Anti‐Kell in pregnancy

Abstract

Summary. A review of data on haemolytic disease of the newborn (HDN) collected in Newcastle upon Tyne over 25 years revealed 194 pregnancies in which anti‐Kell was the only antibody detected. Sixteen affected babies were born. None was hydropic, three had very severe disease but all survived. There were also three stillbirths, none of which had post‐mortem appearances of HDN. The highest recorded anti‐Kell titres in individual patients ranged from 1/1 to 1/2048 and bore no relation to the severity of the disease. Of the eight pregnancies in which amniotic fluid examination predicted a high risk of stillbirth, half resulted in unaffected babies. We suggest that haemolytic disease caused by anti‐Kell is less severe than suggested by some workers. The use of guidelines developed from the study of Rhesus disease to determine the need for intervention in women with anti‐Kell may be inappropriate.

Molecular Basis of Kell Blood Group Phenotypes

“…Hemolytic disease of the newborn (HDN) due to maternal antibody to KELl is infrequent but the in cidence of anti-KELl in obstetric patients is about 0.1% [50,51], Although there is some disagreement as to the severity of anti-KELl hemolytic disease [52], mainly due to the in ability of relating antibody titers [53] or amniotic bilirubin levels [54] to HDN, maternal antibodies to KELl along with anti-D and anti-c are a significant cause of HDN [52,53,[55][56][57][58]. Recent studies suggest that, unlike anti-D [59], fetal anemia caused by KELl antibodies may involve suppression of erythropoiesis rather than hemolysis [60][61][62].…”

Maternal red blood cell alloimmunization requiring intrauterine transfusion: a comparative study on management and outcome depending on the type of antibody

“…It is known to cause severe fetal anemia and some hemolytic diseases of the newborn . Unfavorable outcome is found in 1.5% to 3.9% of cases . Anti‐c seems to cause only a few fetal complications .…”

Inhibition of Erythroid Progenitor Cells by Anti-Kell Antibodies in Fetal Alloimmune Anemia

“…7,10 In addition, the concentrations of bilirubin in amniotic fluid and in fetal or neonatal serum are lower than those in anti-D alloimmunized fetuses. 7,9,11 Also, the titer of anti-Kell antibodies in maternal serum correlates very poorly with the degree of fetal anemia. 12 These observations suggest that in Kell alloimmunization fetal anemia is caused by the suppression of erythropoiesis in addition to hemolysis.…”