※ 引述《zimach (^____________^")》之銘言：
: p12倒數第四行
: prophylaxis[將anti-D IgG打入母體內....]
: []的解釋有些小錯誤(看不太懂@_@)，製作組討論之後竊以為應該改為:
: 將anti-D IgG打入母體內，迎接來自胎兒的D-antigen。
: 胎兒的D-antigen一進入母體內就被這些輸入的anti-D作用掉，
: 如此一來媽媽的免疫系統就不會被啟動，
: 也就不會有媽媽產生的anti-D進入胎兒體內造成的溶血了。
: 簡單的說就是把免疫反應的戰場從胎兒體內移到媽媽體內。
: 至於這些外界打入媽媽體內的IgG，因為打入的量很少，
: 所以即使進入胎兒體內，也不會造成太嚴重的反應。
: 不過呢，因為老師上課關於prophylaxis就只是念過而已，
: 以上的解釋是私下查詢+討論的結果，
: 所以如果有任何錯誤還請多多指正 ^^||
相關資料:
May, 1996
IMMUNE MEDIATED HEMOLYTIC DISEASE OF THE NEWBORN
Ileana Lopez-Plaza, M.D.
Assistant Medical Director of Transfusion Services
(前略)
Prevention
Gestational alloimmunization with anti-D in Rh negative mothers can be
prevented by the use of RhIg. The risk of alloimmunization has decreased from
17 % to 0.1% with RhIg prophylaxis. The immunosuppresive effect is believed to
result from an interference with antigen recognition during the induction phase
of the primary immunization. RhIg is a formulation prepared from the plasma of
humans sensitized with anti-D. Its preparation and processing makes it a viral
free blood derivative, similar to albumin.
Currently it is available as an intramuscular or intravenous preparation.
One vial contains 300 ug of anti-D which will protect against 30 mL of Rh
positive whole blood or 15 mL of Rh positive RBC. It is recommended that RhIg
be given at 28 weeks gestation and within 72 hours of delivery of an Rh
positive neonate. It is known that the majority of the alloimmunization occurs
after 28 weeks of gestation although the expression of the Rh antigen in the
fetus can be expressed as early as the 4th week of gestation. The amount of
fetomaternal hemorrhage (FMH, circulating fetal blood in the mother) is
estimated after delivery in order to provide an adequate RhIg dose. An initial
screening test, the rosette test, will detect a FMH > than 10 mL. If positive,
a quantitative test, the Kleihauer-Betke acid elution test is performed. The
amount of RhIg to be given is calculated based on the quantity of fetal RBC in
the maternal blood. It is estimated that 0.3% of FMH are greater than 10 mL.
RhIg is also recommended for any obstetrical intervention or maternal abdominal
trauma in the mother which could potentially cause FMH (i.e. abortion, amniocen
tesis, chorionic villi sampling, cordocentesis). For information regarding HDN
or RhIg, please contact Ileana Lopez-Plaza, M.D. at (412) 647-6217
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※ 編輯: Juipeter 來自: 140.112.212.222 (01/07 20:46)
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