Current clinical management of anti-Kell alloimmunization in pregnancy

Exchange transfusions and top‐up transfusions in neonates with Kell haemolytic disease compared to Rh D haemolytic disease

“…In our study, we found no relation between lack of IUT and number of ETs or top‐up transfusions. Our findings are consistent with previous reports [6,8,16–18] and reflect the observation that haemolysis of mature (haemoglobinized) erythrocytes in Kell haemolytic disease is less than in Rh D haemolytic disease [3,4].…”

“…Santiago et al. [17] described three neonates with Kell HDN of whom only one required a top‐up transfusion.…”

IgG3 anti‐Kell allotypic variation results in differential antigen binding and phagocytosis

“…Thus, patients who are homozygous or compound heterozygous for these two IgG3 isoallotypes, which is likely to occur with ethnic origins in eastern Africa, may give false‐negative crossmatches, which may lead to incompatible transfusion, morbidity, and mortality. Moreover, there could be a failure to diagnose maternal alloantibodies that could lead to hemolytic disease of the fetus and newborn (HDFN) . However, these concerns rest on the assumption that IgG3‐03 and IgG3‐13 are clinically significant alloantibodies.…”

Provision ofKEL1‐negative blood to obstetric patients: a 3‐year single‐institution retrospective review

“…7,8 This has been explained by the differences in the suggested mechanisms of anti-Dand anti-K-related HDFN: while hemolysis is the predominant process in anti-D alloimmunization, anti-K cause fetal anemia primarily by suppression of erythropoiesis. [9][10][11] The etiology of anti-KEL1 identified during pregnancy is predominantly transfusion associated and not a consequence of immunization after transplacental hemorrhage from the fetus, 6 and while there is a wide range (30% to >50%) in the estimated percentage of maternal Kell alloimmunization cases attributed to transfusion, 8,[12][13][14][15][16] even the most conservative estimates suggest that a substantial fraction of maternal KEL1 alloimmunization can be prevented by the provision of KEL1 antigen-negative blood. Such policies have been adopted by several countries, excluding the United States, and have reduced the proportion of alloimmunized women with a history of transfusion.…”