Anti-K1 (Kell) Antibody Expressed in Maternal Breastmilk: A Case Report of a Neonate with Multiple Intrauterine Transfusions and Postnatal Exposure to Kell Antibody in Maternal Breastmilk

Abstract

Hemolytic disease of the fetus and newborn is a common consideration in newborn medicine, especially among the jaundiced. Maternal breastmilk provides numerous benefits to the infant, including nutrition and immunologic factors. Here, we present an infant who received three intrauterine transfusions for anemia secondary to anti-K1 (Kell), anti-C, and anti-e antibodies and whose maternal breastmilk tested positive for anti-Kell antibodies. The infant required another transfusion at 4 weeks of life for anemia. We review the pathophysiology of anti-Kell antibodies, the immunology of breast milk, and the intersection of these two topics.

Identification of red blood cell antibodies in maternal breast milk implicated in prolonged hemolytic disease of the fetus and newborn

“…Here, we report a replicable methodology for testing for the presence of RBC antibodies in fresh maternal breast milk in infants with clinically significant, prolonged HDFN. Transmission of clinically significant amounts of maternal antiplatelet IgA antibodies via breast milk has previously been reported, with maternal RBC antibody transmission in humans only remaining a theoretical concept until two recent cases reports and now our case series.…”

“…One case reported an infant who required intrauterine transfusions (IUTs) for anti-K, anti-C, and anti-e; maternal breast milk demonstrated anti-K after the infant required RBC transfusion at 4 weeks, although methodology for testing maternal breast milk was not discussed. 12 A second case report described prolonged anti-D HDFN in an infant born to a highly sensitized mother. This infant had prolonged, persistent anemia and hyperbilirubinemia that recovered after cessation of breastfeeding.…”

“…Two recent case reports have also implicated breast milk as a source of pathologic RBC antibody exposure in infants with prolonged HDFN. One case reported an infant who required intrauterine transfusions (IUTs) for anti‐K, anti‐C, and anti‐e; maternal breast milk demonstrated anti‐K after the infant required RBC transfusion at 4 weeks, although methodology for testing maternal breast milk was not discussed . A second case report described prolonged anti‐D HDFN in an infant born to a highly sensitized mother.…”

More data needed to establish maternal breast milk IgG as cause for anti‐D hemolytic disease of fetus and newborn

“…In a large Swedish registry study, the use of AB universal donor plasma was associated with a 9% increase in mortality in Group O recipients who received five or more units of this component, which was previously considered safe. 2 In a similar but smaller surgical cohort, transfusion of so-called "compatible plasma" (probably all Group AB), the incidence of acute respiratory failure and sepsis was significantly greater with "compatible" plasma versus transfusions of ABOidentical plasma. 3 Multiple reports of adverse outcomes, including increased bleeding and increased organ failure, in both surgical and nonsurgical cohorts raise questions about the time-honored assumption that ABO nonidentical AB plasma is a safe transfusion choice.…”

Erythrozytäre Alloantikörper in der Muttermilch – Ursache einer prolongierten Anämie bei hämolytischer Krankheit des Neugeborenen?

“…So kann man z. B. in dem Fallbericht von DeMoss et al [4] mit dem Nachweis eines Anti-K-Antikörpers in der Muttermilch differenzialdiagnostisch die Frühgeburtlichkeit (35. SSW), 3 intrauterine Transfusionen und Anti-K-Antikörper als Ursachen einer prolongierten Anämie betrachten.…”