The contemporary management of haemolytic disease of the fetus and newborn.

IF 1.8 4区医学 Q3 HEMATOLOGY

Vox Sanguinis Pub Date : 2025-04-22 DOI:10.1111/vox.70027

Mark D Kilby, James B Bussel, Kenneth J Moise

引用次数: 0

Abstract

Haemolytic disease of the fetus and newborn (HDFN) remains an important cause of perinatal mortality and morbidity. The pathogenesis underlying this condition is maternal red cell alloimmunization, with immunoglobulin G (IgG) antibodies produced in response to 'non-self', inherited paternal antigens expressed upon fetal erythrocytes. The IgG antibodies cross the placenta into the fetal circulation causing red cell destruction and fetal anaemia. Intrauterine transfusion (IUT) remains the cornerstone therapy with fetal survival rates up to 97%, but it is an invasive, technically challenging surgical procedure performed at specialized medical centres. The procedure-related risk of IUTs is increased at gestational age before 24 weeks. This has stimulated interest in maternal medical therapies that attenuate the risk of severe fetal anaemia, increase the gestational age of first IUTs, and reduce perinatal mortality and morbidity. This review summarizes current evidence for such treatments: intravenous immunoglobulin therapy and neonatal fragment crystallizable (Fc) receptor blockade for managing severe HDFN.

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胎儿和新生儿溶血病的当代管理。

胎儿和新生儿溶血病（hddn）仍然是围产期死亡率和发病率的重要原因。这种疾病的发病机制是母体红细胞异体免疫，免疫球蛋白G （IgG）抗体产生于对“非自体”的反应，在胎儿红细胞上表达遗传的父亲抗原。IgG抗体穿过胎盘进入胎儿循环，导致红细胞破坏和胎儿贫血。宫内输血（IUT）仍然是胎儿存活率高达97%的基础治疗，但它是一种侵入性的，技术上具有挑战性的外科手术，在专门的医疗中心进行。在24周以前的胎龄，宫内节育器的手术相关风险增加。这激发了人们对产妇医学疗法的兴趣，这些疗法可以降低严重胎儿贫血的风险，增加首次宫内节育器的胎龄，并降低围产期死亡率和发病率。这篇综述总结了目前治疗的证据：静脉注射免疫球蛋白治疗和新生儿碎片结晶（Fc）受体阻断治疗严重hdn。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vox Sanguinis 医学-血液学

CiteScore

4.40

自引率

11.10%

发文量

156

审稿时长

6-12 weeks

期刊介绍： Vox Sanguinis reports on important, novel developments in transfusion medicine. Original papers, reviews and international fora are published on all aspects of blood transfusion and tissue transplantation, comprising five main sections: 1) Transfusion - Transmitted Disease and its Prevention: Identification and epidemiology of infectious agents transmissible by blood; Bacterial contamination of blood components; Donor recruitment and selection methods; Pathogen inactivation. 2) Blood Component Collection and Production: Blood collection methods and devices (including apheresis); Plasma fractionation techniques and plasma derivatives; Preparation of labile blood components; Inventory management; Hematopoietic progenitor cell collection and storage; Collection and storage of tissues; Quality management and good manufacturing practice; Automation and information technology. 3) Transfusion Medicine and New Therapies: Transfusion thresholds and audits; Haemovigilance; Clinical trials regarding appropriate haemotherapy; Non-infectious adverse affects of transfusion; Therapeutic apheresis; Support of transplant patients; Gene therapy and immunotherapy. 4) Immunohaematology and Immunogenetics: Autoimmunity in haematology; Alloimmunity of blood; Pre-transfusion testing; Immunodiagnostics; Immunobiology; Complement in immunohaematology; Blood typing reagents; Genetic markers of blood cells and serum proteins: polymorphisms and function; Genetic markers and disease; Parentage testing and forensic immunohaematology. 5) Cellular Therapy: Cell-based therapies; Stem cell sources; Stem cell processing and storage; Stem cell products; Stem cell plasticity; Regenerative medicine with cells; Cellular immunotherapy; Molecular therapy; Gene therapy.