ABO血型不合

2016-11-01 17:42 阅读: 编辑:sunyoung 来源:家有宝宝
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内容简介:ABO血型系统包括A、B、O及AB四型,其分类是根据红细胞膜上有无A、B血型抗原来分的,即红细胞膜上有A抗原的称为A型,有B抗原的称为B型,无A、B抗原的称为O型,有A、B抗原的称为AB型。
       在妊娠中约有20%~25%为ABO血型不合,但发生胎儿或新生儿溶血仅有2%~2.5%。其原因可能:①胎儿红细胞表面的抗原密度疏或抗原性弱,结合抗体少,不引起溶血;②母血清中抗A-IgG或抗B-IgG量少,不足以引起溶血;③胎儿体液中含有A和B血型物质,可与来自母亲的免疫性抗体结合,阻止抗体对红细胞的作用。

ABO血型不合


       【病因与发病机制】


       ABO血型的基因在第9对染色体上,按照遗传的分离定律及自由组合定律,胎儿的血型可与母亲的血型不同,当母儿之间血型不合时,可发生同种免疫,导致新生儿或胎儿溶血。ABO溶血病好发于O型母亲所生的A型婴儿,B型婴儿次之。这是因为O型母亲具有抗A-IgG或抗B-IgG的人数比A型及B型母亲明显为高,平均效价也较高,且A抗原比B抗原的抗原性强所致。此外,母亲为A型,新生儿为B型或AB型,母亲为B型,新生儿为A型或AB型者,亦可发病,其发病率较低。

       50%的ABO溶血病发生在第一胎,由于母亲孕前已受到自然界中广泛存在的类似A型或B型物质如寄生虫感染,细菌疫菌,破伤风或白喉抗毒素等的刺激,产生了抗A-IgG或抗B-IgG,当妊娠后,此抗体通过胎盘进入胎儿循环,引起溶血。

       诊断要点概述


       1.孕妇O型,丈夫为A型或B型者以及新生儿出生后很快或出生后24~36h内出现黄疸。

       2.产前检查母体血抗A-IgG或抗B?IgG效价>1∶64,提示胎儿可能发生ABO溶血病,当效价>1∶152时提示病情严重,结合病史应考虑终止妊娠。

       3.产妇与新生儿ABO血型不合;脐血血红蛋白<140g/L,胆红素>51μmol/L,网织红细胞及有核红细胞增多,出现球型红细胞;直接抗人体球蛋白试验阴性或弱阳性,多数患儿红细胞胆碱酯酶的活性降低。

       4.产后检查新生儿有无免疫性抗A-IgG或抗B-IgG:当实验室检查抗体释放试验、改良直接抗人体球蛋白试验及游离抗体测定试验等三项中任何一项结果阳性,即可确诊为ABO血型不合。

       临床表现


       ABO溶血病的病情一般比Rh溶血病为轻,黄疸多在出生后第2天至第3天才出现,第4天至第5天达到高峰,如不做血清学检查,轻型病例常易漏诊或误诊为生理性黄疸,有的仅在晚期出现贫血;少数重症亦可发生死胎、重度黄疸或胆红素脑病及重度贫血;肝脏轻度肿大。

       鉴别诊断


       本病应与新生儿其他溶血病鉴别,如Rh溶血病,特别要与新生儿遗传性球形细胞增多症进行鉴别,其临床表现两者相似,易于混淆,主要鉴别点为后者常有家族史,球形红细胞终身存在,红细胞胆碱酯酶活性正常。
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