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#1 09-12-2006 01:19:55

destivic
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Lieu: Nantes
Date d'inscription: 30-11-2006
Messages: 140
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Maladie hémolytique du nouveau-né

La maladie hémolytique du nouveau-né est due à la destruction des hématies de l'enfant par les anticorps présents chez la mère.


Mécanisme :

Les anticorps de la mère peuvent être naturels (anticorps du système ABO, ou certains autres systèmes, Lewis en particulier) ou immuns, c'est à dire résultant d'une immunisation.

Une femme s'immunise lors d'un accouchement à l'occasion duquel des hématies de l'enfant passent dans la circulation maternelle, ou à l'occasion d'une transfusion qui ne respecte pas son phénotype. Sang Rh Positif D, ou Kell Positif transfusé à une femme qui ne possède pas ces antigènes, D ou K.

Lors de la grossesse suivante, les anticorps de la mère passent le placenta et se fixent sur les hématies du fœtus si elles portent les antigènes correspondants. À chaque nouvelle naissance d'un enfant incompatible, les anticorps de la mère sont renforcés, et l'atteinte de l'enfant suivant est plus grave.

C'est pourquoi la recherches des anticorps irréguliers fait partie de la surveillance systématique des grossesses

A la naissance, l'incompatibilité est prouvée chez l'enfant par la détermination de ses groupes ABO, RH, Kell, et d'autres systèmes selon les anticorps maternels dépistés, un test positif à l'antiglobuline encore appelé test de Coombs direct, et, si besoin, une élution positive, cette dernière technique permettant de récupérer les anticorps de la mère qui se sont fixés sur les globules rouges de l'enfant. Enfin la numération formule sanguine (NFS) et le dosage de la bilirubine (libre et conjuguée) permettent d'apprécier le retentissement biologique de cette incompatibilité.


Source : encyclopédie wikipedia


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