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.

STUDY

DESIGN

Computerized MEDLINE search using keywords that included hemolytic disease of the newborn (HDN) and the specific family of anti-red-cell antibody, 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 antibody has been noted in the US, a trend not seen in other countries. Guidelines for intervention in cases of irregular antibodies are limited by the bias of anecdotal reports in the literature in favor of severe cases of HDN.

CONCLUSIONS

In cases of Kell, M, Duffy and Kidd alloimmunization, DNA techniques using amniotic fluid can be used to exclude antigen-negative fetuses. Kell (K1 and K2) alloimmunization should be managed somewhat differently from RhD due to the unique ability of these antibodies to suppress the fetal erythropoietic response.