Natukunda B, Mugyenyi G, Brand A, Schonewille H
Department of Haematology and Transfusion Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Transfus Med. 2011 Aug;21(4):262-6. doi: 10.1111/j.1365-3148.2011.01073.x. Epub 2011 Mar 3.
AIMS/OBJECTIVES: To identify the frequency and nature of maternal red blood cell (RBC) alloimmunisation in Uganda and to determine the prevalence of RhD negativity and the rate of RBC alloimmunisation in Ugandan pregnant women.
Haemolytic disease of the foetus and newborn (HDFN) results from maternal alloimmunisation following exposure to allogeneic RBCs during pregnancy or blood transfusion. The prevalence of maternal RBC alloimmunisation in Ugandans is not known.
Pregnant women at Mbarara Hospital, South Western Uganda, were investigated in a cross-sectional study. Demographics, transfusion and obstetric histories were recorded. Maternal RBC alloimmunisation was demonstrated using immunohaematological techniques.
A total of 2001 pregnant women were recruited; 3.6% of them being RhD negative. Forty-five women (2.2%; 95% CI: 1.6-2.9) were found to be alloimmunised to RBC antigens. There were 38 RBC alloantibodies of known specificity including anti-S, 12; anti-M, 11; anti-Le(a) , 6; anti-D, 4 and 1 each of anti-K, anti-Fy(b) , anti-Jk(a) , anti-Lu(a) and anti-Kp(a) . In two women (4.4%), there were antibody combinations (anti-M+S and anti-K+Kp(a) ). Obstetric history, gestational age and previous immunising events were not significantly associated with the rate of alloimmunisation.
This study revealed a maternal RBC alloimmunisation rate of 2.2% which was comparable with findings from a Zimbabwean study where the prevalence was 1.7%. Given the 6·0% prevalence of anti-D among RhD-negative women in our study and the high immunogenicity of the D antigen, programmes for preventing anti-D alloimmunisation and HDFN in Uganda should be considered seriously.
确定乌干达孕产妇红细胞（RBC）同种免疫的频率和性质，并确定乌干达孕妇中RhD阴性的患病率以及RBC同种免疫的发生率。
胎儿和新生儿溶血病（HDFN）是由于孕期或输血时母体接触异体红细胞后发生同种免疫所致。乌干达孕产妇RBC同种免疫的患病率尚不清楚。
在乌干达西南部的姆巴拉拉医院对孕妇进行了一项横断面研究。记录了人口统计学、输血和产科病史。采用免疫血液学技术检测母体RBC同种免疫情况。
共招募了2001名孕妇；其中3.6%为RhD阴性。45名妇女（2.2%；95%置信区间：1.6 - 2.9）被发现对RBC抗原发生了同种免疫。有38种已知特异性的RBC同种抗体，包括抗 - S，12例；抗 - M，11例；抗 - Le(a)，6例；抗 - D，4例，以及抗 - K、抗 - Fy(b)、抗 - Jk(a)、抗 - Lu(a)和抗 - Kp(a)各1例。两名妇女（4.4%）存在抗体组合（抗 - M + S和抗 - K + Kp(a)）。产科病史、孕周和既往免疫事件与同种免疫发生率无显著相关性。
本研究显示孕产妇RBC同种免疫率为2.2%，与津巴布韦一项患病率为1.7%的研究结果相近。鉴于本研究中RhD阴性妇女中抗 - D患病率为6.0%以及D抗原的高免疫原性，应认真考虑在乌干达开展预防抗 - D同种免疫和HDFN的项目。
