Hirose Masaya, Nakanishi Keiko, Kaku Shouji, Moro Hiroko, Hodohara Keiko, Aotani Hirofumi, Takebayashi Koichi, Noda Yoichi
Department of Obstetrics and Gynecology, Shiga University of Medical Science, Setatsukinowa, Japan.
Fetal Diagn Ther. 2004 Mar-Apr;19(2):182-6. doi: 10.1159/000075147.
To delineate clinical features of a case of fetal hemolytic disease due to anti-Rh17, along with a review of relevant studies published in English and Japanese.
We present clinical features of a -D-/-D- phenotype woman with anti-Rh17 alloimmunization during pregnancy. Relevant English literature in the MEDLINE database was reviewed, while Japanese studies were searched in the Japana Centra Revuo Medicina database.
A Japanese -D-/-D- woman with anti-Rh17 (Hro) was treated during pregnancy. Serial ultrasonography, antibody titers, amniocenteses, and cordocenteses were conducted for perinatal management. Amniocentesis results demonstrated a high delta optical density level of 450 in the amniotic fluid, while cordocentesis revealed alloimmunization between the mother and the fetus as well as fetal hemolytic anemia. Blood flow velocity in the middle cerebral artery indicated a rapid development of fetal anemia. The newborn demonstrated severe anemia and hyperbilirubinemia, which were successfully treated with exchange transfusions. Two cases of prenatally diagnosed fetal hemolytic disease due to anti-Rh17 were found published in English and 5 in Japanese.
A -D-/-D- phenotype patient with anti-Rh17 was successfully managed during pregnancy and a good outcome for the neonate was achieved. Our results and a review of related literature led to the following suggestions. The first pregnancy in a -D-/-D- woman may be affected, an anamnestic immune response can easily occur during pregnancy, the level of anti-Rh17 titer is indicative of the degree of fetal hemolysis, and appropriate intrauterine intervention is warranted for achievement of a good outcome.
阐述1例因抗Rh17导致的胎儿溶血病的临床特征，并综述英文和日文发表的相关研究。
我们呈现了1例孕期发生抗Rh17同种免疫的-D-/-D-表型女性的临床特征。检索了MEDLINE数据库中的相关英文文献，同时在日本医学中央杂志数据库中搜索了日文研究。
1例携带抗Rh17（Hro）的日本-D-/-D-女性在孕期接受了治疗。为进行围产期管理，进行了系列超声检查、抗体效价检测、羊膜腔穿刺术和脐血穿刺术。羊膜腔穿刺术结果显示羊水的Δ光密度水平高达450，而脐血穿刺术显示母胎之间存在同种免疫以及胎儿溶血性贫血。大脑中动脉的血流速度表明胎儿贫血发展迅速。新生儿表现出严重贫血和高胆红素血症，通过换血疗法成功治愈。发现英文发表了2例产前诊断的因抗Rh17导致的胎儿溶血病病例，日文发表了5例。
1例携带抗Rh17的-D-/-D-表型患者在孕期得到了成功管理，新生儿结局良好。我们的结果及对相关文献的综述得出以下建议。-D-/-D-女性的首次妊娠可能会受到影响，孕期容易发生回忆性免疫反应，抗Rh17效价水平可指示胎儿溶血程度，为取得良好结局有必要进行适当的宫内干预。
