基因分型预防Rh疾病：时机已到？
Genotyping to prevent Rh disease: has the time come?
作者信息
van der Schoot C Ellen, de Haas Masja, Clausen Frederik Banch
机构信息
aSanquin Research, Department of Experimental Immunohematology bLandsteiner Laboratory, Academic Medical Centre, University of Amsterdam cSanquin Diagnostic Services, Department of Immunohematology Diagnostics, Amsterdam dSanquin Research, Department of Immunohematology and Blood Transfusion, Center for Clinical Transfusion Research, Leiden and Leiden University Medical Center, Leiden, The Netherlands eDepartment of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
Curr Opin Hematol. 2017 Nov;24(6):544-550. doi: 10.1097/MOH.0000000000000379.
PURPOSE OF REVIEW
In this review, we analyzed the current literature on noninvasive fetal RHD typing to answer the question whether the administration of RhIg to prevent D-alloimmunization during pregnancy can be safely guided by fetal RHD typing.
RECENT FINDINGS
Recently the first centers that implemented large-scale nationwide fetal RHD typing in the second trimester for targeted RhIg administration have published their studies evaluating the diagnostic accuracy of their screening programs. These data show that fetal RHD typing in a routine setting is, at least in a population of European descent, accurate enough to guide both antenatal and postnatal immunoprophylaxis.
SUMMARY
Depending on the ethnic background and the organization of pregnancy care the decisions regarding RhIg can be safely and cost-effectively based on fetal RHD typing by a duplex real-time PCR. As a result, the unnecessary administration of 40% of antenatal RhIg can be prevented, and cord blood serology can be omitted.
综述目的
在本综述中，我们分析了当前关于无创胎儿RHD分型的文献，以回答孕期应用Rh免疫球蛋白（RhIg）预防D同种免疫是否可通过胎儿RHD分型安全指导这一问题。
最新发现
最近，首批在孕中期实施大规模全国性胎儿RHD分型以进行靶向RhIg给药的中心发表了评估其筛查项目诊断准确性的研究。这些数据表明，在常规情况下，至少在欧洲裔人群中，胎儿RHD分型的准确性足以指导产前和产后免疫预防。
总结
根据种族背景和孕期护理组织情况，基于双重实时PCR进行的胎儿RHD分型可为RhIg决策提供安全且具成本效益的依据。因此，可避免40%的产前RhIg不必要给药，且可省略脐血血清学检测。
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