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From the Rh Laboratory, Department of Pediatrics and Child Health, and the Division of Fetal and Maternal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Faculty of Medicine, University of Manitoba, and Health Sciences Centre, Winnipeg, Manitoba, Canada
Abstract
Background: Two recent papers have provided conflicting views regarding the severity of Kell hemolytic disease of the newborn.
Methods: We reviewed our experience during 1944- 1990 with pregnant Kell-alloimmunized Manitoban women and similar women referred from outside of Manitoba.
Results: Between 1944-1990, 311 Kell-immunized Manitoban women had 459 pregnancies, of which 63 ended in abortion or stillbirth unrelated to anti-Kell. Of the infants born, 376 were unaffected and 20 were affected. Twelve did not require treatment; two needed phototherapy, one required a simple transfusion, and one an exchange transfusion. One died of kernicterus and three were hydropic and died; all four deaths occurred between 1948-1954. Fourteen Kell-immunized women with 16 pregnancies were referred from outside Manitoba. Eleven had a history of Kell hydropic fetuses and ten had hydropic fetuses at referral. Five of the hydropic fetuses survived and five died. Five women had Kell-negative infants correctly predicted by amniocentesis (two) and by fetal blood sampling (three). Serial amniotic fluid 
OD 450 readings were 83-89% accurate in predicting the presence and severity of Kell hemolytic disease. Life-threatening inaccuracies occurred, primarily in the early and middle second trimester.
Conclusions: Kell hemolytic disease, although rare, may be as severe as Rh(D) hemolytic disease when it does occur. When there is a history of hydrops or the father is Kell-positive and the maternal anti-Kell indirect antiglobulin titer is 8 or greater, amniocentesis should be performed at 16-20 weeks' gestation. Fetal blood sampling followed by fetal intravascular transfusion is indicated if OD 450 readings approach the 65% level in modified zone 2 of Liley or if amniocentesis is precluded because of an anterior placenta and there is a history of hydrops or ultrasound evidence of fetal hemolytic disease.
This article has been cited by other articles:
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  D. S. MCKENNA, H. N. NAGARAJA, and R. O'SHAUGHNESSY Management of Pregnancies Complicated by Anti-Kell Isoimmunization Obstet. Gynecol., May 1, 1999; 93(5): 667 - 673. [Abstract] [Full Text] [PDF]
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 J. I. Vaughan, M. Manning, R. M. Warwick, E. A. Letsky, N. A. Murray, and I. A.G. Roberts Inhibition of Erythroid Progenitor Cells by Anti-Kell Antibodies in Fetal Alloimmune Anemia N. Engl. J. Med., March 19, 1998; 338(12): 798 - 803. [Abstract] [Full Text] [PDF]
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N. L.C. Luban Hemolytic Disease of the Newborn: Progenitor Cells and Late Effects N. Engl. J. Med., March 19, 1998; 338(12): 829 - 831. [Full Text]
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