The outcome of pregnancy in Kell alloimmunisation

Abstract

Objective To assess management and outcome of pregnancies with anti-Kell in the West Midlands in Design A retrospective review of casenotes.Setting A regional referral clinic for red cell alloimmune disease and fetal medicine unit at a university hospital.Population Sixty-five pregnancies were identified in 52 Kell-sensitised women with Kell positive partners from the records of the Birmingham Blood Transfusion Centre.Methods Information from the casenotes was entered on a database and comparisons were made using the SPSS for Windows statistics package. Main outcome measuresMode of sensitisation, degree of fetal or neonatal anaemia, need for transfusion, gestation at delivery, birthweight and pregnancy outcome.Results Alloimmunisation was transfusion-related in 29 pregnancies and pregnancy-induced in 33. The cause could not be identified in three cases. There were 22 proven Kell positive fetuses, of which 18 were affected, in which alloimmunisation was pregnancy-related in 12 cases and transfusion-related in five. Antibody titres and amniotic fluid OD,,, were not helpful in management. Severe or very severe disease occurred in 50% of the affected pregnancies (9/18). There was no difference in pregnancy outcome between transfusion or pregnancy induced sensitisation.Conclusions Anti-Kell alloimmunisation is an uncommon cause of serious anaemia in a significant proportion of affected pregnancies. There appears to be no difference between that caused by pregnancy or transfusion. Estimation of fetal haemoglobin concentration by cordocentesis is recommended, as antibody titres and amniocentesis are not helpful.the UK over 13 years.

Intravenous Fetal Exchange Transfusion before 22 Weeks of Gestation in Early and Severe Red-Cell Fetomaternal Alloimmunization

“…Amniocentesis has been proposed and the ¢OD 450 plotted on the Queenan curve [17] predicted fetuses severely affected during the second trimester with a sensitivity of 100% and a specificity of 79.4% [18]. However, in Kell alloimmunization, the ¢OD 450 does not correlate with fetal anemia [4,5].…”

“…Anti-c, Kell, and Fy a may cause severe fetal anemia [3]. Kell alloimmunization deserves a special mention and still carries a high perinatal mortality rate [4,5]. The proportion of fetuses at risk of hemolytic disease due to other alloimmune antibodies has been estimated to be 5/10,000 live births in France.…”

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

“…Nevertheless, the diagnostic value of antibody titers remains questionable. The correlation between antibody titer and the degree of severity of anemia is more superior in anti-D than in anti-K [35,61]. As mentioned above, the later antibody may cause severe HDFN, even at low titers.…”

“…In a population study from the Netherlands, Koelewijn et al [1] found 26% of K-positive fetuses from mothers with anti-K suffered from severe HDFN, with 4 of 5 children requiring in utero intervention. In a study from the UK, severe or very severe disease occurred in 50% of the affected pregnancies [35]. Based on these facts, the presence of a markedly high antibody titer and a K homozygous partner, the fetus (case 3) was considered to be at high risk of HDFN, which might be minimized or prevented by IVIG therapy.…”

Manejo de la embarazada con isoinmunización por anticuerpos irregulares

“…Existen diversas series de casos de pacientes con isoinmunización anti-kell que muestran resultados con enfermedad de leve a muy severa, incluyendo óbito fetal y muerte perinatal (22)(23)(24)(25)(26)(27). En relación a los títulos de anticuerpos, debemos destacar que la presencia de EHP no se relaciona con los títulos de anticuerpos (24)(25)(26)(27). Cellano (k; K2).…”