A recent study published in Transfusion suggests that more cases of hemolytic disease of the fetus and newborn (HDFN) can be prevented in the United States through the use of Kell-matched blood transfusions, which is not always standard practice.
When a person is negative for the Kell antigen, a protein found on red blood cells, they can develop antibodies against the antigen if they become exposed to it. If a Kell-negative patient receives a blood transfusion that contains Kell-positive blood cells, for example, or becomes pregnant with a Kell-positive child, anti-Kell antibodies can be produced through a process called alloimmunization. If these antibodies cross the placenta and attack fetal red blood cells, HDFN can occur.
Anti-Kell alloimmunization caused by blood transfusions can be prevented by matching the Kell antigen status of the patient and donor. However, no universal policy exists in the United States to enforce this practice.
The study included 69 women aged 50 years or younger who tested positive for anti-Kell antibodies and were patients at the University of California, San Francisco (UCSF). Of these patients, 65% had no other conditions that would increase their risk of developing alloantibodies.
Read more about HDFN causes and risk factors
Findings revealed that 67% of participants had a history of blood transfusions and pregnancy, 13% had a history of only pregnancy and 17% had a history of only transfusions. Only about one-third of patients received their transfusions at UCSF, with the rest receiving them from other hospitals and clinics.
Following the identification of anti-Kell antibodies, 15 patients became pregnant. Of the pregnancies that were carried to term, five resulted in healthy deliveries and three required intrauterine transfusion, intravenous immunoglobulin or plasmapheresis. One of the three infants died due to prematurity and hemolysis.
“Our results support reconsideration of a national policy of prophylactic K-matching or K-negative transfusion for people with pregnancy potential as a way to prevent further alloimmunization and improve clinical care in this population,” the authors concluded.
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