Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Santa Monica OBGYN, Santa Monica, CA, USA.
Am J Clin Pathol. 2023 Jul 5;160(1):78-80. doi: 10.1093/ajcp/aqad011.
Massive fetomaternal hemorrhage (FMH) is rare and reported to be the cause in approximately 3% of all fetal deaths. Maternal management of massive FMH includes prevention of Rh(D) alloimmunization in Rh(D)-negative mothers by administration of Rh(D) immune globulin (RhIG).
We describe a case of a 30-year-old O-negative, primigravida woman who presented at 38 weeks of gestation with decreased fetal movements. She underwent an emergency cesarean section and delivered an O-positive baby girl who died shortly after birth.
The patient's FMH screen was positive, with a Kleihauer-Betke test demonstrating 10.7% fetal blood in maternal circulation. The calculated dose of 6,300 µg RhIG was given prior to discharge over 2 days using an intravenous (IV) preparation. Antibody screening a week after discharge showed anti-D and anti-C. The anti-C was attributed to acquired passive immunity from the large dose of RhIG. Anti-C reactivity waned and was negative at 6 months, but the anti-D pattern persisted at 9 months postdelivery. Negative antibody screens were noted at 12 and 14 months.
This case highlights the immunohematology challenges of IV RhIG as well as the success in preventing alloimmunization with IV RhIG given the patient's complete resolution of anti-C and no anti-D formation, with a subsequent healthy pregnancy.
巨大胎儿母体出血（FMH）罕见，据报道约占所有胎儿死亡的 3%。Rh（D）阴性母亲的大量 FMH 母体管理包括通过给予 Rh（D）免疫球蛋白（RhIG）来预防 Rh（D）同种免疫。
我们描述了一例 30 岁的 O 阴性初产妇，她在 38 周妊娠时出现胎动减少。她接受了紧急剖宫产，产下一名 O 阳性女婴，出生后不久死亡。
患者的 FMH 筛查呈阳性，Kleihauer-Betke 试验显示母体循环中有 10.7%的胎儿血液。根据计算，在 2 天内分 2 次静脉（IV）给予 6300µg 的 RhIG。出院后一周的抗体筛查显示抗-D 和抗-C。抗-C归因于从大量 RhIG 获得的被动获得性免疫。抗-C 反应性减弱，在产后 6 个月时呈阴性，但在产后 9 个月时抗-D 模式仍持续存在。在 12 个月和 14 个月时，抗体筛查均为阴性。
本病例突出了 IV RhIG 的免疫血液学挑战，以及在患者完全消除抗-C 和无抗-D 形成的情况下，IV RhIG 成功预防同种免疫的情况，随后有了一次健康的妊娠。
