Abstract：
OBJECTIVE: Despite advances in the prevention of rhesus (Rh)(D) alloimmunization, alloantibodies to Rh(D) and non-Rh(D) red blood cell antigens continue to be detected in ∼4% of US pregnancies and can result in hemolytic disease of the fetus and newborn (HDFN). Recent reports on HDFN lack granularity and are unable to provide antibody-specific outcomes. The objective of this study was to calculate the frequency of alloimmunization in our large hospital system and summarize the outcomes based on antibody specificity, titer, and other clinical factors.
METHODS: We identified all births in a 6-year period after a positive red blood cell antibody screen result during pregnancy and summarized their characteristics and outcomes.
RESULTS: A total of 707 neonates were born after a positive maternal antibody screen result (3.0/1000 live births). In 31 (4%), the positive screen result was due to rhesus immune globulin alone. Of the 676 neonates exposed to alloantibodies, the direct antibody test (DAT) result was positive, showing antigen-positivity and evidence of HDFN in 37% of those tested. Neonatal disease was most severe with DAT-positive anti-Rh antibodies (c, C, D, e, E). All neonatal red blood cell transfusions (15) and exchange transfusions (6) were due to anti-Rh alloimmunization. No neonates born to mothers with anti-M, anti-S, anti-Duffy, anti-Kidd A, or anti-Lewis required NICU admission for hyperbilirubinemia or transfusion.
CONCLUSIONS: Alloimmunization to Rh-group antibodies continues to cause a majority of the severe HDFN cases in our hospital system. In neonates born to alloimmunized mothers, a positive DAT result revealing antigen-positivity is the best predictor of anemia and hyperbilirubinemia.
METHODS: We identified all births in a 6-year period after a positive red blood cell antibody screen result during pregnancy and summarized their characteristics and outcomes.
RESULTS: A total of 707 neonates were born after a positive maternal antibody screen result (3.0/1000 live births). In 31 (4%), the positive screen result was due to rhesus immune globulin alone. Of the 676 neonates exposed to alloantibodies, the direct antibody test (DAT) result was positive, showing antigen-positivity and evidence of HDFN in 37% of those tested. Neonatal disease was most severe with DAT-positive anti-Rh antibodies (c, C, D, e, E). All neonatal red blood cell transfusions (15) and exchange transfusions (6) were due to anti-Rh alloimmunization. No neonates born to mothers with anti-M, anti-S, anti-Duffy, anti-Kidd A, or anti-Lewis required NICU admission for hyperbilirubinemia or transfusion.
CONCLUSIONS: Alloimmunization to Rh-group antibodies continues to cause a majority of the severe HDFN cases in our hospital system. In neonates born to alloimmunized mothers, a positive DAT result revealing antigen-positivity is the best predictor of anemia and hyperbilirubinemia.
摘要：
■尽管在预防恒河猴（Rh）（D）同种免疫方面取得了进展，Rh（D）和非Rh（D）红细胞抗原的同种抗体继续在美国怀孕的4％中检测到，并可能导致胎儿和新生儿的溶血病（HDFN）。最近关于HDFN的报道缺乏粒度,并且无法提供抗体特异性结果。本研究的目的是计算我们大型医院系统的同种免疫频率，并根据抗体特异性总结结果，滴度,和其他临床因素。
■我们在妊娠期间红细胞抗体筛查结果阳性后的6年内确定了所有新生儿，并总结了其特征和结局。
■在母体抗体筛查结果阳性（3.0/1000活产）后，共有707名新生儿出生。在31（4%）中，阳性筛查结果仅归因于恒河猴免疫球蛋白。在676名暴露于同种抗体的新生儿中，直接抗体检测（DAT）结果为阳性，在37％的测试中显示抗原阳性和HDFN的证据。新生儿疾病最严重的是DAT阳性抗Rh抗体（c，C,D,e,E).所有新生儿红细胞输血（15）和交换输血（6）都是由于抗Rh同种免疫。没有患有抗M的母亲所生的新生儿，反S,反Duffy,抗KiddA,或抗Lewis需要因高胆红素血症或输血而入院NICU。
■Rh组抗体的同种异体免疫继续导致我们医院系统中大多数严重的HDFN病例。在同种免疫母亲出生的新生儿中，显示抗原阳性的DAT阳性结果是贫血和高胆红素血症的最佳预测指标.
■我们在妊娠期间红细胞抗体筛查结果阳性后的6年内确定了所有新生儿，并总结了其特征和结局。
■在母体抗体筛查结果阳性（3.0/1000活产）后，共有707名新生儿出生。在31（4%）中，阳性筛查结果仅归因于恒河猴免疫球蛋白。在676名暴露于同种抗体的新生儿中，直接抗体检测（DAT）结果为阳性，在37％的测试中显示抗原阳性和HDFN的证据。新生儿疾病最严重的是DAT阳性抗Rh抗体（c，C,D,e,E).所有新生儿红细胞输血（15）和交换输血（6）都是由于抗Rh同种免疫。没有患有抗M的母亲所生的新生儿，反S,反Duffy,抗KiddA,或抗Lewis需要因高胆红素血症或输血而入院NICU。
■Rh组抗体的同种异体免疫继续导致我们医院系统中大多数严重的HDFN病例。在同种免疫母亲出生的新生儿中，显示抗原阳性的DAT阳性结果是贫血和高胆红素血症的最佳预测指标.
