Rhesus immune globulin has resulted in a marked decrease in the prevalence of RhD alloimmunization in pregnancy; however, antibody formation to other red cell antigens continues to occur. Evaluation for the presence of anti-red cell antibodies should be routinely undertaken at the first prenatal visit. If anti-red cell antibodies are detected, consideration of a consultation or referral to a maternal-fetal medicine specialist with experience in the monitoring and treatment of these patients is warranted. Cell-free DNA can be used to determine fetal red cell antigen status to determine whether the pregnancy is at risk of complications from the red cell antibodies. First-time sensitized pregnancies are followed up with serial maternal titers, and, when indicated, serial Doppler assessment of the peak systolic velocity in the middle cerebral artery should be initiated by 16 weeks of gestation. When there is a history of an affected fetus or neonate, maternal titers are less predictive of fetal risk; if the fetus is antigen positive, serial peak systolic velocity in the middle cerebral artery measurements should be initiated by 15 weeks of gestation because intraperitoneal intrauterine blood transfusions can be used at this gestation if needed. The mainstay of fetal therapy involves intrauterine transfusion through ultrasound-directed puncture of the umbilical cord with the direct intravascular injection of red cells. A perinatal survival rate exceeding 95% can be expected at experienced centers. Neonatal phototherapy and "top-up" transfusions attributable to suppressed reticulocytosis often are still required for therapy after delivery.

中文翻译：

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妊娠期红细胞同种异体免疫的管理。


恒河猴免疫球蛋白导致妊娠期 RhD 同种异体免疫的患病率显着降低;然而，针对其他红细胞抗原的抗体形成继续发生。应在第一次产前检查时常规评估是否存在抗红细胞抗体。如果检测到抗红细胞抗体，则应考虑会诊或转诊给具有监测和治疗这些患者经验的母胎医学专家。游离 DNA 可用于确定胎儿红细胞抗原状态，以确定妊娠是否有红细胞抗体并发症的风险。首次致敏妊娠应通过连续母体滴度检测进行随访，如有指征，应在妊娠 16 周时开始对大脑中动脉的峰值收缩速度进行连续多普勒评估。当有受累胎儿或新生儿的病史时，母体滴度对胎儿风险的预测性较低;如果胎儿抗原阳性，应在妊娠 15 周时开始测量大脑中动脉的连续收缩期峰值速度，因为如果需要，可以在妊娠期使用腹膜内宫内输血。胎儿治疗的主要手段是通过超声引导下穿刺脐带进行宫内输血，并直接血管内注射红细胞。在经验丰富的中心，预计围产期存活率超过 95%。新生儿光疗和归因于抑制网织红细胞增多症的“补充”输血在分娩后通常仍需要治疗。