maternal blood group incompatibility hemolytic disease
Introduction
Introduction to maternal and child blood group incompatibility Maternal and child blood group incompatibility is a blood group immune disease caused by blood group incompatibility between pregnant women and fetuses, which can occur in the early stages of the fetus and newborn. When the dominant antigen inherited by the fetus from the father is missing from the mother, the antigen can enter the mother through pregnancy and childbirth, and stimulate the mother to produce immune antibodies. When the antibody passes through the placenta and enters the blood circulation of the fetus, it can make the red blood cells. Agglutination damage, causing immune hemolysis in the fetus or newborn, which has no effect on pregnant women, but the sick child may die due to severe anemia, heart failure, or death due to massive bilirubin infiltration into brain cells causing nuclear jaundice, even if surviving Its nerve cells and intellectual development as well as motor function will be affected. basic knowledge The proportion of illness: 0.050% Susceptible people: infants and young children Mode of infection: non-infectious Complications: disseminated intravascular coagulation heart failure respiratory failure jaundice
Cause
Maternal and child blood group incompatibility
Agglutination reaction (30%):
In the ABO blood group system, the pregnant women are mostly O-type, the father and the fetus are A, B or AB type, the fetal A, B antigen is the sensitizing source, and the Rh blood type has 6 antigens, respectively C, c, D , d, E, e, which is more antigenic than D, the highest hemolysis rate, so clinically tested with anti-D serum, when the mother or newborn red blood cells and known anti-D serum agglutination, it is Rh positive On the contrary, it is negative. Rh-negative pregnant women can even be sensitized by other antigens to produce antibodies, such as anti-E anti-C antibodies, etc., resulting in maternal and child blood group incompatibility.
Placental breakage (20%):
Fetal red blood cells can not pass through the placenta. Only when the placenta of the pregnancy or childbirth is damaged, the fetal red blood cells in the villus can enter the mother's body. According to the amount of entry, the number of sensitization affects the amount of antibody produced and finally causes the hemolysis of the baby. Wait.
Other factors (20%):
The blood group antibody is an immunoglobulin and has two types of IgG and IgM. IgG with a small molecular weight (7S-r globulin), an incomplete antibody (colloidal mediator antibody or an occlusive antibody), which can pass through the placenta, while IgM has a large molecular weight (19S-gamma globulin) and is a complete antibody (saline agglutinating antibody). Can not pass the placenta. It is IgG that Rh and ABO blood group antibodies can act through the placenta.
Prevention
Maternal and child blood group incompatibility prevention
1. Traditional Chinese medicine treatment: Oral Yinchen Decoction (Yinchen, Rhubarb, Astragalus, Licorice) daily until delivery, the dose is in accordance with the doctor's advice.
2. Comprehensive treatment for each day of the week of pregnancy, including daily intravenous injection of glucose and vitamins.
3. Oral administration of luminal two weeks before the expected date of birth, daily strengthening of the ability of fetal liver cell glucuronidase to bind bilirubin, reducing the occurrence of neonatal jaundice.
Complication
Maternal and child blood group incompatibility complications Complications, disseminated intravascular coagulation, heart failure, respiratory failure, jaundice
It can be complicated by pulmonary hemorrhage, disseminated intravascular coagulation, and respiratory and heart failure. Occasionally, bile sticky syndrome can occur.
Symptom
Maternal and child blood type incompatibility symptoms of hemolytic disease Common symptoms Maternal and child ABO blood group incompatibility edema abortion hepatosplenomegaly died of fetal jaundice
Mild patients have no special symptoms, severe hemolysis, fetal edema, abortion, premature delivery or even stillbirth, mainly after the delivery of anemia, edema, hepatosplenomegaly, jaundice and nuclear jaundice, the severity of the symptoms depends on the number of antibodies , neonatal maturity and compensatory hematopoietic capacity.
Examine
Checking the blood type of mother and child is not hemolytic disease
Mainly rely on laboratory specific antibody testing.
1. Pregnant women should routinely check the blood type before birth, such as O-type, and their husbands are A, B, AB type should be tested for specific antibodies, positive people suggest that they have been sensitized.
2.Rh blood group incompatibility antibody titer>1:32, ABO blood group incompatibility antibody titer>1: 512 indicates that the condition is serious.
3. Amniotic fluid examination is feasible when conditions are available. After 36 weeks of gestation, amniotic fluid bilirubin content >0.2mg% suggests that the fetus has hemolytic damage.
Diagnosis
Diagnosis and differential diagnosis of maternal and child blood group incompatibility
Mainly rely on laboratory specific antibody examination, any previous miscarriage, unexplained stillbirth, blood transfusion history or history of neonatal severe jaundice should exclude the possibility of maternal and child blood type.
1, fetal edema: caused by severe hemolysis, a few can cause stillbirth, surviving children can be systemic edema, pale skin, chest and abdomen effusion, and heart failure, such as increased heart rate, low heart blunt, difficulty breathing, etc. Often occurring in severe Rh hemolytic disease, ABO hemolysis occurs less.
2, Astragalus: more than 24 hours after birth, especially Rh hemolysis appeared early, more often within 6 to 12 hours after birth, 48 hours quickly increased.
