Gibble J W, Ness P M
American Red Cross, Chesapeake, Regional Blood Service, Baltimore, Maryland.
Clin Lab Med. 1992 Sep;12(3):553-76.
This article has presented an overview of developments in the treatment of HDN. The number of cases requiring treatment that have occurred in the last decade has dropped because of the development and implementation of Rh immunoprophylaxis, although this treatment still appears to be underutilized in the United States. Failure to recognize the need for immunoprophylaxis in certain situations (including unrecognized abortion) has led to a small residual population of alloimmunized mothers who will require comprehensive treatment during subsequent pregnancies. Alloimmunization to other red cell antigens remains a small but significant problem in other women. Although great advances have been made in the monitoring of these pregnancies, amniotic fluid analysis remains a mainstay for the third-trimester evaluation of alloimmunized pregnancies. Noninvasive methods such as ultrasound evaluation and the monocyte assays may supplement, but cannot entirely replace, the need for direct assessment. The most striking advancement in the evaluation and treatment of these infants has been the ability to access the fetal circulation directly through intravenous umbilical cord sampling. This method allows for an immediate assessment of fetal anemia as well as a route for direct fetal transfusion. The method has also permitted a more complete assessment of fetal physiology. However, the method may be overutilized at the present time and has some degree of risk to the fetus, even in experienced hands. Additional methods of treatment for the alloimmunized pregnancy include plasma exchange, intravenous immunoglobulin infusion, and promethazine hydrochloride. The popularity of plasma exchange has probably decreased with the advent of more direct fetal sampling and treatment techniques, but it may be useful in the treatment of first-trimester pregnancy losses. Intravenous immunoglobulin and promethazine hydrochloride appear to be promising alternatives that require more investigation. It is apparent that efforts need to be channeled towards prevention of HDN in a health system that is highly aware of increasing costs and the benefits of preventive medicine.
本文概述了新生儿溶血病（HDN）治疗方面的进展。由于Rh免疫预防措施的发展和实施，过去十年中需要治疗的病例数量有所下降，尽管在美国这种治疗方法的使用似乎仍未充分。在某些情况下（包括未被识别的流产）未能认识到免疫预防的必要性，导致了一小部分同种免疫的母亲群体，她们在后续妊娠期间需要综合治疗。对其他红细胞抗原的同种免疫在其他女性中仍然是一个虽小但很重要的问题。尽管在这些妊娠的监测方面取得了巨大进展，但羊水分析仍然是孕晚期对同种免疫妊娠进行评估的主要手段。超声评估和单核细胞检测等非侵入性方法可以作为补充，但不能完全取代直接评估的需求。在这些婴儿的评估和治疗方面最显著的进展是能够通过静脉脐血采样直接进入胎儿循环。这种方法可以立即评估胎儿贫血情况，并为直接进行胎儿输血提供途径。该方法还使得对胎儿生理学有更全面的评估成为可能。然而，目前这种方法可能被过度使用，即使是经验丰富的医生操作，对胎儿也有一定程度的风险。对同种免疫妊娠的其他治疗方法包括血浆置换、静脉注射免疫球蛋白和盐酸异丙嗪。随着更直接的胎儿采样和治疗技术的出现，血浆置换的应用可能减少了，但它可能对治疗孕早期的妊娠丢失有用。静脉注射免疫球蛋白和盐酸异丙嗪似乎是有前景的替代方法，需要更多的研究。显然，在一个高度重视成本增加和预防医学益处的卫生系统中，需要致力于预防新生儿溶血病。
