Obstetrics and Gynaecology, Fetal Medicine Unit, University of Los Andes, San Carlos de Apoquindo 2200, Santiago, Chile.
Expert Rev Hematol. 2009 Oct;2(5):577-82. doi: 10.1586/ehm.09.45.
Hemolytic disease of the fetus and newborn (HDFN) is due to maternal alloantibodies directed against paternally inherited antigens on fetal red cells, and it is still a problem in affected pregnancies despite the routine use of anti-D immunoglobulin during pregnancy and shortly after delivery. The current noninvasive management of HDFN starts with the determination of fetal RhD genotype by use of cell-free fetal DNA in maternal plasma. When the fetus is antigen positive, the follow-up is performed by Doppler ultrasonography for the detection of moderate or severe anemia on the basis of an increase peak velocity of systolic blood in the middle cerebral artery. Finally, if anemia is suspected, an invasive approach is required in order to perform an intrauterine blood transfusion, which should only be attempted when the fetus needs transfusion. This approach reduces the iatrogenic conversion of mild-to-severe disease, which occurred as a result of the previous invasive management, and prevents unnecessary administration of human-derived blood products. These changes represent one of the genuine successes of fetal therapy.
胎儿和新生儿溶血病 (HDFN) 是由于母体同种异体抗体针对胎儿红细胞上父系遗传抗原引起的，尽管在怀孕期间和分娩后不久常规使用抗-D 免疫球蛋白，但在受影响的妊娠中仍然是一个问题。目前，对 HDFN 的非侵入性管理始于通过使用母体血浆中的无细胞胎儿 DNA 来确定胎儿 RhD 基因型。当胎儿呈抗原阳性时，通过多普勒超声检查根据大脑中动脉收缩期血流峰值速度的增加来检测中度或重度贫血来进行随访。最后，如果怀疑贫血，则需要进行侵入性方法以进行宫内输血，只有当胎儿需要输血时才应尝试这种方法。这种方法减少了因先前的侵入性管理而导致的轻度至重度疾病的医源性转化，并防止了不必要的人源血液制品的使用。这些变化代表了胎儿治疗的真正成功之一。
