Department of Gynecology and Obstetrics, Beaujon Hospital, AP-HP, and University Paris Diderot, France.
French Blood Establishment, Paris, France.
J Obstet Gynaecol. 2020 May;40(4):468-472. doi: 10.1080/01443615.2019.1629400. Epub 2019 Aug 1.
We report on our experiences since 2010 with pregnant women with rare blood types. The lack of compatible blood is a challenge for the anaesthetist whose priority is to prevent and treat anaemia in late pregnancy in order to avoid immunisation after transfusion of incompatible blood. In our hospital, the blood type is checked during the first obstetric consult, which is variable, starting from the fourth month of pregnancy. Rare blood types are most often diagnosed in an advanced stage of pregnancy (30 weeks of gestation: WG) due to the late inscription for obstetrics consult, resulting in even later anaesthetic visit. In our 13 patients, the most common blood systems are Duffy, MNS, and RH. 61.5% of the patients have associated antibodies (anti-MNS5). The majority of patients received iron with significant increase of ferritin (17.24 ± 12.95 μg/L 262.2 ± 404.4 μg/L, = .033). Six of the patients had 2-3 injections of EPO between 29 - 36 + 1 WG. There were no transfers for paediatric management of haemolytic disease in the newborn following the birth. Overall, this treatment of patients with a rare blood group has also changed our practices for the follow-up of other pregnant women, and ferritin is more regularly prescribed.Impact statement For rare blood groups, the frequency in the general population is less than 1/4000. The most common antibodies at risk of haemolytic disease and 'hydrops fetalis' are anti-D, anti-E, anti-C, and anti-K. The survey of pregnant women with a rare blood type takes into account the maternal risk of 'transfusion deadlock' and haemolytic disease of the newborn. Rare blood types are most often diagnosed in an advanced stage of pregnancy (30 WG) due to the late inscription for obstetrics consults at Maternity. The most common blood systems are Duffy, MNS, RH, and 61.5% of the patients have associated antibodies (anti-MNS5). The most efficient treatment of prenatal anaemia was iron perfusions who allowed significant increase of ferritin and a maternal haemoglobin concentration of 12.1±1.46 g/dL in the ninth month of pregnancy. A pregnant woman with a rare blood group is a situation that requires a technical platform specialised in haemorrhagic risk and a multidisciplinary team, including a blood bank as well as anaesthetic and obstetrical teams, with excellent interdisciplinary coordination.
我们报告自 2010 年以来患有稀有血型孕妇的经验。缺乏相容血液是麻醉师的挑战，其首要任务是预防和治疗妊娠晚期贫血，以避免输注不相容血液后的免疫。在我们的医院中，血型在第一次产科咨询时进行检查，这是可变的，从怀孕第四个月开始。由于产科咨询的晚期登记，稀有血型通常在妊娠晚期（30 周妊娠）诊断，导致麻醉访问甚至更晚。在我们的 13 名患者中，最常见的血液系统是 Duffy、MNS 和 RH。61.5%的患者存在相关抗体（抗-MNS5）。大多数患者接受铁剂治疗，铁蛋白显著增加（17.24±12.95μg/L 262.2±404.4μg/L，=0.033）。6 名患者在 29-36+1 周妊娠期间接受了 2-3 次 EPO 注射。新生儿出生后无因新生儿溶血病而转儿科治疗。总的来说，这种治疗稀有血型患者的方法也改变了我们对其他孕妇的随访实践，并且更经常开具铁蛋白处方。
影响陈述 对于稀有血型，其在普通人群中的频率小于 1/4000。最常见的有风险发生溶血病和“胎儿水肿”的抗体是抗-D、抗-E、抗-C 和抗-K。对稀有血型孕妇的调查考虑了产妇发生“输血障碍”和新生儿溶血病的风险。由于在妇产科就诊的晚期登记，稀有血型通常在妊娠晚期（30 周妊娠）诊断。最常见的血液系统是 Duffy、MNS、RH，61.5%的患者存在相关抗体（抗-MNS5）。产前贫血最有效的治疗方法是铁输注，它可以显著增加铁蛋白和孕妇在妊娠第九个月时的血红蛋白浓度至 12.1±1.46g/dL。患有稀有血型的孕妇是一种需要具有专门的出血风险技术平台和多学科团队的情况，包括血库以及麻醉和产科团队，具有出色的跨学科协调能力。
