Aim: This study was aimed to review and establish the practice of exchange transfusion (ET) with whole blood reconstituted (WBR) in hemolytic disease of newborn (HDN). Objectives: To observe fall in indirect serum bil...Aim: This study was aimed to review and establish the practice of exchange transfusion (ET) with whole blood reconstituted (WBR) in hemolytic disease of newborn (HDN). Objectives: To observe fall in indirect serum bilirubin, correction of anemia and comparison with related studies. Background: Hemolytic disease of the Newborn is characterized by presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia. Exchange transfusion with or without phototherapy is the method of choice for treating the newborn with on going hemolysis Methods/Materials: Sample size consisted of 110 neonates in whom 119 exchange transfusions were carried out with WBR. WBR was prepared by suspending O Rhesus-D (RhD) positive/negative cells (compatible with neonate’s/ mother’s serum) in AB plasma. Double volume exchange transfusion(s) were carried out through umbilical vein by push-pull technique. Results: Out of 110 cases, 61 (55.5%) were of RhD HDN whereas ABO and other group HDN cases were 30 (27.3%) and 19 (17.3%) respectively. An average post-ET fall in indirect serum bilirubin by 54.6% and correction of anemia by3.7 gm/dl were reported in the study. Conclusion: An average post-ET fall in indirect serum bilirubin and correction of anemia was found to be more significant when compared to other studies. Hence we recommend exchange transfusion in HDN with WBR to obtain reasonable fall in indirect serum bilirubin and high average rate of correction of anemia.展开更多
A Chinese woman of blood group B,D-and her husband of blood group AB,CCDeewere examined.The woman had not been transfused before.Their first two babiesdied.Anti-Hro and anti-e were found in the mother’s serum.During ...A Chinese woman of blood group B,D-and her husband of blood group AB,CCDeewere examined.The woman had not been transfused before.Their first two babiesdied.Anti-Hro and anti-e were found in the mother’s serum.During her third pregnancy,the titer of antibodies went up quickly,approximately one titer per month.After 36 weeksof pregnancy,the baby was delivered by Caesarean section.The cord blood Hb was 88g/L,his red blood cell count 2.7×10<sup>12</sup>/L,and total biIirubin 114.6 mol/L.The baby was ofblood group AB,and CDe-D-genotype.Exchangetransfusion was begun 2.5 hours afterbirth.O,ccDEE washed red cells together with group AB plasma were used.Two dayslater,7Oml washed O,ccDEE concentrated red cells were administered.The baby is aliveand in good health.展开更多
目的探讨新生儿溶血病(HDN)的类型、抗体分布与输(换)血治疗的血液配型方案及疗效的关系。方法收集本院新生儿科2016年1月—2019年12月共350例住院HDN临床资料,包括年龄、性别、体重、胎次,回顾性统计患儿的溶血类型、血型抗体分布与治...目的探讨新生儿溶血病(HDN)的类型、抗体分布与输(换)血治疗的血液配型方案及疗效的关系。方法收集本院新生儿科2016年1月—2019年12月共350例住院HDN临床资料,包括年龄、性别、体重、胎次,回顾性统计患儿的溶血类型、血型抗体分布与治疗转归,分析其中输(换)血病例的血液配型方案,并以输血前后患儿血红蛋白(Hb)的变化评估其输血效果,以换血前后患儿的胆红素(Bil)和血红蛋白(Hb)的变化评估其换血效果。结果本组新生儿溶血病例中,ABO-HDN占94%(329/350),换血率为0.91%(3/329);Rh-HDN占5.43%(19/350),换血率为42.1%(8/19);ABO+MNSs-HDN占0.29%(1/350);Rh+Kidd-HDN占0.29%(1/350)。按照推荐方案输(换)血,11名输血患儿的输血次数1—2(1.82±0.40)次、(47.55±6.86)mL/次、输血量40—10(86.4±21.09)mL,输血前后Hb(g/L)分别为85.00±21.66 vs 125.09±12.96(P<0.05);12名换血患儿的换血次数1—2(1.17±0.39)次、(516.59±123.64)mL/次、换血量300—1403(602.69±279.05)mL;换血前后TBil(μmol/L)分别为327.22±97.40 vs 206.26±62.92(P<0.05),IBil(μmol/L)分别为295.66±110.98 vs 187.99±62.61(P<0.05),DBil(μmol/L)分别为37.23±31.83 vs 18.24±12.46(P>0.05);Hb(g/L)分别为105.64±44.94 vs 143.00±22.09(P<0.05)。结论HDN虽然以ABO血型系统最多见,但输(换)血疗法主要应用于Rh HDN,换血后Bil降低、Hb提升效果更明显。展开更多
目的探讨及早诊治新生儿RhD溶血病(RhD-HDN)换血术后合并毛细血管渗漏综合征(CLS)的意义。方法收集2名疑似RhD-HDN换血术后合并毛细血管渗漏综合征男性患儿(患儿1、2)的病历资料,检测母亲及患儿的ABO、Rh(D)血型及HDN相关试验,比较患儿...目的探讨及早诊治新生儿RhD溶血病(RhD-HDN)换血术后合并毛细血管渗漏综合征(CLS)的意义。方法收集2名疑似RhD-HDN换血术后合并毛细血管渗漏综合征男性患儿(患儿1、2)的病历资料,检测母亲及患儿的ABO、Rh(D)血型及HDN相关试验,比较患儿换血的详细过程、换血前后的血红蛋白(Hb)、总胆红素(TBIL)值,换血后白蛋白(ALB)及活化部分凝血活酶时间(APTT)、体重变化值。评估RhD-HDN及CLS的诊断及治疗方法。结果患儿1、2母亲血型均为A Rh(-),患儿血型均为A RhD(+),均诊断为RhD-HDN,患儿1、2分别于出生后4 h及产时出现黄疸,遂均做换血治疗。患儿1:换血2次,第1次换血157 mL/kg,A型RhD(-)悬浮红细胞470 mL,同型血浆240 mL,换血时间3.5 h,第2次换血换血种类同第1次,悬浮红细胞462 ml,血浆231 ml,换血时间3 h 20 min。两次换血前后Hb(g/L)为113 vs 146(第1次)、106 vs 146(第2次),TBIL(μmol/L)为331.1 vs 245.1(第1次)、351.5 vs 258.7(第2次);患儿2换血1次,输入A型RhD(-)悬浮红细胞340 mL,AB型RhD(-)血浆180 mL,换血时间3 h。换血前后Hb(g/L)为77 vs 156,TBIL(μmol/L)为219.8 vs 175.1。2名患儿均在换血后出现CLS症状,患儿1诊断为RhD-HDN,新生儿贫血,CLS;患儿2诊断为RhD-HDN,新生儿贫血,类白血病反应,胎粪吸入综合征(MAS)及CLS;经针对原发病、限液、抗感染、利尿、小剂量糖皮质激素、抗微血栓等综合治疗后2名患儿痊愈出院。结论注重孕(妇)期特殊血型的检测、对是特殊血型且发生过抗原暴露的孕妇的抗体效价做动态监测和必要治疗,有助于其娩出的新生儿RhD-HDN的及时诊和预后,减少新生儿换血后发生CLS。展开更多
文摘Aim: This study was aimed to review and establish the practice of exchange transfusion (ET) with whole blood reconstituted (WBR) in hemolytic disease of newborn (HDN). Objectives: To observe fall in indirect serum bilirubin, correction of anemia and comparison with related studies. Background: Hemolytic disease of the Newborn is characterized by presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia. Exchange transfusion with or without phototherapy is the method of choice for treating the newborn with on going hemolysis Methods/Materials: Sample size consisted of 110 neonates in whom 119 exchange transfusions were carried out with WBR. WBR was prepared by suspending O Rhesus-D (RhD) positive/negative cells (compatible with neonate’s/ mother’s serum) in AB plasma. Double volume exchange transfusion(s) were carried out through umbilical vein by push-pull technique. Results: Out of 110 cases, 61 (55.5%) were of RhD HDN whereas ABO and other group HDN cases were 30 (27.3%) and 19 (17.3%) respectively. An average post-ET fall in indirect serum bilirubin by 54.6% and correction of anemia by3.7 gm/dl were reported in the study. Conclusion: An average post-ET fall in indirect serum bilirubin and correction of anemia was found to be more significant when compared to other studies. Hence we recommend exchange transfusion in HDN with WBR to obtain reasonable fall in indirect serum bilirubin and high average rate of correction of anemia.
文摘A Chinese woman of blood group B,D-and her husband of blood group AB,CCDeewere examined.The woman had not been transfused before.Their first two babiesdied.Anti-Hro and anti-e were found in the mother’s serum.During her third pregnancy,the titer of antibodies went up quickly,approximately one titer per month.After 36 weeksof pregnancy,the baby was delivered by Caesarean section.The cord blood Hb was 88g/L,his red blood cell count 2.7×10<sup>12</sup>/L,and total biIirubin 114.6 mol/L.The baby was ofblood group AB,and CDe-D-genotype.Exchangetransfusion was begun 2.5 hours afterbirth.O,ccDEE washed red cells together with group AB plasma were used.Two dayslater,7Oml washed O,ccDEE concentrated red cells were administered.The baby is aliveand in good health.
文摘目的探讨新生儿溶血病(HDN)的类型、抗体分布与输(换)血治疗的血液配型方案及疗效的关系。方法收集本院新生儿科2016年1月—2019年12月共350例住院HDN临床资料,包括年龄、性别、体重、胎次,回顾性统计患儿的溶血类型、血型抗体分布与治疗转归,分析其中输(换)血病例的血液配型方案,并以输血前后患儿血红蛋白(Hb)的变化评估其输血效果,以换血前后患儿的胆红素(Bil)和血红蛋白(Hb)的变化评估其换血效果。结果本组新生儿溶血病例中,ABO-HDN占94%(329/350),换血率为0.91%(3/329);Rh-HDN占5.43%(19/350),换血率为42.1%(8/19);ABO+MNSs-HDN占0.29%(1/350);Rh+Kidd-HDN占0.29%(1/350)。按照推荐方案输(换)血,11名输血患儿的输血次数1—2(1.82±0.40)次、(47.55±6.86)mL/次、输血量40—10(86.4±21.09)mL,输血前后Hb(g/L)分别为85.00±21.66 vs 125.09±12.96(P<0.05);12名换血患儿的换血次数1—2(1.17±0.39)次、(516.59±123.64)mL/次、换血量300—1403(602.69±279.05)mL;换血前后TBil(μmol/L)分别为327.22±97.40 vs 206.26±62.92(P<0.05),IBil(μmol/L)分别为295.66±110.98 vs 187.99±62.61(P<0.05),DBil(μmol/L)分别为37.23±31.83 vs 18.24±12.46(P>0.05);Hb(g/L)分别为105.64±44.94 vs 143.00±22.09(P<0.05)。结论HDN虽然以ABO血型系统最多见,但输(换)血疗法主要应用于Rh HDN,换血后Bil降低、Hb提升效果更明显。
文摘目的探讨及早诊治新生儿RhD溶血病(RhD-HDN)换血术后合并毛细血管渗漏综合征(CLS)的意义。方法收集2名疑似RhD-HDN换血术后合并毛细血管渗漏综合征男性患儿(患儿1、2)的病历资料,检测母亲及患儿的ABO、Rh(D)血型及HDN相关试验,比较患儿换血的详细过程、换血前后的血红蛋白(Hb)、总胆红素(TBIL)值,换血后白蛋白(ALB)及活化部分凝血活酶时间(APTT)、体重变化值。评估RhD-HDN及CLS的诊断及治疗方法。结果患儿1、2母亲血型均为A Rh(-),患儿血型均为A RhD(+),均诊断为RhD-HDN,患儿1、2分别于出生后4 h及产时出现黄疸,遂均做换血治疗。患儿1:换血2次,第1次换血157 mL/kg,A型RhD(-)悬浮红细胞470 mL,同型血浆240 mL,换血时间3.5 h,第2次换血换血种类同第1次,悬浮红细胞462 ml,血浆231 ml,换血时间3 h 20 min。两次换血前后Hb(g/L)为113 vs 146(第1次)、106 vs 146(第2次),TBIL(μmol/L)为331.1 vs 245.1(第1次)、351.5 vs 258.7(第2次);患儿2换血1次,输入A型RhD(-)悬浮红细胞340 mL,AB型RhD(-)血浆180 mL,换血时间3 h。换血前后Hb(g/L)为77 vs 156,TBIL(μmol/L)为219.8 vs 175.1。2名患儿均在换血后出现CLS症状,患儿1诊断为RhD-HDN,新生儿贫血,CLS;患儿2诊断为RhD-HDN,新生儿贫血,类白血病反应,胎粪吸入综合征(MAS)及CLS;经针对原发病、限液、抗感染、利尿、小剂量糖皮质激素、抗微血栓等综合治疗后2名患儿痊愈出院。结论注重孕(妇)期特殊血型的检测、对是特殊血型且发生过抗原暴露的孕妇的抗体效价做动态监测和必要治疗,有助于其娩出的新生儿RhD-HDN的及时诊和预后,减少新生儿换血后发生CLS。
