title: Treatment of hemolytic disease of the newborn caused by anti-Kell antibody with recombinant erythropoietin.
abstract: 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. After birth, the baby had HDN and hyperbilirubinemia develop (peak bilirubin 21 mg/dL at day 9 of life). which was treated with phototherapy. Although the hyperbilirubinemia resolved, she became progressively anemic (hematocrit 22%) with an inappropriately low reticulocyte response (1.1%) and erythropoietin (EPO) level (20 mU/mL). To avoid the need for a blood transfusion, she was treated with recombinant erythropoietin (rEPO) and oral iron supplements. One week after starting EPO, the reticulocyte count increased to 9.1%. Erythropoietin therapy was continued for a total of 9 weeks, with resolution of her anemia at the end of therapy (hematocrit 35%). Thus, we were able to successfully treat the anemia with rEPO with avoidance of blood transfusion. This patient demonstrates that the antibody-mediated erythroid suppression in Kell alloimmune anemia can be overcome by rEPO. Recombinant erythropoietin should therefore be considered in the management of infants with severe or hypoproliferative anti-Kell-associated anemia.
authors.affiliation: Department of Pediatric Hematology-Oncology, New York University Medical Center, New York 10016, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Dhodapkar
authors.forename: F
authors.initials: F
authors.lastname: Blei
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D004899:Erythroblastosis, Fetal / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000188:drug therapy / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D007626:Kell Blood-Group System / Q000276:immunology*; D010789:Phototherapy; D011247:Pregnancy; D011994:Recombinant Proteins
chemical_list: D001323:Autoantibodies; D007626:Kell Blood-Group System; D011994:Recombinant Proteins; D004921:Erythropoietin