Non-anti-D antibodies in red-cell alloimmunization

Objective: Review the fetal/neonatal outcome and management of pregnancies associated with alloimmunization to irregular anti-red-cell antibodies. Stu dy Design: Computerized MEDLINE search using keywords that included hemolyt ic disease of the newborn (HDN) and the specific family of anti-red-cell an tibody, such as anti-Kell antibody. Results: A review of the prevalence of antibodies associated with HDN in reproductive age women revealed a marked decrease in the incidence of anti-RhD. An increasing incidence of anti-K1 a ntibody has been noted in the US, a trend not seen in other countries. Guid elines for intervention in cases of irregular antibodies are limited by the bias of anecdotal reports in the literature in favor of severe cases of HD N. Conclusions: In cases of Kell, M, Duffy and Kidd alloimmunization, DNA t echniques using amniotic fluid can be used to exclude antigen-negative fetu ses. Kell (K1 and K2) alloimmunization should be managed somewhat different ly from RhD due to the unique ability of these antibodies to suppress the f etal erythropoietic response. (C) 2000 Elsevier Science Ireland Ltd. All ri ghts reserved.