目的:大量母胎出血(FMH)是罕见的,据报道是所有胎儿死亡中约3%的原因。大量FMH的母亲管理包括通过施用Rh(D)免疫球蛋白(RhIG)来预防Rh(D)阴性母亲的Rh(D)同种免疫。
方法:我们描述了一个30岁的O阴性病例,初产妇在妊娠38周时出现胎动减少。她接受了紧急剖腹产,并分娩了一名O阳性女婴,该女婴在出生后不久死亡。
结果:患者的FMH筛查为阳性,Kleihauer-Betke测试显示母体循环中有10.7%的胎儿血液。使用静脉内(IV)制剂在出院前2天内给予计算剂量的6,300µgRhIG。出院后一周的抗体筛查显示抗D和抗C。抗C归因于来自大剂量RhIG的获得性被动免疫。抗C反应性减弱,6个月时呈阴性,但抗-D模式在分娩后9个月持续存在。在12个月和14个月时注意到抗体筛查阴性。
结论:该病例强调了IVRhIG的免疫血液学挑战,以及在患者抗C完全消退且无抗D形成的情况下,用IVRhIG预防同种免疫的成功。随后的健康怀孕。
Massive fetomaternal hemorrhage (FMH) is rare and reported to be the cause in approximately 3% of all fetal deaths. Maternal management of massive FMH includes prevention of Rh(D) alloimmunization in Rh(D)-negative mothers by administration of Rh(D) immune globulin (RhIG).
We describe a
case of a 30-year-old O-negative, primigravida woman who presented at 38 weeks of gestation with decreased fetal movements. She underwent an emergency cesarean section and delivered an O-positive baby girl who died shortly after birth.
The patient\'s FMH screen was positive, with a Kleihauer-Betke test demonstrating 10.7% fetal blood in maternal circulation. The calculated dose of 6,300 µg RhIG was given prior to discharge over 2 days using an intravenous (IV) preparation. Antibody screening a week after discharge showed anti-D and anti-C. The anti-C was attributed to acquired passive immunity from the large dose of RhIG. Anti-C reactivity waned and was negative at 6 months, but the anti-D pattern persisted at 9 months postdelivery. Negative antibody screens were noted at 12 and 14 months.
This
case highlights the immunohematology challenges of IV RhIG as well as the success in preventing alloimmunization with IV RhIG given the patient\'s complete resolution of anti-C and no anti-D formation, with a subsequent healthy pregnancy.