Legler Tobias J
Department of Transfusion Medicine, University Medical Center, Georg-August-University, Göttingen, Germany.
Transfus Apher Sci. 2020 Oct;59(5):102950. doi: 10.1016/j.transci.2020.102950. Epub 2020 Sep 25.
Rhesus D (RhD) negative pregnant women carrying an RhD positive fetus are at risk of developing anti-D during or after pregnancy. Anti-d-immunoglobulin (RhIg), which is mainly produced from special plasma donated in a few countries for the whole world, is able to prevent an anti-D alloimmunization. Through the introduction of ante- and postnatal anti-d-prophylaxis into clinical routine, the frequency of hemolytic disease of fetus and newborn decreased considerably. Postnatal prophylaxis from the beginning in the 1960s has been applied only to women who delivered an RhD positive newborn. Because the fetal RhD status can be determined with high sensitivity and accuracy from the mother's peripheral blood, targeted antenatal anti-d-prophylaxis is becoming a new standard procedure in more and more countries. Phototherapy and exchange transfusion are still the main pillars for the treatment of RhD hemolytic disease of the newborn. The efficacy of IVIg in the management of these neonates is not conclusive and cannot be recommended until a larger randomized, double-blind, placebo-controlled study is performed.
怀有RhD阳性胎儿的RhD阴性孕妇在孕期或产后有产生抗D抗体的风险。抗D免疫球蛋白（RhIg）主要由少数几个国家捐献的特殊血浆为全世界生产，它能够预防抗D同种免疫。通过将产前和产后抗D预防措施引入临床常规操作，胎儿和新生儿溶血病的发生率大幅下降。20世纪60年代开始的产后预防仅应用于分娩出RhD阳性新生儿的女性。由于可以从母亲外周血中高灵敏度和高准确性地确定胎儿的RhD状态，针对性的产前抗D预防在越来越多的国家正成为一种新的标准程序。光疗和换血仍然是新生儿RhD溶血病治疗的主要支柱。静脉注射免疫球蛋白（IVIg）在这些新生儿治疗中的疗效尚无定论，在进行更大规模的随机、双盲、安慰剂对照研究之前，不能推荐使用。
