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目的对1例RHD阴性产妇产下的RHD阳性新生儿因D抗原遮蔽现象造成血清学假阴性的进一步鉴定与分析。方法采用血清学方法检测新生儿及其父母双方ABO及Rh血型抗原,对患儿血样进行直接抗球蛋白试验、游离抗体试验及放散试验,对患儿母亲血清进行抗体鉴定,对患儿红细胞热放散洗涤后再做D抗原鉴定。PCR扩增患儿Rh基因的上下游盒子并电泳分析产物。结果新生儿血型初次定型为A、d Ccee,患儿母亲血型为A、dccee,患儿父亲为O、DCCee;新生儿直接抗球蛋白试验阳性、游离抗体试验阳性且抗体特异性为抗-D抗体、放散试验阳性且抗体特异性为抗-D抗体;患儿红细胞热放散洗涤后与试剂抗-D发生凝集为RhD阳性;PCR产物电泳发现同时存在上游盒子、下游盒子及杂交盒子,为RHD+/RhD-杂合型。结论因母亲体内高效价的抗体进入患儿体内后完全封闭了新生儿红细胞上的D抗原,造成其红细胞上没有多余的D位点与血清试剂结合,产生假阴性现象。
Objective To further identify and analyze serological false-negatives caused by occlusion of D antigen in a RHD-positive newborn born to a RHD negative mother. Methods Serological methods were used to detect ABO and Rh blood group antigens in newborns and their parents. The blood samples were directly tested for antiglobulin, free antibody test and elution test. The serum of maternal children was identified by antibodies. Diffusion after washing do D antigen identification. PCR amplification of Rh gene upstream and downstream boxes and electrophoresis analysis of products. Results The neonatal blood type was A, d Ccee, the blood type of the mother was A, dccee, the father of the children was O, DCCee. The newborn direct antiglobulin test was positive, the free antibody test was positive and the antibody specificity was anti-D Antibody, the test was positive and the antibody specificity was anti-D antibody. After the erythrocytes were washed by heat, the antibody was agglutinated to RhD positive with the reagent anti-D. The PCR products were found to contain the upstream box, the downstream box and the hybridization box. / RhD-heterozygous. Conclusion Due to high titer of antibodies in the mother body into the children completely closed after neonatal D antigen on the erythrocytes, resulting in the red blood cells do not have extra D site with serum reagents, resulting in false negatives.