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目的分析1例Rh D阴性母亲高滴度抗-D致双胎新生儿D抗原遮蔽血清学特点,并讨论双胎新生儿发生HDFN的救治。方法采用微柱凝胶法及盐水法、热放散试验等检测血型,采用微柱凝胶技术检测父亲、母亲、大婴、小婴的不规则抗体、抗体鉴定及抗体效价。结果父亲、母亲、大婴、小婴的ABO血型和Rh分型分别为B、d CCee;B、DCc Ee;O、DCc Ee;B、DCc Ee,大婴、小婴RHD基因检测结果均为RHD/d(阳性),母亲及大婴、小婴抗体筛查均为阳性,抗体鉴定结果显示血清中均存在抗-D,母亲产前、产后抗体效价均为1024,大婴、小婴经及时输血换血治疗病情得到控制。结论母亲高滴度抗-D可导致新生儿D抗原完全遮蔽,在临床检测过程中需采用多种血清学方法及基因检测验证此类现象,避免误判血型结果。对产前Rh D阴性和特殊情况的孕产妇进行抗体筛查和鉴定,对其新生儿可能发生HDFN的输血换血救治具有非常重要的意义。
OBJECTIVE: To analyze the serological characteristics of D antigen occlusion in one newborn with high titer anti-D induced by Rh D negative mothers and to discuss the treatment of HDFN in twin infants. Methods The blood samples were detected by microcolumn gel method, saline method and thermal emanation test. The micro-column gel technique was used to detect the irregular antibodies, antibody identification and antibody titer of father, mother, infant and infant. Results The genotypes of ABO and Rh of father, mother, big baby and small baby were B, d CCee, B, DCc Ee, O, DCc Ee, B, DCc Ee, RHD / d (positive), mother and baby, baby antibody screening were positive, antibody identification showed that the presence of anti-D serum, mothers of prenatal and postpartum antibody titers were 1024, baby, baby Transfusion of blood transfusion after treatment of the disease under control. Conclusion High titers of anti-D in maternal mothers can completely block neonatal D antigen. Many serological methods and genetic tests are needed to validate this phenomenon during clinical testing to avoid false positive result of blood type. Antibody screening and identification of prenatal Rh D-negative and special cases of pregnant women is of great significance for the possible treatment of transfusion of HDFN in newborns.