title: Serial blood donations for intrauterine transfusions of severe hemolytic disease of the newborn with the use of recombinant erythropoietin in a pregnant woman alloimmunized with anti-Ku.
abstract: BACKGROUND
  The management of a pregnant woman with the rare Ko phenotype and anti-Ku is a special challenge, because matched blood is extremely rare and the possibility of severe hemolytic disease of the newborn is high.
  
  
  METHODS
  A 30-year-old woman with rare Ko (Knull) phenotype presented at 18 weeks of gestation with positive indirect agglutination test results. She had anti-Ku due to previous blood transfusion, one pregnancy, and two abortions.
  
  
  METHODS
  During this pregnancy, anti-Ku titers ranged from 1024 to 4096. At the 26th week of gestation ultrasound showed a hydropic fetus and urgent intrauterine exchange transfusion was performed with the maternal red blood cells (RBCs). Recombinant human erythropoietin (rHu-EPO) and intravenous (IV) iron were administered to the mother to ensure an adequate supply of matched RBCs for intrauterine transfusions and possible perinatal hemorrhage.
  
  
  RESULTS
  Intrauterine transfusions were repeated every 1 to 3 weeks. By 35 weeks 2 days of gestation, the mother had donated 4 units of blood, and four intrauterine transfusions had been performed. Cesarean section was then decided and a healthy male newborn was born. He was treated with phototherapy but without exchange transfusions. By the 15th day of life rHu-EPO was administrated to the newborn because of anemia. The maternal RBCs completely disappeared from the child's blood by Day 100.
  
  
  CONCLUSIONS
  As shown in this case, treatment with rHu-EPO and IV Fe has effectively increased the mother's capacity to donate RBCs for autologous use and intrauterine transfusions, with no adverse effects to the mother or the child.
authors.affiliation: Department of Transfusion Medicine, University Hospital of Heraklion, Crete, Greece. xatzakis@her.forthnet.gr
authors.forename: Evaggelia
authors.initials: E
authors.lastname: Lydaki
authors.forename: Irene
authors.initials: I
authors.lastname: Nikoloudi
authors.forename: Petros
authors.initials: P
authors.lastname: Kaminopetros
authors.forename: Irene
authors.initials: I
authors.lastname: Bolonaki
authors.forename: Stavros
authors.initials: S
authors.lastname: Sifakis
authors.forename: Katerina
authors.initials: K
authors.lastname: Kikidi
authors.forename: Evgenios
authors.initials: E
authors.lastname: Koumantakis
authors.forename: Kaliopi
authors.initials: K
authors.lastname: Foundouli
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000188:drug therapy / Q000276:immunology; D034961:Antigens, Nuclear / Q000276:immunology*; D001782:Blood Donors; D001805:Blood Transfusion, Intrauterine; D002585:Cesarean Section; D004268:DNA-Binding Proteins / Q000276:immunology*; D004899:Erythroblastosis, Fetal / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007518:Isoantibodies / Q000097:blood; D007626:Kell Blood-Group System / Q000276:immunology; D000072200:Ku Autoantigen; D008297:Male; D011247:Pregnancy / Q000097:blood*; D011994:Recombinant Proteins; D012720:Severity of Illness Index
chemical_list: D034961:Antigens, Nuclear; D004268:DNA-Binding Proteins; D007518:Isoantibodies; D007626:Kell Blood-Group System; D011994:Recombinant Proteins; D004921:Erythropoietin; C000606509:Xrcc6 protein, human; D000072200:Ku Autoantigen