A. Babinszki et al., Prognostic factors and management in pregnancies complicated with severe Kell alloimmunization: Experiences of the last 13 years, AM J PERIN, 15(12), 1998, pp. 695-701
Because of the recent referral of an anti-Kell sensitized pregnant woman, w
hose fetus became severely anemic despite intensive antepartum surveillance
, the prevalence and characteristics of fetal Kell isoimmunization were rev
iewed and analyzed. Cases with Kell and RhD alloimmunization requiring intr
auterine intravascular transfusions (IUT) at the Mount Sinai Medical Center
during the 13-year period ending March 1998 were compared. Thirty-six fetu
ses with RhD and 5 with Kell isoimmunization required IUTs. Lower fetal and
neonatal hematocrit levels were observed in the RhD group. A significantly
higher incidence of polyhydramnios was found among fetuses with Kell isoim
munization and the maternal serum titers were much lower than those in the
RhD group, Delta OD450 values did not reliably reflect the Kell sensitized
fetus's condition. There were no intrauterine deaths or neonatal direct hyp
erbilirubinemia in the Kell group, and the hemolytic disease of the newborn
was more severe in the RhD group. Although the course of the hemolytic dis
ease in our cases of Kell isoimmunization showed a better prognosis than th
at in the RhD group, the importance of this condition should not be underes
timated, and differences in the pathophysiology of Kell and RhD alloimmuniz
ation should be taken into consideration during the management of these cas
es.