新生儿MN血型不合溶血病致极重度贫血误诊分析并文献回顾OA
Misdiagnosis of extremely severe anemia caused by MN blood group incompatibility hemolytic disease of the newborn and literature review
目的 探讨新生儿MN血型不合溶血病所致极重度贫血的临床特点、误诊原因及预防策略.方法 回顾性分析2022年7月成都市金牛区妇幼保健院收治1例以极重度贫血为首发表现的新生儿MN血型不合溶血病误诊患儿的临床资料.结果 患儿因出生后立即出现严重皮肤苍白和呼吸困难入院,初诊为"新生儿极重度贫血",但未明确病因.实验室检查提示血红蛋白41 g/L,网织红细胞比值0.116,间接胆红素占总胆红素的83.3%,血浆游离血红蛋白386 mg/L,结合珠蛋白低于可检测范围,符合急性血管内溶血表现.初步排除ABO和Rh血型不合溶血病后,进一步行血型血清学检查显示,患儿MN血型为M(+)N(+),母亲MN血型为NN型M(-)N(+),抗M抗体阳性(效价1∶16),确诊为MN血型不合溶血病.误诊时间为40 h.确诊后,给予输注M抗原阴性红细胞悬液后贫血迅速纠正,同时联合蓝光光疗、免疫球蛋白、有创呼吸机辅助呼吸等综合治疗,患儿恢复良好,住院14 d后顺利出院.随访2个月,患儿血清总胆红素正常,生命体征平稳,生长发育与同龄儿相仿.结论 新生儿MN血型不合溶血病虽罕见,但可致极重度贫血,临床表现缺乏特异性,易被误诊.对于排除常见溶血病后仍存在严重贫血的患儿,应尽早行母婴MN血型及抗M抗体检测,避免误诊误治.
Objective To investigate the clinical characteristics,misdiagnosis causes and prevention strategies of extremely severe anemia caused by MN blood group incompatibility hemolytic disease of the newborn.Methods The clinical data of 1 neonate with extremely severe anemia as the initial manifestation,who was misdiagnosed as MN blood group incompatibility hemolytic disease and admitted to Maternal and Child Health Hospital of Jinniu District,Chengdu City,in July 2022,were retrospectively analyzed.Results The neonate was admitted to the hospital due to severe skin pallor and dyspnea immediately after birth,and was initially diagnosed as extremely severe anemia of the newborn;however,the underlying etiology remained unclear.Laboratory tests revealed a hemoglobin level of 41 g/L,a reticulocyte ratio of 0.116,indirect bilirubin accounting for 83.3%of total bilirubin,a plasma free hemoglobin of 386 mg/L,and a haptoglobin below the detectable range,which was consistent with the manifestation of acute intravascular hemolysis.After initially excluding ABO and Rh blood group incompatibility hemolytic diseases,further blood group serological testing showed that the neonate's MN blood group was M(+)N(+),while the mother's MN blood group was NN type M(-)N(+)with a positive anti-M antibody(titer 1∶16).Therefore,a diagnosis of MN blood group incompatibility hemolytic disease was confirmed.The misdiagnosis lasted 40 h.After confirmation,the anemia was quickly corrected by transfusion of M antigen-negative red blood cell suspension,and combined with comprehensive treatments such as blue light phototherapy,immunoglobulin and invasive ventilator-assisted ventilation,the neonate recovered well and was discharged smoothly after 14 days of hospitalization.During 2 months of follow-up,the neonate's serum total bilirubin was normal,vital signs were stable,and growth and development were comparable to those of peers.Conclusion Although MN blood group incompatibility hemolytic disease of the newborn is rare,it can cause extremely severe anemia,with non-specific clinical manifestations,which is prone to misdiagnosis.For neonates with severe anemia after excluding common hemolytic diseases,maternal and neonatal MN blood group and anti-M antibody detection should be performed as early as possible to avoid misdiagnosis and mistreatment.
谈丽菊;娄小燕;吴迪;何柳
成都市金牛区妇幼保健院新生儿科,成都 610000成都市金牛区妇幼保健院新生儿科,成都 610000成都市金牛区妇幼保健院新生儿科,成都 610000成都市金牛区妇幼保健院新生儿科,成都 610000
新生儿溶血病MN血型不合误诊极重度贫血抗M抗体
hemolytic disease of the newbornMN blood group incompatibilitymisdiagnosisextremely severe anemiaanti-M antibody
《临床误诊误治》 2026 (11)
19-24,6
四川省妇幼医学科技创新课题重点项目(2020ZD07)成都市医学科研课题立项项目(2020173)
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