What is it about?
The frequency of occurrence of RhD alloimmunization, due to preventive protocols, is decreased in our country, but more often there are other antigens that emerge as a cause of hemolytic disease of fetus. The most prominent is Kell antigen, which promotes specific course of disease based on an innate pathogenetic mechanism. Anti - Kell antibody production is, just as in other atypical antibodies, provoked with transfusion of incompatible blood. Except by the immune - mediated hemolysis, anti – Kell antibodies can also inhibit the function of progenitor (erytroid and megakariocyte) cell lines.
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Why is it important?
We present the case of G1P1 woman in whom a distinct fetal hydrops was sonographicaly detected in the 28th week of pregnancy. The results of immunological tests have undoubtedly pointed to Kell immunization (anti – Kell antibody titer was more then 1:32), and antenatal tests for evaluation of fetal condition (Doppler ultrasound and CTG) have clearly shown the severe form of hemolytic disease. We have concluded that the fetus is in a hopeless, terminal stage of the disease, and then decided to terminate pregnancy.
Perspectives
The only clinical approach to a problem of Kell alloimunization is, active one. Early cordocentesis is recommended as the optimal method for evaluation of fetal condition. The clinical outcome of the fetus will strictly depend on a timely intrauterine transfusion (IUT) procedure. Prophylaxis emerges as a crucial factor in prevention of Kell – alloimmunization. It is to be considered that all females in childhood and throughout the reproductive period should take only K1 – negative blood transfusion in order to decrease the incidence of Kell – alloimmunization.
Prof. Jelena D Milosevic Stevanovic
Faculty of Medicine, University of Nis, Serbia and Clinic of Gynecology and Obstetrics, Clinical Center Nis, Serbia
Read the Original
This page is a summary of: Kell immunization: A case report, Medicinski pregled, January 2009, National Library of Serbia,
DOI: 10.2298/mpns0908369t.
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