Anti-Kell and anti-C alloimmunization: report of three cases

Hemolytic disease of the newborn is characterized by the transfer of antibodies to fetus which was produced against the antigens on the
erythrocytes. Due to widespread use of Rh immunoglobulin for prevention of Rh hemolytic disease, the importance of hemolytic disease due to antibodies other than anti-D has increased. The spectrum of the disease varies from mild hyperbilirubinemia to severe hys fetalis.
In this report, three neonates hospitalized for hyperbilirubinemia and anemia who were diagnosed to have subgroup incompatibility were presented. Case I was a term newborn with hyperbilirubinemia detected at postnatal 22nd hour without any abnormal physical finding except for generalized jaundice. The neonate whose Direct Coombs test was positive and had anemia, was treated with phototherapy and IVIG. Subgroup analysis revealed anti-C antibodies. Case II was a term neonate admitted due to hyperbilirubinemia at postnatal 5th day. After he was treated with phototherapy for 48 hours, bilirubin levels decreased to 12 mg/dl. After termination of phototherapy, rebound bilirubin levels increased to 18 mg/dl. Anti-kell antibodies were detected in subgroup analysis. Case III was admitted at postnatal 24th hour due to hyperbilirubinemia. A sibling who died in neonatal period with a history of exchange transfusion at postnatal 2nd day was recorded. Physical examination was normal except jaundice and a murmur with 2/6 intensity at mesocardiac area. IVIG was given to the neonate with Direct Coombs positivity. Subgroup analysis confirmed the presence of anti-kell antibodies. Exchange transfusion was performed with Kell negative blood. The importance of hemolytic disease of the newborn due to subgroup incompatibility has increased. Subgroup incompatibilities which were thought only to cause mild anemia is now considered to cause severe obstetric and neonatal complications. Newborns with hemolytic anemia should thoroughly be evaluated for subgroup incompatibility.

Anti-Kell ve anti-C alloimmünizasyonu: Üç olgu sunumu

Yenidoðanýn hemolitik hastalýðý, eritrositler üzerinde yer alan antijenlere karþý oluþan antikorlarýn fetüse geçmesi nedeni ile ortaya çýkan bir hastalýktýr. Günümüzde Rh uyuþmazlýðý nedeni ile Rh (D) immunglobulinlerin yaygýn olarak kullanýlmasý sonucunda anti-D dýþýndaki antikorlarýn neden olduðu subgrup uyuþmazlýðýna baðlý yenidoðanýn hemolitik hastalýðýnýn önemi ve sýklýðý giderek artmaktadýr. Klinik bulgular, yenidoðanýn hafif sarýlýðýndan baþlayýp aðýr his fetalis olgularýna kadar deðiþen bir spektrumda izlenmektedir.
Bu yazýda, yenidoðan döneminde sarýlýk ve anemi tanýlarý ile yatýrýlan ve subgrup uyuþmazlýðý tespit edilen üç olgu sunulmuþtur. OLGU 1: Postnatal 22. saatinde sarýlýðý fark edilen zamanýnda doðmuþ bebeðin fizik muayenesinde sarýlýk dýþýnda patolojik bulgu saptanmadý. Direkt coombs pozitifliði ve anemisi olan hastaya fototerapi baþlandý ve intravenöz immünglobulin (ÝVÝG) verildi. Subgrup analizinde anti-C antikor pozitifliði saptandý. OLGU 2: Postnatal beþinci gün sarýlýk þikâyeti ile baþvuran term olgu, 48 saat süreyle uygulanan fototerapi sonrasýnda total serum bilirubini (TSB) 12 mg/dl’ye düþtü. Fototerapi kesildikten 12 saat sonra bakýlan TSB 18 mg/dl’ye yükselmesi üzerine yapýlan tetkiklerinde anti-Kell antikorlarý pozitif saptandý. OLGU 3: Postnatal 24. saatinde ortaya çýkan sarýlýk nedeniyle yatýrýlan term bebeðin öyküsünde kardeþine iki günlük iken kan deðiþimi yapýldýðý ve kaybedildiði öðrenildi. Fizik muayenesinde cilt ve konjuktivalarý ikterik, mezokardiak odakta 2/6 þiddetinde üfürüm saptandý. Direkt coombs testi pozitif olduðu için ÝVÝG verildi. Subgrup analizinde anti-Kell antikorlarý pozitif olarak saptandý. Kell negatif kan ile bebeðe kan deðiþimi uygulandý.
Günümüzde özellikle subgruplara baðlý geliþen hemolitik aneminin önemi giderek artmaktadýr. Daha önceleri hafif anemi ile seyrettiði düþünülen subgrup uyuþmazlýklarýnýn da artýk ciddi fetal ve neonatal komplikasyonlara yol açabileceði bilinmektedir. Bu nedenle hemolitik anemisi olan yenidoðan bebekler olasý subgrup uyuþmazlýðý açýsýndan dikkat edilmelidir.