新生儿MNS系统溶血致重度贫血一例

A Case of Severe Anemia Caused by Neonatal Hemolysis of the MNS Blood Group System

摘要: 病史摘要：患儿女，汉族，4天，主因发现贫血3小时入院。患儿系第1胎第1产，胎龄38周4天足月儿，因其母羊水少行剖宫产分娩娩出，羊水性质清，量少，脐带、胎盘未诉异常，阿氏评分不详，出生体重2600 g。本院监测新生儿溶血病阴性，予多次输注悬浮红细胞后仍存在贫血，转上级医院后母婴血型抗体示MNS溶血。症状体征入院查体：生命体征平稳，精神反应欠佳，无发热，全身皮肤苍黄，未见瘀斑及出血点，巩膜无黄染，口唇欠红润，全身浅表淋巴结未触及，前囟平坦，张力不高，双肺呼吸音粗，可闻及痰鸣音，肝脾不大，脐带未脱，脐周无红肿，肢端暖。诊断方法：依据临床表现及实验室检查，诊断重度贫血、新生儿肺炎、卵圆孔未闭。诊疗经过：给予哌拉西林他唑巴坦抗感染、维生素K1预防出血、AB型Rh阳性悬浮红细胞输注、蛋白琥珀酸铁、维生素B₁₂、叶酸补充造血原料、丙种球蛋白免疫阻断治疗。临床转归：转上级医院后诊断明确MNS系统溶血病，给予丙种球蛋白阻断溶血、输入红细胞后患儿血红蛋白未再降低，目前患儿贫血已纠正，各系统随访符合月龄。

Abstract: Case Summary: A 4-day-old female Han infant was admitted to hospital due to anemia identified 3 hours prior to admission. She was the first child of a primipara, born at a gestational age of 38 weeks and 4 days via cesarean section for oligohydramnios. The amniotic fluid was clear but scanty, with no reported abnormalities of the umbilical cord or placenta. The Apgar score was not recorded. Her birth weight was 2600 g. Neonatal hemolytic disease screening conducted in our hospital yielded negative results. Despite multiple transfusions of packed red blood cells, the infant remained anemic. She was then transferred to a higher-level hospital, where maternal-neonatal blood group antibody testing confirmed MNS blood group system hemolysis. Signs and Symptoms on admission: The infant had stable vital signs but poor mental responsiveness, with no fever. Generalized sallow-yellow skin was observed, without petechiae or ecchymoses. No scleral icterus was noted, and the lips were poorly perfused. No palpable superficial lymph nodes were detected. The anterior fontanelle was flat with normal tension. Coarse breath sounds and rhonchi were auscultated in both lungs. The liver and spleen were not enlarged. The umbilical cord was still attached, with no periumbilical redness or swelling, and the extremities were warm. Diagnostic Methods: Based on clinical manifestations and laboratory tests, the diagnoses were severe anemia, neonatal pneumonia, and patent foramen ovale. Treatment Course: The infant was administered piperacillin-tazobactam for anti-infection, vitamin K₁ for bleeding prophylaxis, AB-type Rh-positive packed red blood cell transfusion, protein succinylated iron, vitamin B₁₂ and folic acid for hematopoietic support, and intravenous immunoglobulin (IVIG) for immune blocking therapy. Clinical Outcome: After transfer to the higher-level hospital, a definitive diagnosis of MNS blood group system hemolytic disease was established. With IVIG treatment to inhibit hemolysis and red blood cell transfusion, the infant’s hemoglobin level stabilized and no longer decreased. Currently, the infant’s anemia has been completely corrected, and follow-up evaluations of all organ systems show development consistent with her chronological age.