妊産婦の Type & Screen と新生児溶血性疾患

抄録

The number of pregnant women with anti-D antibodies have been recently decreased due to the routine administration of anti-D immunoglobulin soon after delivery. Screening test even in D-positive pregnant women have been generally tested. All obstetric patients who delivered in our hospital during the past ten years (from April, 1976 to March, 1986) were screened for unexpected antibodies. If an IgG antibody was detected in maternal serum, it was identified and titrated, as well the cord blood of her infant was examined for HDN. The incidence of unexpected antibodies was 2.01% (231 out of 11, 468), which was 8.43% in D-negatives and 1.92% in D-positives. Out of 231 unexpected antibodies there were 50 (21.6%) IgG, 174 (75.3%) IgM and 7 IgG-IgM antibodies. 88% of IgG antibodies could cause HDNs, and all IgG in addition to 35% of IgM antibodies could cause hemolytic transfusion reaction. Out of 41 (82%) IgG antibodies for Rh system, there were 24 anti-E, 14 anti-D and 3 other antibodies. Although the ratio of E-incompatible pregnancies was 32.5%, HDNs requiring exchange transfusion were more in cases with anti-D than those with anti-E. In D-positive pregnant women who received transfusion previously, unexpected antibodies were detected in 3.85%. E-incompatible transfusions were possibly more immunogenic and might cause more severe HDNs. It is recommended that E-incompatible transfusion in childbearing women should be withheld.