A NEW METHOD OF TREATMENT FOR INTRAUTERlNE FETAL HEMOLYTIC ANEMIA CAUSED BY BLOOD TYPE INCOMPATIBILITY
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概要
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MN血液型不適合のために過去4回妊娠29-36週にて子宮内胎児死亡を来した症例に対して新しく開発した母体血中抗体除去法を施行し生児をうることができたので報告する.本妊婦の血液型はO,NNss,CcDeeで夫はO,MMss,CcDEeであり,今回の妊娠18週における抗M抗体は×512に上昇したため再度の胎内死亡を防ぐために先ず抗体を含まない新鮮凍結血漿を用いてplasmapheresis(1回の交換量2,500ml)を6回実施したところ重症の輸血後肝炎を発症した.肝炎の急性期が過ぎた後抗体除去法を開始したが本法は成分採血装置により患者血漿を採取し,バッグ内で4℃,10分間,1/2.5量のMM血球と反応させ抗M抗体を吸着除去した後に血漿を再輸注するもので,血漿量3.0-7.0L/週の割合で妊娠23-32週にわたり計22回行った.これにより母体血中抗体の上昇は×512に留まり,羊水中ODD-450値はLiley graphのupper mid zoneの範囲を維持し,母体肝機能は正常化して児頭大横径の変化も標準的であったが,妊娠33週に入り胎動の減弱とNST上sinusoidal patternがみられ胎児切迫仮死の診断の下に緊急布切を行い1,960gの女児をApgar score 2で娩出,児は強度の貧血を呈したため交換輸血,血小板輸濫等を要したが生後の身体的知能的発育は正常である.本法の原理は他の抗体除去にも応用可能で,血液型不適合による胎児貧血の進行を抑え胎外生活が可能となるまで子宮内生存を延長させる方法として副作用も少なく有用であると考えられる.
- 社団法人日本産科婦人科学会の論文
- 1983-01-01
著者
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Yoshida Hisahiro
Department Of Drug Metabolism And Disposition Meiji Pharmaceutical University
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Yoshida Hisahiro
Department Of Gynecology And Obstetrics And Blood Transfusion Service Faculty Of Medicine. Kyoto Uni
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Aso Takeshi
Department Of Obstetrics And Gynecology Fukui Medical School
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Aso Takeshi
Department Of Comprehensive Reproductive Medicine Graduate School Tokyo Medical And Dental Universit
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Yoshida Yataro
Department Of Gynecology And Obstetrics And Blood Transfusion Service Faculty Of Medicine. Kyoto Uni
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TATSUMI Kenichi
Department of Gynecology, and Obstetrics and Blood Transfusion Service, Faculty of Medicine. Kyoto U
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Tatsumi Kenichi
Department Of Gynecology And Obstetrics And Blood Transfusion Service Faculty Of Medicine. Kyoto Uni
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麻生 武志
Department of Obstetrics and Gynecology, Fukui Medical School
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Tatsumi Kenichi
Department of Environmental and Agricultural Engineering, Tokyo University of Agriculture & Technology
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