产前有创性检查后胎儿-母体出血体积的意义。

Significance of the volume of fetomaternal hemorrhage after performing prenatal invasive tests.

机构信息

Flow Cytometry Section, Department of Hematology, Fundación Jiménez Díaz, Madrid, Spain.

出版信息

Cytometry B Clin Cytom. 2011 Jan;80(1):38-42. doi: 10.1002/cyto.b.20548.

DOI:10.1002/cyto.b.20548

PMID:20632413

Abstract

BACKGROUND

Fetal erythrocytes cross the placenta during gestation, but invasive prenatal procedures might develop into fetomaternal hemorrhage (FMH). We examine whether flow cytometry immunophenotyping might be useful for measuring the volume of FMH after such procedures.

METHODS

Fetal erythrocytes (%) were determined in 153 pregnant women after amniocentesis (129) and chorionic villous sampling (24) using a monoclonal antibody against fetal hemoglobin. Fetal erythrocytes were identified for their high expression of fetal hemoglobin (HbF(++) ). Blood samples from two control groups, 53 healthy males and 21 pregnant women not submitted to invasive tests, were used to establish normal values of circulating HbF(++) erythrocytes in adults.

RESULTS

The highest percentage of HbF(++) erythrocytes in the control groups was 0.015%. The rate of HbF(++) erythrocytes in samples after invasive tests ranged between <0.01% and 0.15%. Seventy-three women (47%) had ≤0.015% HbF(++) erythrocytes, and this rate was higher in 80. Nine women presented >1 ml of FMH (volume of packed cells corresponding to 0.054-0.15% HbF(++) erythrocytes), but only two had sonographic evidence of bleeding.

CONCLUSIONS

Most women in our series had a very low volume of FMH after the invasive tests. Acute bleeding should be thoroughly investigated in women with either more than 1 ml of packed cells or more than 0.05% of HbF(++) erythrocytes. Intermediate values between >0.015% and <0.05%, should be carefully considered depending on the week of gestation. Data obtained before 15 weeks might reflect previous cell trafficking between fetus and mother instead of acute hemorrhage.

摘要

背景

胎儿红细胞在妊娠期间穿过胎盘，但侵入性产前程序可能会发展为胎儿母体出血（FMH）。我们检查流式细胞术免疫表型分析是否可用于测量此类程序后 FMH 的体积。

方法

在羊膜穿刺术（129 例）和绒毛膜活检（24 例）后，使用针对胎儿血红蛋白的单克隆抗体，在 153 名孕妇中确定胎儿红细胞（%）。胎儿红细胞因其高表达胎儿血红蛋白（HbF（++））而被识别。从两个对照组，53 名健康男性和 21 名未接受侵入性测试的孕妇的血液样本中，建立了成人循环 HbF（++）红细胞的正常值。

结果

对照组中 HbF（++）红细胞的最高百分比为 0.015%。侵入性测试后样本中的 HbF（++）红细胞率在<0.01%至 0.15%之间。73 名女性（47%）的 HbF（++）红细胞≤0.015%，而 80 名女性的这一比例更高。9 名女性出现>1ml 的 FMH（相当于 0.054-0.15% HbF（++）红细胞的红细胞压积体积），但只有 2 名女性有出血的超声证据。

结论

在我们的系列中，大多数女性在侵入性测试后出现非常低的 FMH 量。对于红细胞压积>1ml 或 HbF（++）红细胞>0.05%的女性，应彻底调查急性出血。介于>0.015%和<0.05%之间的中间值应根据妊娠周数仔细考虑。在 15 周之前获得的数据可能反映了胎儿和母亲之间先前的细胞转移，而不是急性出血。