van Wamelen D J, Klumper F J, de Haas M, Meerman R H, van Kamp I L, Oepkes D
Department of Obstetrics, Leiden University Medical Center, Leiden.
Obstet Gynecol. 2007 May;109(5):1093-8. doi: 10.1097/01.AOG.0000260957.77090.4e.
To evaluate the usefulness of the obstetric history and the maternal serum Kell antibody titer in the management of pregnancies with Kell alloimmunization.
In a retrospective cohort study of 41 pregnancies complicated by Kell alloimmunization, the obstetric history, divided into presence or absence of a previous Kell-positive child, and Kell antibody titers in the index pregnancy were correlated with the gestational age at the onset of fetal anemia.
Women with a previous Kell-positive child had a lower gestational age at the first intrauterine transfusion compared with those without a previous Kell-positive child (P=.01). However, in two of 29 pregnancies in the latter group, severe fetal anemia requiring transfusion was detected before 20 weeks of gestation. In neither group were maternal Kell antibody titers significantly correlated with gestational age at first intrauterine transfusion (P=.62 and P=.72, respectively). In all but two pregnancies (1:2 and 1:4, respectively), antibody titers were at least 1:32 before the first intrauterine transfusion.
For timely detection of all cases of severe fetal anemia, Kell-alloimmunized pregnancies with a Kell-positive fetus and titers greater than or equal to 1:2 should be closely monitored from 16 to 17 weeks of gestation onward.
评估产科病史及孕妇血清凯尔抗体滴度在凯尔血型同种免疫妊娠管理中的作用。
在一项对41例合并凯尔血型同种免疫妊娠的回顾性队列研究中，将产科病史（分为既往有无凯尔阳性胎儿）与本次妊娠中的凯尔抗体滴度与胎儿贫血开始时的孕周进行关联分析。
既往有凯尔阳性胎儿的女性与既往无凯尔阳性胎儿的女性相比，首次宫内输血时的孕周更低（P = 0.01）。然而，后一组29例妊娠中有2例在妊娠20周前检测到需要输血的严重胎儿贫血。两组中孕妇凯尔抗体滴度与首次宫内输血时的孕周均无显著相关性（分别为P = 0.62和P = 0.72）。除两例妊娠外（抗体滴度分别为1:2和1:4），所有妊娠在首次宫内输血前抗体滴度至少为1:32。
为了及时发现所有严重胎儿贫血病例，对于凯尔阳性胎儿且抗体滴度大于或等于1:2的凯尔血型同种免疫妊娠，应从妊娠16至17周起密切监测。
