茵陈蒿汤联合西药治疗母儿ABO血型不合疗效分析

目的：评价中西药结合治疗对母儿ABO血型不合的疗效以及新生儿溶血发生与孕次关系的探讨。方法：对314例抗体滴度≥l：64的ABO母儿血型不合孕妇（20-45岁）进行研究,其中246例孕期给予以中西药结合治疗（茵陈蒿汤联合25%葡萄糖液、维生素C、维生素E、苯巴比妥）,68例作为对照,观察孕妇IgG抗A/B抗体效价变化及新生儿溶血发生情况。结果：治疗组抗体效价降低与对照组相比,差异有统计学意义（P〈0.05）,治疗组新生儿溶血发生率与对照组相比,差异有统计学意义（P〈0.05）。孕次越大,新生儿溶血的发生率越高。结论：中西药结合治疗对降低孕妇IgG抗A/B效价及防治新生儿溶血疗效满意,新生儿溶血发生可能与孕次呈正相关。     

新生溶血病患儿红细胞上致敏抗体对Rh 血型检测的影响

目的:探讨新生溶血病患儿红细胞致敏抗体对其Rh血型鉴定的影响。方法:采用抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)五种方法对近三年来我院收集的163例新生溶血病患儿红细胞进行Rh血型检测,对五种检测结果不一致的患儿红细胞进行0.2 M 2-巯基乙醇抗体放散,比较放散后五种方法检测结果并验证其准确性。结果:29例直接抗体试验阳性患儿的五种Rh血型检测结果不一致,经0.2 M 2-巯基乙醇抗体放散后检测结果均一致。Rh血型准确性验证表明,红细胞放散测定的Rh血型完全符合临床现象。结论:患儿红细胞的致敏抗体达一定数量后,会影响抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)对Rh血型鉴定,0.2M 2-巯基乙醇抗体放散法是一种正确鉴定新生儿Rh血型的简单可行的方法。     

The RHD variants in Chinese population

The Rhesus (Rh) blood group system is the most important blood group system in hemolytic disease of the fetus and newborn (HDFN). In clinical transfusions, the D antigen in the Rh blood group system comes third, behind antigens A and B which from ABO blood group system. Over the past decade, molecular technologies have been used to investigate the RHD allele in different ethnic groups. This review first introduces the basic structure of RhD protein and coding genes, then focuses on D-negative, weak D, partial D, DEL, RhD_null variants reported in the Chinese population. To date, more than 460 RHD variants have been reported around the world, but less than 70 RHD variants have been reported in the Chinese population. Further research is needed to identify more RHD polymorphism and establish criteria for blood detection and transfusion guidelines for RHD variants. Only in this way can we better guarantee the safety of blood transfusion and prevent the occurrence of HDFN. With the accumulation of research and clinical data, we should be clearer which RHD variants are to be regarded as RhD negative and which need to be regarded as RhD positive.     

Immunogenetic studies of maternal-fetal relationships: a review: why newborn rhesus monkeys don't get hemolytic disease

The discovery of the Rh blood group factor in humans was made using the red blood cells of rhesus monkeys. Because of its importance to human medicine and immunogenetics, this finding contributed greatly to the appreciation of the importance of nonhuman primates in research. It is now widely recognized that blood group incompatibility between mother and fetus can lead to differential fertility, fetal death, and hemolytic disease of the newborn (HDN).The blood group systems of several nonhuman primate species have been studied in detail and found to be analogous, although not identical, to those of humans. It is therefore surprising that HDN has been reported in only four nonhuman primate species-marmosets, sacred baboons, chimpanzees, and orangutans. Maternal-fetal blood group incompatibility and its consequences have been extensively studied in rhesus monkeys, and these macaques may well be representative of many nonhuman primates. Rhesus monkeys exhibit all five of the conditions that lead to HDN in humans: (1) blood group incompatible matings: (2) transplacental hemorrhage: (3) maternal immunization to blood group alloantigens on fetal erythrocytes: (4) transplacental transfer of maternal antibodies; and (5) coating of the newborn's erythrocytes. Yet, newborns show no clinical or hematological evidence of HDN.We have shown that the rhesus alloantibodies engendered by transplacental immunization do not mediate immune elimination of the newborn's erythrocytes. Evaluation of the maternal antibodies demonstrated that they have low titers and low avidities and perhaps belong to IgG subclasses that do not bind effectively to receptors on phagocytic cells of the rhesus reticuloendothelial system. The newborn's genotype may also affect the expression of allogeneic blood group antigens and thereby help protect the newborn's cells from destruction. These factors together undoubtedly play a major role in the survival of the antibody-coated newborn's RBC and are thus able to account for the absence of HDN in this species.     

Blood transfusion and lung surgeries in pediatric age group: a single center retrospective study

Incompatibility of blood groups or unexpected antibodies are primary considerations when acute hemolysis occurs during or after transfusion. However, less attention is paid to drug-induced immune hemolytic anemia (DIIHA), which is a rare but potentially life-threatening autoimmune disease. We present the case of a 34-year-old woman (group A, RhD+) who was treated with multiple antibiotics after meningioma resection. As her hemoglobin (Hb) decreased significantly from 109 g/L to 52 g/L without obvious bleeding, a blood transfusion was conducted soon after the medication, during which acute hemolysis occurred. An unexpected antibody, anti-M (MNS blood group system), was identified in the patient. It was confirmed that both the recipient and donor were group A, M antigen negative (M−) with CCDee phenotype, and no agglutination reactivity was observed in major crossmatch by testing the specimens before and after transfusion. Meanwhile, the results of the direct antiglobulin test (DAT) changed from negative to positive. Anti-meropenem, a drug-dependent antibody of meropenem, was detected, and hemolysis resolved after cessation. Anti-meropenem may mainly act through an \     

AB0 blood group incompatibility and inbreeding effects: Evidence for an interaction

Summary It is known that consanguinity reduces the chances of maternal-foetal incompatibility but it is not known whether inbreeding influences the expression of the effects of such incompatibility. This paper investigates and finds evidence for an interaction between inbreeding and AB0 blood group incompatibility on the expression of neonatal mortality, sibship precocious mortality, neonatal jaundice, asphyxia, and sex ratio, through screening of 3923 consecutive newborns. Inbreeding and incompatibility individually showed variable effects on the above parameters, but their interaction was such that, in the presence of inbreeding, incompatibility reduced the incidence/relative risk of all the above factors. Such a uniform negative interaction was presumed to be due to homozygosity of some pleiotropic genes caused by inbreeding.     

Deficiencia visual y neurológica posterior a la disfunción del sistema de derivación ventrículo-peritoneal: reporte de caso

Neurological visual impairments in children have multiple causes, some of them reversible while others are not. Hydrocephalus is one of the most important and common ones as it can result in permanent impairment. There are multiple causes of hydrocephalus, intraventricular hemorrhage being the main one. This generally occurs when the germinal matrix bleeds and is very common in preterm newborns.We present the clinical case of a patient with cerebral palsy, intraventricular hemorrhage, and hydrocephalus as a result of a preterm multiple pregnancy who developed optic atrophy during childhood secondary to ventricle-peritoneal shunt dysfunction. During the rehabilitation and treatment period, she received neurorehabilitation sessions, which improved her visual acuity and capacity. We found similarities and differences with other cases and we confirmed the importance of the treatment chosen for the recovery of visual capacity.     

Hemolytic Transfusion Reactions

After receiving apparently compatible blood three patients suffered hemolytic reactions. The compatibility tests were by saline and indirect Coombs technique including a screening tube of group 0 cells. The antibodies responsible for these reactions were not clearly demonstrable for several days following the transfusion. In two instances the antibody was anti-E.These case reports point up the following. (a) Currently used cross-matching procedures will occasionally fail to demonstrate an incompatibility. (b) In two of the cases the direct Coombs test was negative on an immediate post-transfusion specimen, when it could have been of great aid in diagnosis. (c) When a transfusion reaction of hemolytic type is suspected, a follow-up study several days after the reaction may clarify the diagnosis; when possible, transfusions should be avoided in the interim.     

The Rhesus site

The Rhesus (Rh) blood group system is the most important blood group system in hemolytic disease of the fetus and newborn (HDFN). In clinical transfusions, the D antigen in the Rh blood group system comes third, behind antigens A and B which from ABO blood group system. Over the past decade, molecular technologies have been used to investigate the RHD allele in different ethnic groups. This review first introduces the basic structure of RhD protein and coding genes, then focuses on D-negative, weak D, partial D, DEL, RhD_null variants reported in the Chinese population. To date, more than 460 RHD variants have been reported around the world, but less than 70 RHD variants have been reported in the Chinese population. Further research is needed to identify more RHD polymorphism and establish criteria for blood detection and transfusion guidelines for RHD variants. Only in this way can we better guarantee the safety of blood transfusion and prevent the occurrence of HDFN. With the accumulation of research and clinical data, we should be clearer which RHD variants are to be regarded as RhD negative and which need to be regarded as RhD positive.     

Incidence of unexpected red blood cell antibodies in the north of China

This study aimed to investigate the frequency of unexpected antibodies and evaluate the cumulative incidence of additional unexpected antibodies in Beijing. From January 1, 2011 to December 31, 2014, blood samples from 2,095 patients from 98 medical institutes in Beijing were sent to the Beijing Red Cross Blood Center for antibody identification. Of the unexpected antibodies, 29.5% were autoantibodies and 70.5% were alloantibodies. Anti-E was the most prevalent form of allo-antibodies (n = 445), accounting for 52.9% of the Rh system, followed by anti-M (76.6% of the MNS system) and then 142 cases of anti-C,e, 128 cases of anti-E,c, and 113 cases of anti-Lea. The cumulative incidences of additional antibodies were 0.55% (after the first transfusion), 1.82% (second time), 2.33% (fourth time), 3.07% (firth time), and 4.24% (seventh time). Antibody against the Rh system was the most prevalent, followed by antibodies against MNS, Lewis, Kidd, P1, and Duffy.     

Immunogenetic studies of rhesus monkeys

To assay for transplacental immunization in rhesus monkeys, sera from 253 postpartum females, 31 virgin females, and 40 males were tested for erythrocyte agglutinins. Nineteen percent of the mothers exhibited antibodies, but less than three percent of the virgin females or males did so. Antibodies were detected in 26 percent of the mothers who bore blood group-incompatible infants, in contrast to only eight percent of the mothers with compatible offspring. Thus, blood group incompatibility may lead to transplacental alloimmunization of the rhesus female. Unlike the situation in humans, hemolytic disease was not observed, even when the erythrocytes of the newborn rhesus were coated with maternal antibodies.     

The glycosphingolipid composition of the placenta of a blood group P fetus delivered by a blood group Pk1 woman and analysis of the anti-globoside antibodies found in maternal serum

To further define the molecules that may mediate spontaneous abortion due to maternal-fetal blood group incompatibility within the P blood group system, we have examined the fine specificities of maternal antibodies and the glycolipid antigens from the placenta of a P infant born to a Pk1 mother. Maternal antibodies obtained during therapeutic plasmapheresis were analyzed to determine their reactivities with placental glycolipid extracts on thin-layer plates. Second antibodies specific for IgM, IgG, and IgA revealed immunoglobulins of all of these classes strongly reactive with one major placental glycolipid that comigrates with globoside. GC/MS analysis confirmed that the major P-active pentaglycosylceramide of placenta has the same structure as that previously shown for the P antigen of red blood cells: GalNAc beta 1-3Gal alpha 1-4Gal beta 1-4Glc-Cer. Serum antibodies partially purified by affinity chromatography on globoside-octyl-Sepharose specifically recognize glycolipids that contain terminal GalNAc beta 1-3Gal . . . residues and also recognize the same sequence as an internal determinant in some, but not all, glycolipids with extended globoside core regions. Thus, in the blood group P incompatible fetus, the major P antigen present in placenta has the same carbohydrate structure as the P antigen present in fetal and adult erythrocytes and might be a target for the maternal immune system.     

Diabetic pregnancy: evidence of selection on the Rh blood group system.

The blood glucose levels of pregnant women with insulin-dependent diabetes mellitus and the blood glucose levels of newborns during the first few hours of life show an association with maternal Rh genotype. Distortions of joint maternal-fetal Rh phenotype distribution have also been observed. Because a cluster of genes involved in glycide metabolism is located on the short arm of chromosome 1, the present observations may reflect the action of these genes.     

自身抗体引起的ABO血型正反定型结果不一致

目的:对因自身抗体引起ABO血型正反定型结果不一致的疑难血标本进行血型鉴定和分析,探讨其原因和解决办法。方法:先用直接抗人球蛋白试验(DAT)和间接抗人球蛋白试验(IAT)确定ABO血型正反定型结果不一致的原因是由于自身抗体的存在,然后做吸收放散试验、抗体筛选试验等排除自身抗体的干扰以便血型的正确判定。结果:ABO血型正反定型结果不一致因自身抗体引起的有10例,其中温抗体7例,冷抗体3例,温抗体同时同种抗体阳性2例,冷抗体同时同种抗体阳性2例。结论:自身抗体会影响ABO血型的正确判定,选用合适的试验进行分析判断以提高血型鉴定的准确性。     

Análisis del impacto presupuestal en Colombia de la prueba de HPV con genotipificación comparada con la citología

Introduction:

The detection of the human papillomavirus (HPV) through the combination of the HPV test and other techniques such as cytology has impacted the detection and timely treatment of lesions associated with cervical cancer.

Objective:

To estimate the budgetary impact of the strategy of early detection of HPV with DNA test genotyping with reflex cytology versus conventional cytology in women aged 30 to 65 years attending the cervical cancer screening program at a health benefit managing entity in Colombia.

Materials and methods:

Using a decision tree and a Markov model, the clinical implications and direct costs of screening, diagnosis, and treatment were estimated in a cohort of women. The analysis considered two screening cycles and their annual costs. The data on the prevalence of clinical results and the costs were taken from the health managing entity. The information on the progression, persistence, and regression of the health states were taken from the ATHENA study.

Results:

The screening scheme with the HPV test, genotyping, and reflex cytology compared to conventional cytology was cost-saving. The average cost per screening cycle with the HPV test was estimated at COP $ 129,201,363 and with cytology at COP $ 186,309,952, i.e., a saving of COP $ 57,108,589 (30.7%).

Conclusion:

The implementation of the screening strategy under evaluation suggests prospective savings derived from the early detection of health states associated with the development of cervical cancer.     

DIAGNOSIS OF THE HEMOLYTIC ANEMIAS

Classification of the varieties of hemolytic anemia is based upon whether hemolysis is due to inherent defects within the erythrocyte or to extracellular factors.Confirmation of diagnosis in cases in which the disease is clinically suspected is made upon the basis of the following laboratory data: Hyperbilirubinemia giving an indirect van den Bergh reaction, observation of typical factors in a smear of the blood, a reactive bone marrow, increased urobilinogen in stools and urine, and absence of bilirubinuria.Differentiation of the different types depends upon determination of altered fragility of erythrocytes as indicated by tests of resistance to heat, acid, and mechanical and osmotic stimuli, and upon the identification of an antibody.The importance of detecting antibodies demonstrable in acid serum is mentioned.In a majority of cases, acquired hemolytic anemia is caused by antibodies, malignant disease, or toxic agents.     

Drug treatment of malaria infections can reduce levels of protection transferred to offspring via maternal immunity

Maternally transferred immunity can have a fundamental effect on the ability of offspring to deal with infection. However, levels of antibodies in adults can vary both quantitatively and qualitatively between individuals and during the course of infection. How infection dynamics and their modification by drug treatment might affect the protection transferred to offspring remains poorly understood. Using the rodent malaria parasite Plasmodium chabaudi, we demonstrate that curing dams part way through infection prior to pregnancy can alter their immune response, with major consequences for offspring health and survival. In untreated maternal infections, maternally transferred protection suppressed parasitaemia and reduced pup mortality by 75 per cent compared with pups from naïve dams. However, when dams were treated with anti-malarial drugs, pups received fewer maternal antibodies, parasitaemia was only marginally suppressed, and mortality risk was 25 per cent higher than for pups from dams with full infections. We observed the same qualitative patterns across three different host strains and two parasite genotypes. This study reveals the role that within-host infection dynamics play in the fitness consequences of maternally transferred immunity. Furthermore, it highlights a potential trade-off between the health of mothers and offspring suggesting that anti-parasite treatment may significantly affect the outcome of infection in newborns.     

新生儿ABO 溶血病相关危险因素的临床分析

目的:分析新生儿ABO溶血病的临床相关危险因素,提高对新生儿ABO溶血病的防治水平。方法:选择ABO血型不合的孕妇433例,根据以上产妇产前IgG抗A(B)效价、产妇妊娠次数和产妇年龄分别分组,分析各组产妇间发生新生儿溶血病(HDN)的差异及临床相关性。结果:产妇产前IgG抗A(B)效价、产妇妊娠次数和产妇年龄均与HDN发生率呈正相关性(P<0.05);IgG抗A(B)效价>256时,HDN发生率将显著提高(P<0.01);产妇妊娠次数和年龄增加后,HDN发生率将显著增加(P<0.01)。结论:夫妻血型不合的产妇进行产前保健时,应进行IgG抗A(B)效价检查,当IgG抗A(B)效价>64或IgG抗A(B)效价进行性增加时,应及早做好HDN的干预措施;通过减少意外妊娠及高龄产妇数量,可减少HDN的发生。