Wu Hui, Li Rui, Wei Hongling, Zhu Weiwei, Xing Yan
Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
Children (Basel). 2024 Nov 21;11(12):1409. doi: 10.3390/children11121409.
BACKGROUND/OBJECTIVES: The clinical characteristics and outcomes of hemolytic disease of the newborn (HDN) caused by irregular antibodies remain unclear. Herein, we analyzed the clinical features and prognosis of HDN.
Children admitted to our institution between June 2009 and December 2022 with a definite diagnosis of HDN were evaluated. Patients with irregular antibodies were matched in a 1:3 ratio to those with ABO incompatibility. Children with confirmed Rh-incompatibility hemolytic disease were divided into the RhD subgroup (hemolysis induced by Rh anti-D) and the non-RhD group (hemolysis induced by other Rh antibodies).
The irregular antibody and ABO incompatibility group included 32 and 96 patients, respectively. Compared to the ABO incompatibility group, the irregular antibody group showed earlier jaundice; higher incidence of liver and spleen enlargement and anemia; higher direct antiglobulin test (DAT) positivity; earlier and more severe anemia; higher rates of enhanced phototherapy, blood transfusion, and blood exchange; and longer hospital stay (all < 0.05). Compared to the non-RhD group, the RhD subgroup showed an earlier occurrence of jaundice and a higher incidence of liver and spleen enlargement (both < 0.05). The multiple irregular antibody subgroup further showed earlier occurrence of jaundice and a higher rate of enhanced phototherapy, blood transfusion, and blood exchange than the single-antibody group (both < 0.05).
HDN caused by irregular red blood cell antibodies is rare, but clinical manifestations are serious. It is important to pay attention to the screening of irregular antibodies during pregnancy, to strengthen monitoring, and to provide intrauterine treatment and early intervention as necessary.
背景/目的：由不规则抗体引起的新生儿溶血病（HDN）的临床特征和结局尚不清楚。在此，我们分析了HDN的临床特征和预后。
对2009年6月至2022年12月在我院确诊为HDN的患儿进行评估。将不规则抗体患儿与ABO血型不合患儿按1:3的比例进行匹配。确诊为Rh血型不合溶血病的患儿分为RhD亚组（由Rh抗-D引起的溶血）和非RhD组（由其他Rh抗体引起的溶血）。
不规则抗体组和ABO血型不合组分别有32例和96例患者。与ABO血型不合组相比，不规则抗体组黄疸出现更早；肝脾肿大和贫血发生率更高；直接抗球蛋白试验（DAT）阳性率更高；贫血出现更早且更严重；强化光疗、输血和换血率更高；住院时间更长（均P<0.05）。与非RhD组相比，RhD亚组黄疸出现更早，肝脾肿大发生率更高（均P<0.05）。多种不规则抗体亚组黄疸出现比单抗体组更早，强化光疗、输血和换血率更高（均P<0.05）。
由不规则红细胞抗体引起的HDN罕见，但临床表现严重。孕期重视不规则抗体筛查，加强监测，必要时提供宫内治疗和早期干预很重要。
