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作者报道1例7岁患儿重度晚发性贫血和长期ABO/Rh血型判断错误,并从髓细胞中检出抗D抗体,从而证实患儿存有髓内和血管外溶血。病例:女1950g,孕34周娩出,母27岁,G_4P_3,Rh(一),有严重Rh致敏史,孕期25、30周时抗D抗体滴度分别为1∶512和1∶16384。胎儿于30孕周前接受3次O型Rh(-)红细胞宫内输注、出生时肌张力低,红细胞压积0.34,接受O型Rh(-)红细胞输注。出生时和生后3天血型O,Rh(-),直接Coombs试验(-),胆红素298μmol/L,予以5天光疗,第3周出院,第7周时患儿苍白,肝脾肿大,呼吸不规则,Hb45g/L,网织红细胞0.001,总胆红素36μmol/L,血型O,Rh(-),直接Coombs试验(-),间接(+),抗D抗体1∶128,Kleihauer-Betke染色示仅0.038%的循环红细胞含
The authors report a case of severe late-onset anemia and long-term ABO / Rh blood group misses in a 7-year-old child and anti-D antibodies were detected from the myeloid cells, confirming the presence of intramedullary and extravascular hemolysis in children. Case: Female 1950g, delivered 34 weeks pregnant, mother 27 years old, G_4P_3, Rh (a), a history of severe Rh sensitization, anti-D antibody titers at 1 week and 25 weeks of pregnancy were 1:512 and 1:16384 respectively. The fetus receives intrauterine O-Rh (-) red blood cells three times intrauterine injections prior to 30 weeks of gestation with low hypotonia at birth and a hematocrit of 0.34 for O-Rh (-) erythrocyte infusion. Blood type O, Rh (-), direct Coombs test (-) and bilirubin 298μmol / L were given at birth and 3 days after birth. Hb45g / L, reticulocyte 0.001, total bilirubin 36μmol / L, blood group O, Rh (-), direct Coombs test (-), indirect (+), anti-D antibody 1:128, Kleihauer-Betke staining showed only 0.038% of circulating red blood cell containing