Implementation of routine screening for Kell antibodies: does it improve perinatal survival?

• Published in: Transfusion (Philadelphia, Pa.) Vol. 48; no. 5; pp. 953 - 957
• Main Authors: Kamphuis, Marije M., Lindenburg, Irene, Van Kamp, Inge L., Meerman, Robertjan H., Kanhai, Humphrey H.H., Oepkes, Dick
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-05-2008; Blackwell Publishing
• Subjects: Anemia - immunology; Anemia - mortality; Anemia - therapy; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Transfusion, Intrauterine; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cohort Studies; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Humans; Hydrops Fetalis - diagnosis; Hydrops Fetalis - immunology; Hydrops Fetalis - mortality; Hydrops Fetalis - therapy; Intensive care medicine; Isoantibodies - blood; Kell Blood-Group System - immunology; Mass Screening - statistics & numerical data; Medical sciences; Netherlands - epidemiology; Pregnancy; Pregnancy Complications, Hematologic - diagnosis; Pregnancy Complications, Hematologic - immunology; Pregnancy Complications, Hematologic - mortality; Pregnancy Complications, Hematologic - therapy; Retrospective Studies; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Netherlands; Medical screening; Survival; Transfusion
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2007.01626.x

BACKGROUND: In 1998 a national program for first‐trimester screening for red cell (RBC) antibodies in all pregnant women was implemented. The aim of our study was to assess the impact on perinatal mortality caused by Kell alloimmunization
STUDY DESIGN AND METHODS: Prospectively collected data on all pregnant women referred to our center from 1988 until 2005 for intrauterine transfusion (IUT) for fetal anemia due to Kell alloantibodies were analyzed. The cohort was divided into two groups, those treated before 1998 and those treated after 1998. The primary outcome was fetal and neonatal survival. Secondary outcome variables were gestational age, fetal hemoglobin (Hb) levels at first IUT, severity of hydrops, and total number of IUTs per pregnancy. Causes for mortality were analyzed in detail.
RESULTS: A total of 43 pregnancies were included, 18 before introduction of screening and 25 thereafter. Perinatal survival increased from 61 percent in the first period to 100 percent after introduction of screening. After 1998, fetal hydrops was generally less severe at first IUT, while gestational age and fetal Hb levels at first IUT were similar.
CONCLUSION: Implementation of routine screening for Kell antibodies in pregnancy was associated with an increased referral rate for suspected fetal anemia, more timely referrals, and a higher perinatal survival rate after intrauterine treatment.