REZUS_PROTOKOL
.pdf: |
|
: |
|
|
|
|
|
- |
! «" # . $. . %» |
||
. . ., |
% & % ' ( |
||
|
|
( ), |
|
. . _________ |
___________ *.$. + ', |
||
« |
» __________2013 . |
« |
» __________2013 . |
___________________________________________________________________________
« ,
. . »
! !
$ & RhD
& % % &
RhD- .
! "
#-# $
« $%& . . . »
01/2013
$ -! ' 2013
(:
1.% ) *. ., # )- , ( ' !
« $%& . . » 2.% +. ., . ( ' ! « $%& .. . »
3., .-., ,. .* ( " /, . . .
! ':
1.. ., . 0 " 1 !
« $%& . . . »
2.-.$, . ' " 1 ! « $%&. . . »
3.. ., # ! « $%& . . . »
I. 2 *$34 !-.-. 5
! ' 1 « ' |
( RhD |
( " 6 |
( RhD-0 » |
( # ( -# ,
( ', ) — 0 # !. II. .2 3 .7- $$7*%
/ ( ( 6/ :
–! ! 05.11.97 8 1387 «2 1
( ' 6 1
» ($' , 1997, 8 46, . 5312.).
–! ! 26.10.99 8 1194 «2 ! 1 ' ( # "
' ( ( / 6» ($' , 1999, 8 44, . 5322).
III. 2 9- !2*2:-. 5
! ' 1 « ' ( RhD
( " 6 ( RhD-0 » '
) 6/ 1 #:
– 2( ( # 1 # ' 1 , 1 'RhD- ( " 6 ( RhD-0 .
–1 ' (
–2 / ';, ( # ( /,
( ( 1 1
' ( # " ' ( ( / 6.
/ ( ( ) ' 1:
! & ' |
|
|
$ ' |
& |
% |
|
|
$# |
|
' |
||
|
1a |
1 |
1 |
|||
|
|
(() % |
||||
|
1b |
2 |
|
|
||
|
|
|
||||
|
|
|
||||
|
2a |
$# |
' |
1 |
||
|
|
|
|
|
||
|
|
|
|
|
||
|
2b |
2 |
||||
|
|
|
|
|
||
3a |
$# |
' |
|
|||
|
||||||
|
« #- » |
|
|
|||
|
|
|
|
|||
|
3b |
2 « #- » |
||||
|
|
|
|
|||
$ |
4 |
# |
|
|||
|
|
|
||||
|
|
(, ( ) |
||||
|
|
( |
# ' |
|||
D |
5 |
|
0, |
1 |
||
|
|
( ' «1 |
||||
|
|
( ( 1» |
|
|
|
|
A)< ': (
" 6.
B)2 ' : #
( , # ' ( ".
C)< # 1 : 6/ 1 #
, ' # 1
'.
D)< # 1 : # , # ' (
( .
E): 6 # '
, # ' 6#
.
III.-<-.- ! 232%2*
( ' 1 « ' ( RhD
( " 6 ( RhD-0 »/ ( ( «$ ,
» . . . »
2 9- 2! 2$7 $ # # ' " ' ( ( "
1609 , 1932 Diamond, Blackfan Baty ' #
0 # " 1, " # ,
( '. 1940 ( ) (Wiener, Landsteiner, Levine)
-0 ( 6 ( '
Rh(+) - .
1946 . H.Wallerstein ( 1 ( ". Beavis 1956 ( W.Liley 1961 ' (
( (, ( ( ( 1 "
' '. A.W.Liley 1963 . ( " ( 0 (
- #. ! # 6 (
, " ( ( ( ( #
( (, # # ", 1 ( .
270 1 , 0 6/ 1 26 (( . ! (( ( 6 # ' , 1
# ', #
# , ' ) 6/ '
" . (( # 6
.
$ ( RhD RhCE, RhD
' RhD- (D protein), RhCE , , C/c E/e-0.
' 6 5 , 0 6 28 (( .
14% ( ( ( ( RhD- , , ( . = « - ». < ' ( ( ( d- , 1 0 # ' ( 1
D-null. .' RhD-0,
( ' 6 Rh- , -, $, - 0. 3 " '1
# ' ((, 6/ 1% – Du. & (( '; 6 " ( D- (' , D weak)
( D- (# # , D partial).
% Rh-0, ' # ( # (, ( Kell, 1 1 " , (
) (. 2, #
# ' ( ( Kell " (, 1
( RhD, ( ' 1 1
(.
# '
# 6 ( ( ( 0 RhD-
-( ( ) 1969 . ! National Institute for Health and Clinical Exellence (') # 46/100 000 1969
1,6/100 000 1990. 3 ( 1 , ( " ,
( " ( |
( 0 ( RhD |
' |
( ( ( |
RhD- ' " / ( |
|
6' 1 1, ( " 6/ 1 ( RhD-0 . % ( ( 0 ( # ) (
( 0 3 ', 18-27% ( 1 ( ( ( 28 '.
2 " # ( ( ( #
# ' ( ", #, " 6
', # ' 6 " 1, , # "
1 # ' 6 (.
, " 6, ( ( ( ( 0
. ! ( ' ' 1
, " ' 1 ( RhD-0 /
' ) # (.
# ' %
! # # 6 -0 '
( . ! # ' 6 Ig M, ' 6
( 1 # ( '. ! ( ( ( ' ( 1 '
( Ig G, " ( ' ( ( ,
.
' ( 1 ( " ( # ( , '; ( " # ' 0,1-0,2 . & # ( # 0
' ( RhD ( # (. 2
'; ( # # '
Ig G, # '; '.
, ( # '1 ( (
50-75 , # – 0,1 .
RhD Ig G, ( # ( ', ' ' 6 ( 1
, 1 ) 6 0. ( ( 1 ,, , ( . ' 1
0 . ! 0 ' ( 6
20 / ( 6 , ( 0 70 / ( 6
'. . # ' (.
! ( ( (, # 6/ (
' " ' 6) (, ( ( ( "
. 2' #, # ( 0 ' 70 / '. 3 # 0 ( . ! (, #
) 0 ( # ( (,
, ) ' ( #
(. 2, ( " ' ' 6. ! ' ( " 0
63% # ' 6 " " 2 .
( ( ( 6, # ( , ( ) ( ( , ( " ( '
( ) 6 ' 0 0 6 .
. " 0 6 '
( 0 # .
6 # 6 ' (, (25-30%) " (20-25%)
(. ! ( ' ( ( 120 / ), ( – 70-120 / , ( " – " 70 / .
" ( 6 2
# , " ( , # ( (.
" 1, # # ' ) (
'1 (, ( 6 , # 1
( " ( « - ».
- '
1.% RhD .
! -RhD- ' ( (
1 , " (, # # "
" 6 # ' ( . "
" 0 # " ( 1 1:16- 1:32, '
1:512 ) ( ' (. %
( # ', (# " 1 " 2, 4 .
, ( (( " '
'. .' 6 ' 1 3
(IgG1 3), 6/ Fc-( 0 6/ 1
. IgG2 4 ' 6 , 1
' ( (( |
( 6 |
|||||
(. , ( |
|
( |
( , |
|||
. , |
|
|
|
( " |
|
# |
' G1 G3 |
(. 3 # 94 % |
|||||
# |
" # ' (. ! |
|
|
|||
' 74% # " # ' ( . % " 6, ( ' ' (
1 ' 1.
2 ' 6 " ( ,
" ' 1 (, ( ) 6 " .
2.( # ( ( 1 ( / 6 ( 0.
< ( # ( (( #
(, ( 0
" ( # . < " /
6 , / ' ( 1
( 1:16 ). $ , ' , , ( 0 /
( # #.
( # ( ( 1 ( ( 1 " # 1 . ! ( ) " ' '
# ( ( / 450 , ( ( ( ( # ' '. # γ-2! 450
" ( # ( 6 "
1 ( 1 . . ' ' (
( ( ( ( 6 " (
# " ( # #. 2,
.
-( 1, , ' , ( ) ( 1 (
( ). ( ' (
( 2 1%, # " #
. ! ( 1 2 ,
', , . !
( ( , . ,
# " 15,6%, # ' , # #
( .
-1, 6' ) " " (-
#, ( # . !
, 15% ( # . % , # '1 # ( ' , / 1 1 1 , '1
( (, ' 2- 3 ', ( 1 # 0 ( ( ( ( .
3.(
( ( #
': (-, (, # # ( 1 ,
/ 1 (, ) ( (,
( # # ( # # . .'
( 6 (- (, # 1 ( ' "94%. 2, " ,- , #, ( 1 ,14% 1 (, # ( # 1 ' 6
# .
, # " #
(: , - (, ( " . 2,
( 6 (, ) ( # 0
# ' ( # 6 00, # ( 1 ( 1 # 1 " " 1
# , ( ( (
# ' ( .
4.< (( #
. ' 00, ' ( )
, ' , (( # . !
( , ( 1 ( ( (
' " " 1 ( , ( # #). %,
# '; , " ' "
# . < ( #
(1 / , # , '/ ), ' ) 6 ( ( #
#
(, ( " 1995 Mari G.et al. = ???
' 6# # ' (
" '1 #, 1
( 1 #. & " ( #
' 6 # , ' ( ( .
-/ ( / (( # " # , # , " ' ( 0 ((
0), ( ( Kell, 1
, ( (, #, ' '
( 1 1 # #.
/ " 0
( ( ) ( ' ) 1
.
. ' & Rh(-)
% % % &
1.! ( ( # ( ' "
" ' ( (( -0. !
Rh-(-) ( " '1 ' '.
(( ( Rh-(+) 6 Rh-(-) ( ( Rh-(-) ( "
', ( -0 "
'1 ' #
' . ".
2. ! # -( " 0 |
', Rh-(-) |
( '1 ( #
-Rh- .
3.! -Rh- ( (
|
" 4 '. ! |
( |
' 28 ( |
( 0 # D-Ig (1 1500 -). ! )
" # 1
( ' # 6 , #
' ( ( . ! " # " ( -D-Ig '
-D-Ig, , (
.
4.D-Ig ( ( 6' , (
), ( ', ( " )
( #, ( 1 " ( (
( . % :
a) # # ' ). ! (
1 # 1 (1 ' (, ( ' (,
) / " ( # (
( 1/(, () ( ( " ( (Rh-(), # ( (( (, " 6/ 1
-D- ' . % ( RhD- ( " ( " 6 ( - RhD . !( " -0 ( " 6
-D- ' .
b) ( ( ' 12 , ( ' ) 1 # ( " (
c)( ' ( 12 , ( " 6/
. ! ( " 6/ # "
-D-Ig " 6 . < 12 #
-D-Ig . 2 " ' # # "
( 6/ #, ( " 6/ ' '.
d)" ( (
e)'
g) ' ' (
1 2-
500 -D-Ig.
$:
-( Rh-( " ", ( '
6 . % " ( '
– ( ', ' '.
- ! Rh-(-) ( " ( '1 -D-
' .
- ( Rh (+) ( " ( " ",
( , ( ( )
'1 -D ' .
$ :
! ( #
RhD- ) ( ( ( ( '1
-D ' .
. (, ( Rh(+) ( " ",
( 0 # -D ' # 72 # ). $ 1500 - ' ( # / ( 0- # ' 15 , # #
0 # ( 6/ 1 1. '; 0-
# ' 6 (:
-( )
- # (, # ' (
-" ' ' (
-( '
-(
,
!" #:
- $# # 1 D-Ig (1500 ) - # #, !" # – 2 $ $.
$ # ,
.
! ' ( D 0 (Du) 0 6 -D
' 6 -D '
# ( # 6 ( 0
# 3 ), ( -D
' ' . ( #
" 1 ( . )).
! D-Ig 6
( ' ( (, ' ,
( (, ( " .
RhD-
! ( - RhD- , ( 1
. . ( 8 50 12.05.85
# ( 1 2 ( 20 , 1
6 ( 36 . # 1 # 6 6 # # 6 # 1 4 ( 6'
'.