Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.
Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Transfusion. 2020 Nov;60(11):2537-2546. doi: 10.1111/trf.16061. Epub 2020 Sep 7.
Alloimmunization can impact both the fetus and neonate.
(a) calculate the incidence of clinically significant RBC isoimmunization during pregnancy, (b) review maternal management and neonatal outcomes, (c) assess the value of prenatal and postnatal serological testing in predicting neonatal outcomes.
A retrospective audit of consecutive alloimmunized pregnancies was conducted. Data collected included demographics, clinical outcomes, and laboratory results. Outcomes included: incidence of alloimmunization; outcomes for neonates with and without the cognate antigen; and sensitivity and specificity of antibody titration testing in predicting hemolytic disease of the fetus and newborn (HDFN).
Over 6 years, 128 pregnant women (0.4%) were alloimmunized with 162 alloantibodies; anti-E was the most common alloantibody (51/162; 31%). Intrauterine transfusions (IUTs) were employed in 2 (3%) of 71 mothers of cognate antigen positive (CoAg+) neonates. Of 74 CoAg+ neonates, 58% required observation alone, 23% intensive phototherapy, 9% top up transfusion, and 3% exchange transfusion; no fetal or neonatal deaths occurred. HDFN was diagnosed in 28% (21/74) of neonates; anti-D was the most common cause. The sensitivity and specificity of the critical gel titer >32 in predicting HDFN were 76% and 75%, respectively (negative predictive value 95%; positive predictive value 36%). The sensitivity and specificity of a positive direct antiglobulin test (DAT) in predicting HDFN were 90% and 58%, respectively (NPV 97%; PPV 29%).
Morbidity and mortality related to HDFN was low; most alloimmunized pregnancies needed minimal intervention. Titers of >32 by gel warrant additional monitoring during pregnancy.
同种免疫可影响胎儿和新生儿。
（a）计算怀孕期间临床显著 RBC 同种免疫的发生率，（b）回顾母体管理和新生儿结局，（c）评估产前和产后血清学检测在预测新生儿结局中的价值。
对连续的同种免疫妊娠进行回顾性审计。收集的数据包括人口统计学资料、临床结局和实验室结果。结局包括：同种免疫发生率；具有和不具有同源抗原的新生儿的结局；以及抗体滴定检测在预测胎儿和新生儿溶血病（HDFN）中的敏感性和特异性。
在 6 年期间，128 名孕妇（0.4%）发生了 162 种同种抗体同种免疫；抗-E 是最常见的同种抗体（51/162；31%）。在 71 名具有同源抗原阳性（CoAg+）新生儿的母亲中，有 2 名（3%）接受了宫内输血（IUT）。在 74 名 CoAg+新生儿中，58%仅需要观察，23%需要强化光疗，9%需要补充输血，3%需要换血；没有胎儿或新生儿死亡。在 28%（21/74）的新生儿中诊断出 HDFN；抗-D 是最常见的原因。临界凝胶滴度>32 预测 HDFN 的敏感性和特异性分别为 76%和 75%（阴性预测值 95%；阳性预测值 36%）。直接抗球蛋白试验（DAT）阳性预测 HDFN 的敏感性和特异性分别为 90%和 58%（NPV 97%；PPV 29%）。
与 HDFN 相关的发病率和死亡率较低；大多数同种免疫妊娠需要最少的干预。凝胶滴度>32 需在孕期进行额外监测。
