新生兒溶血症一病例報告

Hemolytic Disease of the Fetus and Newborn: A Case Report

范姜素貞(Su-Jane Fan-Chiang) ； 葉鴻武(Hung-Wu Yeh) ； 張鑑佑(Vincent Chang) ； 陳佑先(Yu-Hsieh Chen) ； 李坤美(Kun-Mei Lee) ； 李黛苹(Tai-Ping Lee)

《北市醫學雜誌》 9卷4期 (2012/12) Pp. 412-418

https://doi.org/10.6200/TCMJ.2012.9.4.11

摘要

新生兒溶血症Hemolytic disease of the Fetus and Newborn（HDFN）是新生兒病理性黃疸最常見之原因，在國人中又以Anti-E、Anti-c異體抗體造成HDFN最為常見，在西方人則以Rh系統血型中Rh（D）最重要。本案例為新生兒出生後第六天黃疸值仍偏高（16.0 mg/dl），檢測直接抗球蛋白試驗（Direct anti-globulin test; DAT）結果為陽性，抗體敏感化的嬰兒紅血球，經由沖出試驗（Elution test）抗體鑑定為anti-E+c，故請母親回院抽血檢測DAT結果為陰性，抗體篩檢試驗結果為陽性反應，抗體鑑定為anti-E+c，證實本案例由母體內anti-E+c抗體經由通過胎盤所導致新生兒溶血性疾病。主治醫師依據血庫提供母親及新生兒檢驗報告，第七天對新生兒立即進行第一次的換血（Exchange transfusion）治療，第十六天出院時黃疸值降為12.9 mg/dl；過了2天又因其黃疸情況嚴重再度入院，此時黃疸值為17.1mg/dl，主治醫師於第十九天進行第二次的換血治療，第二十一天出院時黃疸值已降為12.0 mg/dl。

關鍵字

新生兒溶血症 ； 黃疸 ； 直接抗球蛋白試驗 ； 沖出試驗 ； 換血治療

並列摘要

Hemolytic disease of the fetus and newborn, HDFN, is the most common cause of pathological jaundice in newborns; the major cause is ABO incompatibility followed by allogenic antibodies. In Taiwan, anti-E and anti-c are the most common allogenic antibodies causing HDFN, whereas in Western countries the most severe symptoms in newborns occur due to anti-D antibody related hemolysis. Herein we reported a newborn case that presented with high level of serum bilirubin at 6 days after delivery. The newborn tested positive for the direct anti-globulin test (DAT) and the bound antibodies were identified to be anti-E+c by the elution test. The mother tested negative for the DAT but was positive by antibody screening test. Anti- E+c antibodies were found by the identification test. The newborn received a first blood exchange transfusion on the 7th day after delivery and was discharged on the 16th day when the serum bilirubin level had decreased to 12.9 mg/dl and the newborn was in a stable condition. However, the newborn was readmitted for further medical treatment two days later after the serum bilirubin level had increased again to 17.1mg/dl. The newborn received a second blood exchange transfusion on the 19th day after delivery and the serum bilirubin level had decreased to 12.0 mg/dl two days later, at which point the newborn was discharge.

並列關鍵字

hemolytic disease of the fetus and newborn (HDFN) ； jaundice ； direct anti-globulin test (DAT) ； elution test ； exchange transfusion