Nasrat H A, Nicolini U, Nicolaidis P, Letsky E A, Gau G, Rodeck C H
Institute of Obstetrics and Gynecology, Royal Postgraduate Medical School, Queen Charlotte's and Chelsea Hospital, London, United Kingdom.
Obstet Gynecol. 1991 Apr;77(4):558-62.
Fetal plasma ferritin concentrations were measured in 43 normal fetuses at 18-36 weeks and in 78 blood samples collected before transfusion from 23 fetuses with Rh alloimmunization. Among controls, there was a significant correlation between fetal serum ferritin and gestational age (r = 0.39, P = .009), consistent with an increase in fetal storage of iron during normal pregnancy. In Rh-alloimmunized fetuses, the ferritin concentration was above the reference range in 63% of the samples. Before the first transfusion, the fetal ferritin concentration was increased compared with controls (mean multiples of the mean = 2.6, range 1-26) and showed a negative correlation with fetal hematocrit (r = -0.43, P less than .05), suggesting that the worse the fetal anemia, the higher the iron store. Serial transfusions were associated with further increase in serum ferritin, which correlated primarily with the total volume of blood transfused. Three fetuses had plasma serum ferritin concentrations above 1 mg/L, a level compatible with a diagnosis of iron overload in children. These observations suggest that there is a potential risk of iron overload in Rh-alloimmunized fetuses undergoing intrauterine blood transfusion.
对43例18至36周的正常胎儿以及23例患有Rh血型同种免疫的胎儿输血前采集的78份血样进行了胎儿血浆铁蛋白浓度测定。在对照组中，胎儿血清铁蛋白与胎龄之间存在显著相关性（r = 0.39，P = 0.009），这与正常妊娠期间胎儿铁储存增加一致。在Rh血型同种免疫的胎儿中，63%的样本中铁蛋白浓度高于参考范围。在首次输血前，胎儿铁蛋白浓度与对照组相比有所升高（平均倍数为2.6，范围为1至26），并且与胎儿血细胞比容呈负相关（r = -0.43，P < 0.05），这表明胎儿贫血越严重，铁储存越高。多次输血与血清铁蛋白进一步升高相关，这主要与输血总量相关。三个胎儿的血浆血清铁蛋白浓度高于1 mg/L，这一水平与儿童铁过载的诊断相符。这些观察结果表明，接受宫内输血的Rh血型同种免疫胎儿存在铁过载的潜在风险。
