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非常延长的抗-D:Rh 免疫球蛋白后同种免疫的困惑:病例报告。

Very Prolonged Anti-D: Confusion Surrounding Alloimmunization After Extra Rh Immunoglobulin: A Case Report.

机构信息

Faculty of Medicine, University of Ottawa, Ottawa, ON.

Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON.

出版信息

J Obstet Gynaecol Can. 2020 Sep;42(9):1151-1153. doi: 10.1016/j.jogc.2019.11.070. Epub 2020 Jan 29.

DOI:10.1016/j.jogc.2019.11.070
PMID:32007389
Abstract

BACKGROUND

Rh immunoglobulin (RhIg) is usually detectable a maximum of 12 to 14 weeks after administration. Positive antibodies beyond this time frame suggests alloimmunization.

CASE

A woman had three pregnancies over a 6-month period, with two first-trimester losses. She received RhIg in the first pregnancy but not in the second. Two months after the second loss, in her third pregnancy, she received RhIg at week 6 due to first-trimester bleeding. She was subsequently anti-D antibody positive up to week 28 with antibodies too low to titre, leading to confusion about whether alloimmunization had occurred.

CONCLUSION

Rh Ig administration led to positive anti-D antibodies lasting 22 weeks, suggesting keeping this differential diagnosis in mind when suspecting alloimmunization with positive antibodies at levels too low to titre.

摘要

背景

Rh 免疫球蛋白(RhIg)通常在给药后最多 12 至 14 周内可检测到。在此时间框架之外出现阳性抗体提示同种免疫。

病例

一名妇女在 6 个月的时间内怀孕了 3 次,其中 2 次发生了早期流产。她在第一次妊娠中接受了 RhIg,但在第二次妊娠中没有接受。第二次流产后两个月,在第三次妊娠中,由于早期出血,她在第 6 周接受了 RhIg。随后,她的抗-D 抗体在第 28 周前呈阳性,但抗体滴度太低,导致对是否发生同种免疫产生了混淆。

结论

Rh Ig 的给药导致了持续 22 周的阳性抗-D 抗体,这表明在怀疑抗体滴度太低而发生同种免疫时,应牢记这种鉴别诊断。

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