-1188. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202109001.htm
[18] Arora S, Doda V, Maria A, et al. Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins[J]. Asian J Transfus Sci, 2015, 9(1): 98-101.
[19] Mohd Nazri H, Noor Haslina MN, Shafini MY, et al. Anti-M induced severe haemolytic disease of foetus and newborn in a Malay woman with recurrent pregnancy loss[J]. Malays J Pathol, 2017, 39(1): 73-76.
[20] Yu M, Graham K, Pasalic L, et al. Recurrent fetal hydrops with maternal M alloimmunisation: not a benign condition[J]. BMJ Case Rep, 2019, 12(7).
[21] Li S, Mo C, Huang L, et al. Hemolytic disease of the fetus and newborn due to alloanti-M: three Chinese case reports and a review of the literature[J]. Transfusion, 2019, 59(1): 385-395.
[22] Rai R, Saha SC, Jain A, et al. Anti-M Alloimmunization in Pregnancy: An Unusual Cause of Bad Obstetric History[J]. J Obstet Gynaecol India, 2016, 66(Suppl 2): 607-609.
[23] Crispin P, Sliwinski K, Wilson C, et al. Cold reacting anti-M causing delayed hemolytic disease of the newborn[J]. Transfusion, 2019, 59(12): 3575-3579.
-