Goodrum L A, Saade G R, Belfort M A, Carpenter R J, Moise K J
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Obstet Gynecol. 1997 Jan;89(1):57-60. doi: 10.1016/s0029-7844(96)00391-2.
To evaluate the change in fetal serum bilirubin levels in response to intrauterine transfusion for red cell alloimmunization.
The records of 37 patients who underwent more than one intrauterine transfusion were reviewed. The following indices were extracted: pre- and post-transfusion fetal hematocrit, total and direct serum bilirubin, reticulocyte count, Kleihauer-Betke test results, volumes of intravascular and intraperitoneal transfusions, and the source used for transfusion. The data were compared for interval 1 (transfusion 1 to 2) and interval 2 (transfusion 2 to 3). The rates of change in bilirubin, reticulocyte count, and percent fetal cells on the Kleihauer-Betke test were defined as the differences between the initial values of one transfusion and the initial values of the next transfusion divided by the number of days between transfusions. Analysis of variance, sign-rank test, and linear regression analysis were used when appropriate. P < .05 was significant.
The median number of intrauterine transfusions for each patient was 3 (range 2-8). Gestational ages ranged from 22 to 37 weeks. Total bilirubin remained above the 97.5 percentile for gestational age in all but five patients. There was a significant decrease in reticulocyte count and fetal cells on the Kleihauer-Betke test, and an increase in hematocrit with serial intrauterine transfusions. Bilirubin increased significantly after the first intrauterine transfusion (3.9 versus 5.0 mg/dL) and remained elevated thereafter.
Fetal total serum bilirubin remains elevated with repeated intrauterine transfusions in fetal alloimmunization. Total bilirubin should not be used to evaluate fetal hematologic responses to the transfusions.
评估胎儿血清胆红素水平对红细胞同种免疫宫内输血的反应变化。
回顾了37例接受不止一次宫内输血患者的记录。提取了以下指标：输血前后胎儿血细胞比容、血清总胆红素和直接胆红素、网织红细胞计数、克-贝试验结果、血管内和腹腔内输血量以及输血所用来源。比较了第1个间隔期（第1次输血至第2次输血）和第2个间隔期（第2次输血至第3次输血）的数据。胆红素、网织红细胞计数和克-贝试验中胎儿细胞百分比的变化率定义为一次输血的初始值与下一次输血的初始值之差除以两次输血之间的天数。在适当情况下使用方差分析、符号秩检验和线性回归分析。P<0.05具有显著性。
每位患者宫内输血的中位数为3次（范围2 - 8次）。孕周为22至37周。除5例患者外，所有患者的血清总胆红素均高于胎龄的第97.5百分位数。随着宫内输血次数增加，克-贝试验中网织红细胞计数和胎儿细胞显著减少，血细胞比容增加。首次宫内输血后胆红素显著升高（3.9对5.0mg/dL），此后一直居高不下。
在胎儿同种免疫中，反复宫内输血后胎儿血清总胆红素仍持续升高。血清总胆红素不应被用于评估胎儿对输血的血液学反应。
