Bollason Gunnar, Hjartardottir Hulda, Jonsson Thorbjorn, Gudmundsson Sveinn, Kjartansson Sveinn, Halldorsdottir Anna Margret
University of Iceland, Faculty of Medicine, Reykjavik, Iceland.
Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland.
Transfusion. 2017 Nov;57(11):2578-2585. doi: 10.1111/trf.14262. Epub 2017 Aug 24.
Red blood cell (RBC) alloimmunization during pregnancy is still a major problem. Historically, anti-D antibodies are most likely to cause severe hemolysis, but other antibodies are also important. In Iceland, postnatal RhIg prophylaxis was implemented in 1969, universal RBC antibody screening was implemented in 1978, but antenatal RhIg prophylaxis is not yet routine.
This nation-wide population study gathered data on alloimmunized pregnancies in Iceland between 1996 and 2015. Blood bank alloimmunization data were linked to Icelandic Medical Birth Registry data. RBC antibodies were classified as either clinically significant or clinically nonsignificant.
In total, 912 positive antibody screens from 87,437 births were identified (1.04% prevalence). The most frequent antibodies were anti-M (19.4%), anti-E (19.0%), and anti-D (12.5%). Anti-D prevalence among D-negative mothers was 1.1%. Icelandic Medical Birth Registry data were available for 881 (96.6%) pregnancies. In the clinically significant group (n = 474), anti-E (27%) and anti-D (20%) were most common, whereas anti-M was most frequent (53%) in the clinically nonsignificant group (n = 407). Mothers in the clinically significant group were older, more often multigravidae, had more abortions and stillbirths, and had shorter gestational length. Newborns in the clinically significant group were less healthy, had lower weight and Apgar scores, and required more treatment. Among specificities in the clinically significant group, anti-D antibodies were most strongly associated with severe hemolysis.
In this study, the prevalence of alloimmunization was similar to that in previous reports. Of all clinically significant antibodies, anti-D was most strongly associated with severe hemolysis, requiring phototherapy or exchange transfusions. Our data emphasize the importance of implementing an antenatal prophylactic RhIg program in Iceland in the near future.
孕期红细胞（RBC）同种免疫仍然是一个主要问题。从历史上看，抗-D抗体最有可能导致严重溶血，但其他抗体也很重要。在冰岛，1969年实施了产后Rh免疫球蛋白预防措施，1978年实施了普遍的红细胞抗体筛查，但产前Rh免疫球蛋白预防尚未成为常规做法。
这项全国性的人群研究收集了1996年至2015年冰岛同种免疫妊娠的数据。血库同种免疫数据与冰岛医学出生登记数据相关联。红细胞抗体被分类为具有临床意义或无临床意义。
在总共87437例出生中，共识别出912例抗体筛查阳性（患病率为1.04%）。最常见的抗体是抗-M（19.4%）、抗-E（19.0%）和抗-D（12.5%）。D阴性母亲中抗-D的患病率为1.1%。881例（96.6%）妊娠的冰岛医学出生登记数据可用。在具有临床意义的组（n = 474）中，抗-E（27%）和抗-D（20%）最为常见，而在无临床意义的组（n = 407）中，抗-M最为常见（53%）。具有临床意义的组中的母亲年龄更大，多产妇更常见，有更多的流产和死产，且孕周更短。具有临床意义的组中的新生儿健康状况较差，体重和阿氏评分较低，需要更多治疗。在具有临床意义的组中的特异性抗体中，抗-D抗体与严重溶血的相关性最强。
在本研究中，同种免疫的患病率与先前报告相似。在所有具有临床意义的抗体中，抗-D与严重溶血的相关性最强，需要进行光疗或换血治疗。我们的数据强调了在不久的将来在冰岛实施产前预防性Rh免疫球蛋白计划的重要性。
