BACKGROUND: Repeated plasmapheresis was used to prevent fetal death from severe anti-Kell alloimmunization until intrauterine transfusions were feasible.
CASE: Repeated maternal plasma exchanges (N = 40) beginning at 7 weeks' gestation were used to treat severe anti-Kell alloimmunization. Ultrasound examination at 19 weeks' gestation revealed diffuse hydrops in this fetus (umbilical venous hemoglobin, 1.2 g/dL), which then required nine intrauterine transfusions through 34 weeks. A healthy 3840-g girl was delivered by cesarean delivery at 36 weeks. Despite aplastic anemia during the first 3 months of life, she is healthy and has no observable abnormalities at age 8.
CONCLUSION: A highly aggressive course of plasmapheresis and intrauterine transfusions can successfully treat fetal anemia caused by anti-Kell alloimmunization even when fetal hemoglobin is extremely low.
Extremely severe Kell alloimmunization was successfully treated with plasmapheresis and intrauterine transfusions.
Clinique de Gynécologie, Obstétrique et Néonatalogie, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France
Address reprint requests to: Damien Subtil, MD, PhD, Hôpital Jeanne de Flandre, Clinique de Gynécologie, Obstétrique et Néonatalogie, CHRU de Lille, 2 Avenue Oscar Lambret, 59 037 Lille Cedex, France; E-mail: email@example.com.
Received November 26, 2001. Received in revised form February 11, 2002. Accepted March 7, 2002.