Cordell V, Soe A, Latham T, Bills V L
BJOG. 2025 Mar;132(4):e53-e60. doi: 10.1111/1471-0528.18008. Epub 2024 Dec 17.
Haemolytic disease of the fetus and newborn (HDFN) is a rare condition that causes a baby to develop anaemia while growing inside the woman; or after birth. Left untreated, this may lead to stillbirth or neonatal death. HDFN is caused when the pregnant woman's antibodies cross the placenta, enter the baby's circulation, and attach to proteins called antigens (inherited from the father) on the baby's haemoglobin containing red blood cells, and cause them to break apart, causing fetal anaemia. Women routinely have their blood tested at the start of pregnancy to assess their ABO blood group and Rh antigens. There are five main Rhesus antigens: D, C, c, E, e; with anti-D being responsible for most cases of HDFN. If a woman is found to be Rh D negative; a 'non-invasive' blood test is performed to assess if the fetal blood group is the same as the woman's. If a woman is found to be Rh D negative, and the baby is found to be D positive, the baby is at risk. This is because the baby has inherited the D antigen from the father; so-called Rhesus incompatibility. Other red blood cell antibodies such as anti-Kell or anti-Duffy can also cause fetal anaemia. Women at highest risk of developing HDFN are those who have had at least one previous birth or a sensitising event (such as abdominal trauma) in a current or previous pregnancy, causing the woman and baby's blood to mix. Current treatment for haemolytic disease of the fetus involves giving fetal blood transfusions, with a small risk of early labour or pregnancy loss. If anaemia develops later in pregnancy, early delivery of the baby may be recommended; which could lead to complications of prematurity. In cases of mild HDFN, the baby may only require light therapy for neonatal jaundice. However, if the anaemia occurs earlier in pregnancy and is severe, the baby may need blood transfusions while still in the womb - and after birth may require an exchange transfusion, to remove the woman's antibodies from their circulation and to treat the anaemia. Intravenous immunoglobulin (IVIG) is a potential non-invasive method to prevent or delay the onset of severe anaemia. It is a blood product given intravenously every week to women who have been deemed at very high risk of early onset HDFN. It can be started at the end of the first trimester until birth, or until anaemia develops. This paper will discuss the evidence behind IVIG and other novel therapies during pregnancy, including the risks and the benefits. The developers of the paper include obstetricians, neonatologists and haematologists to provide different opinions on this topic.
胎儿和新生儿溶血病（HDFN）是一种罕见病症，会导致胎儿在母体内发育或出生后出现贫血。若不治疗，可能会导致死产或新生儿死亡。当孕妇的抗体穿过胎盘，进入胎儿血液循环，并附着在胎儿含血红蛋白的红细胞上一种名为抗原（从父亲遗传而来）的蛋白质上，致使红细胞破裂，引发胎儿贫血时，就会导致胎儿和新生儿溶血病。女性在怀孕初期通常会接受血液检测，以评估其ABO血型和Rh抗原。主要有五种恒河猴抗原：D、C、c、E、e；其中抗-D导致了大多数胎儿和新生儿溶血病病例。如果发现一名女性为Rh D阴性；会进行一项“非侵入性”血液检测，以评估胎儿血型是否与该女性相同。如果发现一名女性为Rh D阴性，而胎儿为D阳性，那么胎儿就有风险。这是因为胎儿从父亲那里遗传了D抗原；即所谓的Rh血型不合。其他红细胞抗体，如抗-Kell或抗-Duffy，也可能导致胎儿贫血。发生胎儿和新生儿溶血病风险最高的女性是那些在当前或既往妊娠中至少有过一次分娩或致敏事件（如腹部创伤），导致母体和胎儿血液混合的女性。目前针对胎儿溶血病的治疗方法包括进行胎儿输血，但存在早产或流产的小风险。如果在妊娠后期出现贫血，可能会建议提前分娩婴儿；这可能会导致早产并发症。对于轻度胎儿和新生儿溶血病病例，婴儿可能仅需接受新生儿黄疸光疗。然而，如果贫血在妊娠早期出现且较为严重，婴儿在子宫内时可能就需要输血，出生后可能还需要进行换血输血，以清除母体内的抗体并治疗贫血。静脉注射免疫球蛋白（IVIG）是一种预防或延缓严重贫血发作的潜在非侵入性方法。它是一种血液制品，每周给被认为有早期发生胎儿和新生儿溶血病高风险的女性静脉注射。可以在孕早期末开始使用，直至分娩，或者直至出现贫血。本文将讨论孕期使用IVIG及其他新疗法背后的证据，包括风险和益处。本文的撰写人员包括产科医生、新生儿科医生和血液科医生，以便就该主题提供不同观点。
