Baiochi Eduardo, Nardozza Luciano Marcondes Machado
Departamento de Obstetrícia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ginecol Obstet. 2009 Jun;31(6):311-9. doi: 10.1590/s0100-72032009000600008.
Alloimmunization is the formation of antibodies when there is an exposition of the individual to non-self antigens, as it occurs, for example, in the transfusion of incompatible blood and pregnancies, in whom the fetus express in its sanguineous cells antigens exclusively of paternal origin. This article is restricted to the alloimmunization against erythrocytes antigens in obstetric patients. Almost all the anti-erythrocytes antibodies can be fit in one of the 29 systems of already recognized sanguineous groups, being more implied in the hemolytic disease of the newborn anti-D, anti-c and anti-Kell, followed by anti-C, anti-E, anti e, anti-Fy feminine and anti-Jk feminine. The research of irregular antibodies, to permit the diagnosis of alloimmunizated people, and the modern genetic techniques have better characterized these patients for the prophylaxis and prenatal segment. The traditional accompaniment of the gestations of risk for hemolytic disease of the newborn, with the spectral analysis of the amniotic liquid and the intraperitoneal transfusion, has being quickly substituted for the Doppler ultrasound evaluation in the middle cerebral artery, the intravascular transfusion guided for ultrasonography in real time, beyond improvements in the materials and the quality of the blood, that in set, have raised the survival of the attempting fetus. Doubtlessly, the correct application of the prophylaxis with use of anti-D is successful with potential to reduce the alloimmunization cases.
同种免疫是指个体接触非自身抗原时抗体的形成,例如在输注不相容血液和妊娠时就会发生这种情况,在妊娠中胎儿血细胞表达的抗原仅来自父方。本文仅限于产科患者中针对红细胞抗原的同种免疫。几乎所有抗红细胞抗体都可归入已识别的29个血型系统中的一个,其中抗-D、抗-c和抗-Kell在新生儿溶血病中更为常见,其次是抗-C、抗-E、抗-e、抗-Fya和抗-Jka。检测不规则抗体以诊断同种免疫者,以及现代基因技术已更好地对这些患者进行了特征描述,以用于预防和产前治疗。传统上对有新生儿溶血病风险的妊娠进行羊水光谱分析和腹腔内输血监测,已迅速被大脑中动脉的多普勒超声评估、实时超声引导下的血管内输血所取代,此外血液材料和质量的改善也提高了受试胎儿的存活率。毫无疑问,正确应用抗-D预防措施是成功的,有潜力减少同种免疫病例。