Woelfer Brigitte, Schuchter Katharina, Janisiw Michael, Hafner Erich, Philipp Karl, Panzer Simon
Department of Obstetrics and Gynecology, Donauspital Vienna, Clinic for Blood Group Serology, University of Vienna, Austria.
Transfusion. 2004 Apr;44(4):512-7. doi: 10.1111/j.1537-2995.2004.03287.x.
Current recommendations for anti-D prophylaxis for women who deliver a D+ offspring vary from country to country, and the introduction of new reagents require pharmacokinetic studies that show serum levels after the injection. Serum levels of anti-D may depend on the maternal body mass index (BMI).
Serum concentrations of total anti-D IgG and IgG1-4 subclasses were determined by flow cytometry in 26 D- women, who had received prophylaxis after delivery of a D+ offspring. Blood samples were drawn on Days 1, 2, 3, and 14 after injection, and the BMI was recorded.
Anti-D levels increased continuously in all women during the first 3 days. The increase was significantly affected by the BMI if higher than 27 kg per m2 (p<0.001). The higher the BMI, the less was the increase of serum anti-D. Mean peak levels 72 hours after injection was 89 ng per mL in lean women, but estimated levels were 28 to 60 percent lower in women with a BMI of 28 to 40 kg per m2. The effect of a BMI higher than 27 kg per m2 on anti-D was not gradual but progressive. Similarly, the BMI affected serum concentrations of anti-D subclasses IgG1-4 (p<0.001).
The BMI needs consideration for the adjustment of the dosage of anti-D, provided its bioavailability to suppress alloimmunization is reflected by measurable amounts in the serum.
各国对于分娩出D+后代的女性进行抗D预防的现行建议各不相同，新试剂的引入需要进行药代动力学研究，以显示注射后的血清水平。抗D的血清水平可能取决于母亲的体重指数（BMI）。
通过流式细胞术测定了26名D-女性在分娩出D+后代后接受预防措施后的总抗D IgG和IgG1-4亚类的血清浓度。在注射后的第1、2、3和14天采集血样，并记录BMI。
在最初3天内，所有女性的抗D水平持续升高。如果BMI高于27kg/m2，这种升高会受到显著影响（p<0.001）。BMI越高，血清抗D的升高幅度越小。瘦女性注射后72小时的平均峰值水平为89ng/mL，但BMI为28至40kg/m2的女性估计水平低28%至60%。BMI高于27kg/m2对抗D的影响不是渐进的，而是递进的。同样，BMI也影响抗D亚类IgG1-4的血清浓度（p<0.001）。
如果抗D抑制同种免疫的生物利用度可通过血清中的可测量量反映出来，那么在调整抗D剂量时需要考虑BMI。
