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胎儿宫内输注红细胞

Author
Kenneth J Moise Jr, MD
Section Editors
Charles J Lockwood, MD, MHCM
Steven Kleinman, MD
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
刘建, 主任医师，教授

引言

胎儿输注红细胞(red blood cell, RBC)是最成功的宫内治疗操作之一。尽管未曾进行过随机试验，但观察性研究已明确表明宫内输血(intrauterine transfusion, IUT)可以提高严重贫血胎儿的生存率。普遍使用预防性Rh(D)免疫球蛋白已大幅减少IUT的需求，但IUT仍是治疗许多原因所致胎儿严重贫血的基本方式，这些原因包括非Rh(D)同种异体免疫、细小病毒B19感染、长期母胎输血和纯合子型α地中海贫血等。

患者选择

我们认为妊娠18-35周时伴有严重胎儿贫血的妊娠女性是IUT的最佳候选者。当胎儿大脑中动脉收缩期峰值流速(middle cerebral artery peak systolic velocity, MCA-PSV)大于1.50中位数倍数(multiples of the median, MoM)时，我们通过经皮脐血取样获取胎血以测定血细胞比容/血红蛋白，如果胎儿血红蛋白比胎龄相应平均值低2个标准差，则实施第一次IUT(表 1)。在这种血红蛋白水平中度下降时进行干预，其胎儿结局优于等到发生严重贫血(血红蛋白水平比胎龄相应正常平均值低7g/dL以上[1])或胎儿水肿时(实际血红蛋白水平<5g/dL)[2]。血细胞比容低于30%也能用作胎儿输血的阈值[3]。

该操作通常仅限用于妊娠18-35周的女性，因为妊娠18周前相关解剖结构较小造成了技术困难，而妊娠35周后进行IUT的风险被认为高于分娩后进行产后输血治疗[4]。

对于极早(≤18周)出现严重同种异体免疫的少见患者，血浆置换和静脉给予免疫球蛋白G可维持胎儿血细胞比容高于危及生命的水平，且维持时长足以达到IUT在技术上可行时的胎龄。病例报告和小型病例系列研究已报道多种治疗方案[5]。

血液制备

匿名供血 — 用于IUT的红细胞应接受与供者红细胞相同的检测。应与母体血进行交叉配血，以降低新红细胞抗原的致敏风险。 (参见“献血者筛查：实验室检查”)

                              

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Literature review current through: 2017-07 . | This topic last updated: 2017-04-11.
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