Iberahim Salfarina, Aizuddin Maryam Jameelah, Kadir Nurulhuda Abd, Rameli Nabilah, Adzahar Sumaiyah, Noor Noor Haslina Mohd, Abdullah Wan Zaidah
School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.
Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.
Oman Med J. 2020 Nov 30;35(6):e206. doi: 10.5001/omj.2020.135. eCollection 2020 Nov.
The majority of hemolytic disease of the fetus and newborn (HDFN) reported in the literature is due to ABO and rhesus incompatibility. However, there are also other minor blood groups that have been identified as a cause of HDFN, although the occurrence is much rarer. The antibody screening program for D negative mother and the anti-D immunoglobulin treatment showed a significant reduction of the occurrence of HDFN secondary to anti-D. In a developed country, the screening for red blood cell antibody in the pregnant mother other than anti-D reduced the possibility of HDFN occurrence hence reduced the fetal morbidity and subsequently increased the fetal well being during pregnancy and after the postnatal period. In this case report, we discuss HDFN in a primigravida patient secondary to multiple alloantibodies (anti-Jk and anti-E). The baby developed jaundice with bilirubin levels approaching the exchange transfusion level. However, with extensive phototherapy and immunoglobulin treatment, the child did not require exchange transfusion. We also included the importance of the routine antenatal antibody screening program. This practice will help the transfusion center to find the antigen negative blood in a timely manner and reduce the morbidities and mortalities of HDFN among the newborns.
文献报道的大多数胎儿及新生儿溶血病(HDFN)是由ABO血型和恒河猴血型不相容引起的。然而,也有其他一些次要血型被确定为HDFN的病因,尽管其发生率要低得多。针对D阴性母亲的抗体筛查计划和抗-D免疫球蛋白治疗显示,抗-D继发的HDFN发生率显著降低。在一个发达国家,对孕妇进行除抗-D以外的红细胞抗体筛查降低了HDFN发生的可能性,从而降低了胎儿发病率,并随后提高了孕期及产后胎儿的健康状况。在本病例报告中,我们讨论了一名初产妇因多种同种抗体(抗-Jk和抗-E)继发的HDFN。婴儿出现黄疸,胆红素水平接近换血水平。然而,通过广泛的光疗和免疫球蛋白治疗,患儿未需要进行换血。我们还强调了常规产前抗体筛查计划的重要性。这种做法将有助于输血中心及时找到抗原阴性血液,并降低新生儿中HDFN的发病率和死亡率。