A case of severe neonatal anemia caused by fetal mother transfusion syndrome combined with anti-M antibody and literature review
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摘要: 识别胎母输血综合征，探讨胎母输血综合征合并不规则抗体导致重度贫血患儿的输血策略。采用血型血清学方法对患儿和母亲进行ABO血型、RhD血型及MN血型鉴定，不规则抗体筛查、鉴定及交叉配血等试验。采用电化学发光法对患儿母亲进行甲胎蛋白测定。患儿母亲产前胎动减少、胎心监护异常，胎儿大脑中动脉峰值流速增大；产时甲胎蛋白异常升高。患儿及母亲血清标本均检测出抗-M抗体，导致交叉配血困难。胎母输血综合征发病较为隐匿，一般不易发现。产前进行不规则抗体筛查，有助于预防新生儿溶血病的发生，保证孕产妇用血安全。Abstract: Identify fetal mother transfusion syndrome, and explore the blood transfusion strategy for severe anemia children caused by fetal mother transfusion syndrome combined with irregular antibodies. The ABO blood group, RhD blood group and MN blood group identification test, irregular antibody screening and identification test and cross matching test were carried out for children and mothers with blood group serological method. The alpha-fetoprotein(AFP) of the mothers of the children was determined by electrochemiluminescence. Prenatal fetal movement of the mother of the child decreased, fetal heart monitoring was abnormal, and the peak velocity of fetal middle cerebral artery increased; Abnormal increase of alpha-fetoprotein during labor. Anti-M antibodies were detected in serum samples of both children and mothers, resulting in difficulties in cross matching. The incidence of fetal mother transfusion syndrome may be relatively hidden and generally not easy to find. Prenatal screening of irregular antibodies may be helpful to prevent the occurrence of hemolytic disease of the newborn and ensure the safety of blood use for pregnant and pregnant women.
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Key words:
- fetal maternal transfusion syndrome /
- anti-M /
- hemolysis of the newborn
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表 1 患儿及母亲血型鉴定结果
序号 ABO/RhD血型 MN血型 抗-A 抗-B 抗-D Ac Bc Oc 抗-M 抗-N 患儿母亲 4+ 4+ 4+ - - - - 4+ 患儿 4+ - 4+ / / / 4+ 4+ 
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表 2 患儿及母亲不规则抗体筛查结果
序号 Rh-hr Kidd MNS Duffy Kell Lewis P 患儿母亲 患儿 C D E c e Jka Jkb M N S s Fya Fyb Kpa Kpb Lea Leb P1 盐水 柱凝集 盐水 柱凝集 筛选细胞1 1 + + - - + - + + - - + + - - + + - + + + ± ± 2 + - + + - + + - + - + + - - + + - - - - - - 3 + + + + + + + + + - + + + - + - + + + + ± ± 筛选细胞2 1 + + - - + - + + + - + - + + + + - + + + ± ± 2 + - + + - - + + - + - + + - + - - + + + + + 3 + + + + + + - + - + + + - - + - + + + + ± ± +为阳性，-为阴性，±为弱凝集。
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表 3 患儿及母亲不规则抗体鉴定结果
序号 Rh-hr Kell Duffy Kidd Lewis P MNS 患儿母亲 患儿 C D E c e Cw K k Kpa Kpb Fya Fyb Jka Jkb Lea Leb P1 M N S s 盐水 柱凝集 盐水 柱凝集 1 + + - - + + - + - + + - + - - - - + - + - + + ± ± 2 + + - - + - + + - + - + + - - + + - + - + - - - - 3 - + + + - - - + - + + - + + - + + + + + - + + ± ± 4 - + - + + - - + - + - - + - - + + + - - + + + ± ± 5 + - - - + - + + - + + - + - + - + + - + + + + + + 6 - - + + - - - + - + + + + - - - + + - + + + + ± ± 7 - - - + + - + - - + - + + + - - + + - + + + + ± ± 8 - - - + + - + + - + + + - + - + + + - - + + + ± ± 9 - - - + + - - + - + + + - + - + + + - + + + + + + 10 - - - + + - - + - + - + + + + - + - + + - - - - - 11 + + + - + - - + - + + - - + - + + - + - + - - - - 12 + + + + - - - + - + - + + + + - + - + + + - - - - +为阳性，-为阴性，±为弱凝集。
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