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胎儿成红细胞增多症预防的近期进展概述。

An overview of recent advances in the prevention of erythroblastosis fetalis.

作者信息

Balasubramaniam Aishwarya, Kumar V Santhosh, Priya S

机构信息

Department of Pharmacology, School of Pharmaceutical Sciences, Vels Institute of Science Technology and Advanced Studies, Chennai, Tamil Nadu, India.

Department of Safety Operations, IQVIA Private Limited, Bengaluru, Karnataka, India.

出版信息

Asian J Transfus Sci. 2025 Jan-Jun;19(1):121-124. doi: 10.4103/ajts.ajts_50_22. Epub 2022 Sep 28.

Abstract

Erythroblastosis fetalis is one of the leading causes of death among newborns and fetuses in India. This condition is characterized by maternal immunoglobin G antibodies destroying the red blood cells (RBCs) of the neonate or fetus, resulting in potentially life-threatening consequences. When a mother with an Rh-positive blood group has a fetus with an Rh-negative blood group, the fetal RBCs trigger maternal antibodies against Rh-antigens. Anti-D antibodies are activated as a result of this process, which is known as isoimmunization. As a result of the antibody reaction, all of the erythrocytes are destroyed, resulting in hemolysis, bilirubin release, and anemia. Intravascular transfusions and intraperitoneal transfusions are examples of antenatal therapies that potentially avoid dangers to the fetus in the early stages of pregnancy. Phototherapy, exchange top-up transfusions, and intravenous immunoglobulin (IVIG) injections are examples of postnatal therapies (IVIG). IVIG therapy is highly recommended since it has a low risk of adverse medication responses and a wide range of survival rates. To avoid isoimmunization, anti-Rh D therapies are indicated. Noninvasive identification of the fetal human platelet antigen 1 genotype using cell-free fetal DNA obtained from maternal blood is one example of progress. This is still in the early stages of research as preventive medicine, the platelet equivalent of Rho (D) Immune Globulin Human (RhoGAM). The erythroblastosis fetalis is highly preventable when it is diagnosed at its early stages. Regular screening of all the patients with ABO incompatibility is necessary to prevent the risks of erythroblastosis fetalis.

摘要

胎儿成红细胞增多症是印度新生儿和胎儿死亡的主要原因之一。这种病症的特征是母体免疫球蛋白G抗体破坏新生儿或胎儿的红细胞(RBC),从而导致潜在的危及生命的后果。当Rh阳性血型的母亲怀有Rh阴性血型的胎儿时,胎儿的红细胞会触发母体针对Rh抗原的抗体。抗D抗体因这一过程(称为同种免疫)而被激活。抗体反应导致所有红细胞被破坏,进而引发溶血、胆红素释放和贫血。产前治疗方法如血管内输血和腹腔输血有可能在怀孕早期避免对胎儿造成危险。产后治疗方法如光疗、置换加量输血和静脉注射免疫球蛋白(IVIG)(IVIG)。强烈推荐IVIG治疗,因为其药物不良反应风险低且生存率范围广。为避免同种免疫,需进行抗Rh D治疗。利用从母体血液中获取的游离胎儿DNA对胎儿人类血小板抗原1基因型进行非侵入性鉴定就是进展之一。作为预防医学,这仍处于研究初期,相当于血小板版本的人Rh(D)免疫球蛋白(RhoGAM)。胎儿成红细胞增多症在早期被诊断时是高度可预防的。对所有ABO血型不相容的患者进行定期筛查对于预防胎儿成红细胞增多症的风险是必要的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/987b/12364061/55940f8f2f0a/AJTS-19-121-g001.jpg

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