Bowman J
Rh Laboratory, Winnipeg, Manitoba, Canada.
Semin Perinatol. 1997 Feb;21(1):39-44. doi: 10.1016/s0146-0005(97)80018-3.
Rh hemolytic disease (HDN) is the prototype of maternal alloimmunization and fetal hemolytic disease. There are other antigens capable of causing alloimmunization and hemolytic disease such as c, Kell, and Fya. Rh immunization is usually caused by a prior Rh positive fetal maternal transplacental hemorrhage, which occurs in at least 75% of pregnancies. Unless treated, hemolytic disease will result in kernicterus or fetal hydrops in 25% of cases, respectively. Neonatal exchange transfusion has eradicated kernicterus. Measures available to predict severity of fetal hemolytic disease are maternal antibody titers, prior history of hemolytic disease, in vitro cell-mediated maternal antibody functional assays, amniotic fluid spectrophotometry, ultrasound fetal assessment, and fetal blood sampling. The Rh or Kell antigen status of the fetus may be determined by amniotic fluid PCR testing. The management of the severely affected fetus consists of early delivery, with or without fetal transfusions, depending on the gestation of the fetus. With the use of these diagnostic and treatment measures, perinatal mortality from hemolytic disease of the fetus and newborn has been reduced in Manitoba, population one million, from 100 per year in the early 1940s to 1 every 3 years in the mid 1990s.
Rh溶血病（HDN）是母体同种免疫和胎儿溶血病的典型病例。还有其他一些能够引起同种免疫和溶血病的抗原，如c、Kell和Fya。Rh免疫通常是由先前Rh阳性胎儿与母体之间经胎盘的出血引起的，这种情况在至少75%的妊娠中都会发生。除非进行治疗，溶血病在25%的病例中会分别导致核黄疸或胎儿水肿。新生儿换血疗法已根除了核黄疸。可用于预测胎儿溶血病严重程度的方法有母体抗体滴度、溶血病既往史、体外细胞介导的母体抗体功能测定、羊水分光光度法、超声胎儿评估和胎儿血样采集。胎儿的Rh或Kell抗原状态可通过羊水PCR检测来确定。对严重受影响胎儿的处理包括根据胎儿的孕周，在有或没有进行胎儿输血的情况下尽早分娩。通过使用这些诊断和治疗措施，在拥有100万人口的曼尼托巴省，胎儿及新生儿溶血病的围产期死亡率已从20世纪40年代初的每年100例降至20世纪90年代中期的每3年1例。
