Babinszki A, Lapinski R H, Berkowitz R L
Department of Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School of Medicine, New York, New York 10029, USA.
Am J Perinatol. 1998;15(12):695-701. doi: 10.1055/s-2007-999304.
Because of the recent referral of an anti-Kell sensitized pregnant woman, whose fetus became severely anemic despite intensive antepartum surveillance, the prevalence and characteristics of fetal Kell isoimmunization were reviewed and analyzed. Cases with Kell and RhD alloimmunization requiring intrauterine intravascular transfusions (IUT) at the Mount Sinai Medical Center during the 13-year period ending March 1998 were compared. Thirty-six fetuses 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 isoimmunization and the maternal serum titers were much lower than those in the RhD group. DeltaOD450 values did not reliably reflect the Kell sensitized fetus's condition. There were no intrauterine deaths or neonatal direct hyperbilirubinemia in the Kell group, and the hemolytic disease of the newborn was more severe in the RhD group. Although the course of the hemolytic disease in our cases of Kell isoimmunization showed a better prognosis than that in the RhD group, the importance of this condition should not be underestimated, and differences in the pathophysiology of Kell and RhD alloimmunization should be taken into consideration during the management of these cases.
由于最近转诊了一名抗 Kell 致敏的孕妇，尽管进行了强化的产前监测，但其胎儿仍出现严重贫血，因此对胎儿 Kell 同种免疫的患病率和特征进行了回顾和分析。比较了在截至1998年3月的13年期间，在西奈山医疗中心需要进行宫内血管内输血（IUT）的 Kell 和 RhD 同种免疫病例。36例 RhD 胎儿和5例 Kell 同种免疫胎儿需要进行宫内血管内输血。RhD 组胎儿和新生儿的血细胞比容水平较低。Kell 同种免疫胎儿中羊水过多的发生率显著更高，且母体血清滴度远低于 RhD 组。DeltaOD450 值不能可靠地反映 Kell 致敏胎儿的状况。Kell 组没有宫内死亡或新生儿直接高胆红素血症，RhD 组新生儿溶血病更严重。尽管我们的 Kell 同种免疫病例中溶血病的病程预后比 RhD 组好，但这种情况的重要性不应被低估，在处理这些病例时应考虑 Kell 和 RhD 同种免疫病理生理学的差异。
