Santiago Juan C, Ramos-Corpas Domingo, Oyonarte Salvador, Montoya Francisco
Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología del Hospital Universitario V. De las Nieves, 180-Granada, Spain.
Eur J Obstet Gynecol Reprod Biol. 2008 Feb;136(2):151-4. doi: 10.1016/j.ejogrb.2007.03.003. Epub 2007 May 3.
Few reports have been published of the current clinical management of anti-Kell alloimmunization in pregnancy; its low frequency of occurrence means that the few long series published have covered very ample time periods in which different kinds of clinical management have overlapped. The objective of the present paper is to present our experience in the current clinical management of pregnant women who are positive for the anti-Kell antibody.
A retrospective analysis was carried out of the case histories of pregnant women who were alloimmunized for the Kell antigen and who were studied and/or treated at the Department of Fetal Medicine in the Virgen de las Nieves University Hospital in Granada (Spain), between 2000 and 2004. The clinical management included the basal measurement of the titre of antibodies, the identification of the paternal phenotype (and that of the fetus, if necessary), the ultrasonographic monitoring of the fetus to detect signs of anaemia, sampling of fetal blood by cordocentesis when fetal anaemia was suspected, and fetal intravascular transfusion when necessary.
Of the 10 pregnancies with anti-Kell antibodies, The Kell antigen was confirmed in the fetus in three cases, in all of which moderate to severe fetal anaemia developed, requiring fetal intravascular transfusions. Although one of the fetus developed antenatal hydrops, a good perinatal result was advised.
The current approach to anti-Kell alloimmunization enables pregnant women who have Kell-positive fetuses to be treated successfully.
关于孕期抗凯尔同种免疫的当前临床管理的报道很少；其发生频率较低，意味着已发表的少数长系列研究涵盖了很长的时间段，在此期间不同类型的临床管理相互重叠。本文的目的是介绍我们在抗凯尔抗体阳性孕妇的当前临床管理方面的经验。
对2000年至2004年期间在西班牙格拉纳达的拉斯涅韦斯圣母大学医院胎儿医学科接受研究和/或治疗的因凯尔抗原发生同种免疫的孕妇病历进行回顾性分析。临床管理包括抗体滴度的基础测量、父亲表型（必要时包括胎儿表型）的鉴定、超声监测胎儿以检测贫血迹象、怀疑胎儿贫血时通过脐静脉穿刺采集胎儿血液以及必要时进行胎儿血管内输血。
在10例抗凯尔抗体阳性的妊娠中，3例胎儿确诊为凯尔抗原阳性，所有这些胎儿均出现中度至重度胎儿贫血，需要进行胎儿血管内输血。尽管其中1例胎儿出现产前水肿，但围产期结局良好。
当前对抗凯尔同种免疫的处理方法能够成功治疗胎儿为凯尔阳性的孕妇。
