日本未熟児新生児学会雑誌　第24巻第2号　79～84頁（2012年）

日本未熟児新生児学会雑誌　24(2)：291-296；2012　

受付日：平成23．09．07

受理日：平成24．01．23

胎児母体間輸血症候群により重症貧血と心不全を合併した低出生体重児の1例―胎児中大脳動脈の血流評価の有用性―

A Low Birth Weight Infant with Severe Anemia and Heart Failure Caused by Fetomaternal Hemorrhage. ―The Usefulness of Fetal Middle Cerebral Artery Doppler Assessment―

＊1松江赤十字病院　小児科，＊2島根大学医学部附属病院　輸血部，＊3島根大学医学部　小児科　新生児集中治療部

＊1Department of Pediatrics, Matsue Red Cross Hospital，＊2Division of Blood Transfusion, Shimane University Hospital，＊3Department of Pediatrics, Faculty of Medicine, Shimane University

柴田直昭＊1＊3・齋藤恭子＊1・竹谷　健＊2

Naoaki SHIBATA＊1＊3，Kyoko SAITO＊1，Takeshi TAKETANI＊2

Key Words：fetomaternal hemorrhage，massive FMH，severe anemia，fetal cerebral blood flow，MCA-PSV

　胎児母体間輸血症候群（fetomaternal hemorrhage；FMH）により重症貧血と心不全を合併した低出生体重児の1例を経験した。症例は在胎期間32週5日，出生体重2,140g，Apgar score 1点（1分値）/3点（5分値）で出生した男児。全身浮腫および肝腫大を認め，母体血HbFは5.3％と上昇し，重度の貧血（Hb3.4g/dL，Hct13.2％）と心不全徴候（心胸郭比の拡大，下大静脈径および右室径の拡大，三尖弁逆流，左室駆出率低下）を認めた。濃厚赤血球輸血とカテコールアミン，利尿薬により貧血，心不全は改善し，日齢54に神経学的後遺症なく退院した。胎児水腫および胎児貧血を認めた場合，母体血のHbFによりFMHを鑑別することが重要である。重症FMHはしばしば神経学的後遺症を合併するが，本症例では脳血流が維持（胎児中大脳動脈収縮期最大血流速度；53.6cm/秒，拡張末期血流速度；15.7cm/秒）されていたため，神経学的後遺症が認められなかった可能性が示唆された。

　A male infant was born by emergency cesarean section at 32 weeks and 5 days of gestational age, because of the abnormal fetal heart rate monitoring characterized with a sinusoidal heart rate pattern by non-stress test. His birth weight was 2,140g, and Apgar score was 1 at 1 minute and 3 at 5 minutes. His skin was very pale with the hemoglobin concentration of 3.4g/dL. Marked systemic edema was also noticed at birth. Echocardiographic examination demonstrated signs of heart failure as follows；left ventricular ejection fraction was 30%, inferior vena cava diameter was 7.7mm, and peak velocity of tricuspid valve regurgitation was more than 3.0m/second. The hemoglobin F（Hb F）value of the mother was increased markedly（5.3%）．Therefore, he was diagnosed as fetomaternal hemorrhage（FMH）with severe anemia and heart failure. His condition improved after administration red blood cells concentrates and cardiovascular agents. Finally, he discharged at the age of 54 days without neurological sequelae. Maternal detection of HbF is helpful in confirming the diagnosis of non-immune fetal hydrops and fetal anemia with FMH. Severe neurological disturbance are often complicated in infants with massive FMH. We emphasized that patients with massive FMH will be cure without any neurological sequelae, if cerebral blood flow of fetus might be preserved.