Selecting K compatible blood components for transfusion can prevent anti-K immunization in women of childbearing age.
With selecting K compatible blood for transfusion, we prevent K immunization and many unnecessary prenatal testing and gynecological examinations for at least 78% of pregnant women with K negative partners, whose fetus is not at risk of hemolytic disease of fetus and newborn.
Kell antibodies are beside RhD and c antibodies one of most clinically important antibodies that can cause severe hemolytic disease of the fetus and newborn (HDFN) in pregnancy,which is still remaining one of the major causes of perinatal morbidity and mortality. Therefore, pregnant women with eryhrocyte alloantibodies anti-K need many prenatal testing and gynecological examinations. The major cause for anti-K immunisation is transfusion of incompatible blood in the past.
We analysed retrospectively the data of 71 pregnant woman with alloantibodies anti-K, which were followed in Blood Transfusion Centre of Slovenia from 2004 -2014. We collected data of partner´s phenotype and woman´s transfusion history. Data were statistically analyzed with basic statistical methods.
61 out of 71 partners were tested (86%) and 48 were K negative (78%).The transfusion history was available for only 23 women (32%). The transfusion history was available for 23 out of 48 women with K negative partner (48%). All of them were transfused. 78% received incompatible-K positive blood, for the rest 22% women donations they received were not K typed.
From the obtained data, we found that in 78% of cases cause for K alloimunnization is transfusion of K incompatible blood in past. With selecting K compatible blood for transfusion, we can prevent K immunization and many unnecessary prenatal testing and gynecological examinations for 78% pregnant women with K negative partners .
Mollison PL, Engelfriet CP, Contreras M. Haemolytic disease of the fetus and the newborn. In: Mollison PL, Engelfriet CP, Contreras M. Mollison's Blood Transfusion in Clinical Medicine. 11th ed. Oxford: Blackwell Science, 2005: 496-545.
Kamphuis MM, Lindenburg I, Van Kamp IL, Meerman RH, Kanhai H, Oepkes D. Implementation of routine screening for Kell antibodies: does it imrpove perinatal survival?. Transfusion 2008; 48: 953-7.
Kanel GC, Davis I, Bowman JE. “Naturally-Occurring” Anti-K1: Possible Association with Mycobacterium Infection. Transfusion 1978;18:472-3.
Marsh WL, Nichols ME, Qyen R, Thayer RS, Deere WL , Freed PJ et al. Naturally Occurring Anti-Kell Stimulated by E. Coli Enterocolitis in a 20-Day-Old Child. Transfusion 1978;18:149-54.
Doelman CJA, Westerman WF, Voorst tot Voorst E van, MIEDEMA K. An anti-K apparently induced by Enterococcus faecalis in a 30-year-old man. Transfusion 1992; 32: 790.
Pereira A, Monteagudo J, Rovira M, Mazzara R, Reverter JC, Castillo R. Anti-K1 of the IgA class associated with Morganella morganii infection. Transfusion 1989; 29: 549-51.
Daniels G, Hadley A, Green CA. Causes of fetal anemia in haemolytic disease due to anti-K. Transfusion 2003; 43: 115-6.
Vaughan JI, Manning M, Warwick RM, Letsky EA, Murray NA, Roberts IA. Inhibition of erythroid progenitor cells by anti-Kell antibodies in fetal alloimmune anemia. N Engl J Med 1998; 338 (12): 798-803.
McKenna DS, Nagaraja Hn, O'shaughnessy R. Management of pregnancies complicated by anti-Kell isoimmunization. Obstet Gynecol 1999; 93: 667-73.
Tuson M, Hue-Roye K, Koval K, Imlay S, Desai R, Garg G, et al. Possible suppression of fetal erythropoesis by Kell blood group antibody anti-Kpa. Immunohematology 2011; 27: 58-60.
Wagner T, Berer A, Lanzer G, Geissler K. Kell is not restricted to the erythropoetic lineage but is also expressed on myleoid progenitor cells. BJH 2000; 110: 409-1.
Wagner T,Resch B, reiterer F, Gassner C, Lanzer G. Pancytopenia due to suppressed hematopoiesis in case of fetal hemolytic disease of the newborn associated with anti-K supported by molecular K1 typing. J Pediatr Hematol Oncol 2004; 26: 13-5.
Akker ESA, Klumper FJCM, Brand A, Kanhai HHH, Oepks d. Kell alloimmunization in pregnancy: associated with fetal thrombocytopenia?. Vox Sanguin 2008; 95: 66-69.
Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, rerearch, and practice. Curr opin Psychiatry 2012; 25: 141-8.
Van Kamp IL, Klumper FJ, Meerman RH, Oepkes D, Scherjon SA, Kanhai HH. Treatment of fetal anemia due to red-cell alloimmunization with intrauterine transfusions in the Netherlands, 1988-1999. Acta Obstet Gynecol Scand 2004; 83: 731-7.
Walker RH. Relevance in selection of serologic tests for obstetric patient. In: Haemolytic Disease of the Newborn. Arlington, VA: Am Assoc Blood Banks, 1984: 173-200.
Strohm P, O'Shaughnessy R, Moore J, et al. Immunohematology 1991;7: 40.
Pepperell RJ, Barrie JU, Pliegner JR. Significance of red-cell irregular antibodies in the obstetric patient. Med J Aust 1977; ii: 453.
Mayne KM, Bowell PJ, Pratt GA. The significance of anti-Kell sensitization in pregnancy. Clin Lab Haematol 1990; 12: 379-385.
Lee E, De Silva M. Unlike Anti-c, Anti-K in pregnancy is more likely to have been induced by previous transfusion; this can be prevented. Transfusion 2004; 44:104A.
Pravilnik o transfuzijskih preiskavah in postopkih ob transfuziji, Ur l 9/2007.
Issitt PD, Anstee DJ. The Kell and Xk Blood Group Systems . In: Issitt PD, Anstee DJ. Applied blood group serology. 4th ed. Montgomery Scientific Publications, 1998: 609-53.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.