Recent data suggest that antibody-mediated suppression of erythroid progenitors may contribute to the anti-Kell-induced alloimmune hemolytic disease of the newborn (HDN). A 32-week-old girl who was positive for Kell was born to a mother who was negative for Kell but known to have anti-Kell antibodies.
If the fetus is negative for the Kell antigen periodic noninvasive assessment is not unreasonable since there is a low false negative rate associated with this test (1–3%). Serial antibody titers are commonly used for monitoring fetal status with a first sensitized pregnancy in Rh disease.
Anti-Kell in pregnancy A review of data on haemolytic disease of the newborn (HDN) collected in Newcastle upon Tyne over 25 years revealed 194 pregnancies in which anti-Kell was the only antibody detected. Sixteen affected babies were born.
Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 1. The 2019 edition of ICD-10-CM O36.0191 became effective on October 1, 2018. This is the American ICD-10-CM version of O36.0191 - other international versions of ICD-10 O36.0191 may differ.
Encounter for prophylactic Rho(D) immune globulin Z29. 13 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z29. 13 became effective on October 1, 2021.
Z67.918. RE: ICD-10 code for Rh negative status in pregnancy. "Unspecified blood type, Rh negative" is Z67. 91.
Hemolytic disease of newborn, unspecified The 2022 edition of ICD-10-CM P55. 9 became effective on October 1, 2021. This is the American ICD-10-CM version of P55.
Is there a difference between alloimmunization and isoimmunization? No, there is no difference between alloimmunization and isoimmunization. The terms are often used interchangeably when referring to alloimmunization during pregnancy, particularly regarding the Rh factor.
Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 1. O36. 0191 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM O36.
Anti-M is a common antibody detected in prenatal samples. Most often it is not clinically significant as it is predominantly an IgM antibody which does not cross the placental barrier. To distinguish IgM from IgG anti-M, some antibody identification methods exist that exclude IgM antibodies.
What is DAT? DAT tests for evidence of a reaction between the mother's and baby's blood groups. If your baby's DAT is positive, there is a risk that he/she could develop anaemia (low number of red blood cells) and/or jaundice (yellow colour to the skin).
Anti-Kell is an important cause of HDN. It tends to occur in mothers who have had several blood transfusions in the past, but it may also occur in mothers who have been sensitized to the Kell antigen during previous pregnancies.
An abnormal (positive) direct Coombs test means you have antibodies that act against your red blood cells. This may be due to: Autoimmune hemolytic anemia. Chronic lymphocytic leukemia or similar disorder. Blood disease in newborns called erythroblastosis fetalis (also called hemolytic disease of the newborn)
Isoimmunization (Sometimes called Rh sensitization, hemolytic disease of the fetus, Rh incompatibility) What is isoimmunization? A condition that happens when a pregnant woman's blood protein is incompatible with the baby's, causing her immune system to react and destroy the baby's blood cells.
Hemolytic Disease of the Newborn, also known as anti-Kell, is one of the most common causes of severe hemolytic (abnormal blood) diseases of newborns. Anti-Kell is a condition in which the antibodies in a pregnant woman's blood cross the placenta and destroy her baby's red blood cells, resulting in severe anemia.
Rh incompatibility is when a mother has Rh-negative blood and her baby has Rh-positive blood. Rh isoimmunization is when the blood from the baby makes the mother's body create antibodies that can harm the baby's blood cells.
Therefore, about 4.5% of babies born to a Kell 1 negative mother are Kell 1 positive. The disease results when maternal antibodies to Kell 1 are transferred to the fetus across the placental barrier, breaching immune privilege.
Anti-Kell 1 is becoming relatively more important as prevention of Rh disease is also becoming more effective. Hemolytic disease of the newborn (anti-Kell 1) is caused by a mismatch between the Kell antigens of the mother and fetus. About 91% of the population are Kell 1 negative and about 9% are Kell 1 positive.
Mothers who are negative for the Kell 1 antigen develop antibodies after being exposed to red blood cells that are positive for Kell 1. Over half of the cases of hemolytic disease of the newborn owing the anti-Kell antibodies are caused by multiple blood transfusions, with the remainder due to a previous pregnancy with a Kell 1 positive baby.
Anti-Kell can cause severe anemia regardless of titer. Anti-Kell suppresses the bone marrow, by inhibiting the erythroid progenitor cells. Hemolytic disease of the newborn can also be caused by anti-Kell 2, anti-Kell 3 and anti-Kell 4 IgG antibodies. These are rarer and generally the disease is milder.
It has been hypothesized that IgG anti-Kell 1 antibody injections would prevent sensitization to RBC surface Kell 1 antigens in a similar way that IgG anti-D antibodies ( Rho (D) Immune Globulin) are used to prevent Rh disease, but the methods for IgG anti-Kell 1 antibodies have not been developed at the present time.
A 32-week-old girl who was positive for Kell was born to a mother who was negative for Kell but known to have anti-Kell antibodies. After birth, the baby had HDN and hyperbilirubinemia develop (peak bilirubin 21 mg/dL at day 9 of life). which was treated with phototherapy.
Treatment of hemolytic disease of the newborn caused by anti-Kell antibody with recombinant erythropoietin
1Department of Pediatric Hematology-Oncology, New York University Medical Center, New York 10016, USA.
Mothers who are negative for the Kell 1 antigen develop antibodies after being exposed to red blood cells that are positive for Kell 1. Over half of the cases of hemolytic disease of the newborn owing the anti-Kell antibodies are caused by multiple blood transfusions, with the remainder due to a previous pregnancy with a Kell 1 positive baby.
Hemolytic disease of the fetus and newborn (HDN) is a condition where the passage of maternal antibodies results in the hemolysis of fetal/neonatal red cells. The antibodies can be naturally occurring such as anti-A, and anti-B, or immune antibodies developed following a sensitizing event.
Testing for HDN involves blood work from both mother and father, and may also include assessment with amniocentesis and Middle Cerebral Artery scans.
There are several intervention options available in early, mid and late pregnancies.
Coombs - after birth baby will have a direct coombs test run to confirm antibodies attached to the infant's red blood cells. This test is run from cord blood.
Suggestions have been made that women of child-bearing age or young girls should not be given a transfusion with Kell 1 positive blood. Donated blood is not currently screened (in the U.S.A.) for the Kell blood group antigens as it is not considered cost effective at this time.
Phototherapy - Phototherapy is used for cord bilirubin of 3 or higher. Some doctors use it at lower levels while awaiting lab results.
Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 1 1 O36.0191 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 Short description: Maternal care for anti-D antibodies, unsp trimester, fetus 1 3 The 2021 edition of ICD-10-CM O36.0191 became effective on October 1, 2020. 4 This is the American ICD-10-CM version of O36.0191 - other international versions of ICD-10 O36.0191 may differ.
The 2022 edition of ICD-10-CM O36.0191 became effective on October 1, 2021.
Hemolytic disease of the newborn (anti-Kell1) is the second most common cause of severe hemolytic disease of the newborn (HDN) after Rh disease. Anti-Kell1 is becoming relatively more important as prevention of Rh disease is also becoming more effective.
Hemolytic disease of the newborn (anti-Kell1) is caused by a mismatch between the Kell antigens of the mother and fetus. About 91% of the population are Kell1 negative and about 9% are Kell1 posi…
• High at birth or rapidly rising bilirubin
• Prolonged hyperbilirubinemia
• Bilirubin Induced Neuorlogical Dysfunction
• Cerebral Palsy
Mothers who are negative for the Kell1 antigen develop antibodies after being exposed to red blood cells that are positive for Kell1. Over half of the cases of hemolytic disease of the newborn owing the anti-Kell antibodies are caused by multiple blood transfusions, with the remainder due to a previous pregnancy with a Kell1 positive baby.
Hemolytic disease of the fetus and newborn (HDN) is a condition where the passage of maternal antibodies results in the hemolysis of fetal/neonatal red cells. The antibodies can be naturally occurring such as anti-A, and anti-B, or immune antibodies developed following a sensitizing event. Isoimmunization occurs when the maternal immune system is sensitized to red blood cell surface antigens. The most common causes of isoimmunization are blood transfusion, and feta…
Testing for HDN involves blood work from both mother and father, and may also include assessment with amniocentesis and Middle Cerebral Artery scans.
Blood testing for the mother is called an Indirect Coombs Test (ICT) or an Indirect Agglutination Test (IAT). This test tells whether there are antibodies in the maternal plasma. If positive, the antibody is identified and given a titer. Titers of 1:4 or higher is considered critical for Kell (comp…
There are several intervention options available in early, mid and late pregnancies.
• IVIG - IVIG stands for Intravenous Immunoglobulin. It is used in cases of previous loss, high maternal titers, known aggressive antibodies, and in cases where religion prevents blood transfusion. Ivig can be more effective than IUT alone. Fetal mortality was reduced by 36% in the IVIG and IUT group than in the IUT alone group. IVIG and plasmapheresis together can reduce o…
• Coombs - after birth baby will have a direct coombs test run to confirm antibodies attached to the infant's red blood cells. This test is run from cord blood.
In some cases, the direct coombs will be negative but severe, even fatal HDN can occur. An indirect coombs needs to be run in cases of anti-C, anti-c, and anti-M. Anti-M also recommends antigen testing to rule out the presence of HDN.
Suggestions have been made that women of child-bearing age or young girls should not be given a transfusion with Kell1 positive blood. Donated blood is not currently screened (in the U.S.A.) for the Kell blood group antigens as it is not considered cost effective at this time.
It has been hypothesized that IgG anti-Kell1 antibody injections would prevent sensitization to RBC surface Kell1 antigens in a similar way that IgG anti-D antibodies (Rho(D) Immune Globulin) …