Fischer K, Poschmann A, Grundmann A, Asmussen S
Zentralinstitut für Transfusionsmedizin, Hamburg, BRD.
Beitr Infusionsther. 1992;30:431-5.
The diagnosis and management of HDN relies on measurement of maternal anti-D, amniotic fluid analysis and fetal blood sampling by chordiocentesis. However, amniocentesis and chordiocentesis have substantial risks of fetomaternal hemorrhage and subsequent increase in maternal anti-D. In addition to quantitation the functional activity of maternal anti-D has been determined by measuring the interaction of red blood cells sensitized by maternal serum in monocyte-monolayer assays. We assessed the functional activity of anti-D by titration of the sensitized red blood cells using selected sera with rheumatoid factor (RF) as human anti-IgG. First experiments using monoclonal anti-D showed a good correlation between erythrophagocytosis and RF titers. The bilirubin-protein ratio in amniotic fluid may be of great value in predicting the severity of HDN, as shown in 94 cases with severe and 39 cases with moderate disease. Amniotic fluid analysis is complicated by the presence of hemoglobin; we developed a computer program to solve this problem. To improve the serological diagnosis of ABO incompatibility, we measured IgG-anti-A, B in 1,392 maternal and newborn sera applying a sensitive gel test with Coombs serum. Furthermore, we determined the hemolytic activity of anti-A, B by microscopic observation of the morphological changes of red blood cells.
新生儿溶血病（HDN）的诊断和处理依赖于母体抗-D的检测、羊水分析以及通过脐静脉穿刺进行胎儿血样采集。然而，羊水穿刺和脐静脉穿刺存在胎儿-母体出血以及随后母体抗-D增加的重大风险。除了定量检测外，还通过在单核细胞单层试验中测量母体血清致敏的红细胞之间的相互作用来确定母体抗-D的功能活性。我们使用含有类风湿因子（RF）作为人抗-IgG的选定血清，通过滴定致敏红细胞来评估抗-D的功能活性。首次使用单克隆抗-D的实验表明红细胞吞噬作用与RF滴度之间具有良好的相关性。羊水胆红素-蛋白质比值在预测HDN的严重程度方面可能具有重要价值，94例重症和39例中度病例的情况表明了这一点。羊水分析因血红蛋白的存在而变得复杂；我们开发了一个计算机程序来解决这个问题。为了改进ABO血型不相容性的血清学诊断，我们应用含库姆斯血清的敏感凝胶试验，检测了1392份母体和新生儿血清中的IgG抗-A、B。此外，我们通过显微镜观察红细胞的形态变化来确定抗-A、B的溶血活性。
