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Abstract：
Red blood cell alloimmunization is the first cause of fetal and neonatal anemia. Alloimmunizations with anti-PP1Pk or anti-P can cause recurrent miscarriages and hemolytic disease of the fetus and newborn in the 2nd and 3rd trimesters of pregnancy. We report on a pregnant patient immunized with anti-P and a history of recurrent miscarriages.
This P2 k (GLOB:-1; P1PK:-1,3) patient had a first pregnancy marked by a caesarean at 38 weeks of gestation (WG) for non-reassuring fetal heart rate. Then, she had three early spontaneous miscarriages. The fifth pregnancy began with a high titer of anti-P at 128. Early initiation of treatment with Intravenous Immunoglobulins (IVIg) and plasma exchanges (PE) starting at 5 WG permitted us to reduce the titer of anti-P below 32. A healthy infant was delivered by caesarean at 38 WG without anemia at birth and no exchange transfusion was required.
The P and Pk antigens are expressed on placental, trophoblastic, and embryonic cells. This explains why P1 k (GLOB:-1; P1PK:1,3), P2 k (GLOB:-1; P1PK:-1,3), or Tj(a-)/p (GLOB:-1; P1PK:-1,-3) patients are prone to recurrent abortions in the first trimester of pregnancy. A literature review demonstrated 87% (68/78) of miscarriages in p patients. However, publication biases are possible with the most severe cases being reported.
Immunizations to P and PP1Pk antigens differ from others in their physiopathology and precocity. The association of PE and IVIg seems to be an effective treatment in the management of anti-PP1Pk or anti-P fetomaternal incompatibilities.
This P2 k (GLOB:-1; P1PK:-1,3) patient had a first pregnancy marked by a caesarean at 38 weeks of gestation (WG) for non-reassuring fetal heart rate. Then, she had three early spontaneous miscarriages. The fifth pregnancy began with a high titer of anti-P at 128. Early initiation of treatment with Intravenous Immunoglobulins (IVIg) and plasma exchanges (PE) starting at 5 WG permitted us to reduce the titer of anti-P below 32. A healthy infant was delivered by caesarean at 38 WG without anemia at birth and no exchange transfusion was required.
The P and Pk antigens are expressed on placental, trophoblastic, and embryonic cells. This explains why P1 k (GLOB:-1; P1PK:1,3), P2 k (GLOB:-1; P1PK:-1,3), or Tj(a-)/p (GLOB:-1; P1PK:-1,-3) patients are prone to recurrent abortions in the first trimester of pregnancy. A literature review demonstrated 87% (68/78) of miscarriages in p patients. However, publication biases are possible with the most severe cases being reported.
Immunizations to P and PP1Pk antigens differ from others in their physiopathology and precocity. The association of PE and IVIg seems to be an effective treatment in the management of anti-PP1Pk or anti-P fetomaternal incompatibilities.
摘要：
红细胞同种免疫是胎儿和新生儿贫血的首要原因。抗PP1Pk或抗P的同种免疫可在妊娠的第2和第3个月引起胎儿和新生儿的复发性流产和溶血病。我们报告了一名接受抗P免疫的孕妇，并有反复流产史。
这位P2k（GLOB：-1;P1PK：-1,3）患者在妊娠38周时进行了剖腹产（WG），其胎儿心率不可靠。然后，她有三次早期自发性流产。第五次妊娠始于128的高滴度抗P。从5WG开始早期开始静脉内免疫球蛋白（IVIg）和血浆置换（PE）治疗，使我们能够将抗P滴度降低到32以下。38WG剖腹产健康婴儿，出生时无贫血，不需要换血。
P和Pk抗原在胎盘上表达，滋养细胞，和胚胎细胞。这解释了为什么P1k(GLOB:-1;P1PK:1,3)，P2k（GLOB：-1；P1PK：-1,3），或Tj（a-）/p（GLOB：-1；P1PK：-1，-3）患者在妊娠的头三个月容易发生复发性流产。文献综述显示，p患者有87％（68/78）的流产。然而,在报告的最严重病例中，出版物偏见是可能的。
P和PP1Pk抗原的免疫在病理生理学和早熟性上与其他不同。PE和IVIg的关联似乎是治疗抗PP1Pk或抗P胎儿不相容性的有效方法。
这位P2k（GLOB：-1;P1PK：-1,3）患者在妊娠38周时进行了剖腹产（WG），其胎儿心率不可靠。然后，她有三次早期自发性流产。第五次妊娠始于128的高滴度抗P。从5WG开始早期开始静脉内免疫球蛋白（IVIg）和血浆置换（PE）治疗，使我们能够将抗P滴度降低到32以下。38WG剖腹产健康婴儿，出生时无贫血，不需要换血。
P和Pk抗原在胎盘上表达，滋养细胞，和胚胎细胞。这解释了为什么P1k(GLOB:-1;P1PK:1,3)，P2k（GLOB：-1；P1PK：-1,3），或Tj（a-）/p（GLOB：-1；P1PK：-1，-3）患者在妊娠的头三个月容易发生复发性流产。文献综述显示，p患者有87％（68/78）的流产。然而,在报告的最严重病例中，出版物偏见是可能的。
P和PP1Pk抗原的免疫在病理生理学和早熟性上与其他不同。PE和IVIg的关联似乎是治疗抗PP1Pk或抗P胎儿不相容性的有效方法。
