title: [Kell immunization--a case report].
abstract: BACKGROUND
  The frequency of occurrence of RhD alloimmunization, due to preventive protocols, is decreased in our country, but more often there are other antigens that emerge as a cause of hemolytic disease of fetus. The most prominent is Kell antigen, which promotes specific course of disease based on an innate pathogenetic mechanism. Anti-Kell antibody production is, just as in other atypical antibodies, provoked with transfusion of incompatible blood. Except for the immune-mediated hemolysis, anti-Kell antibodies can also inhibit the function of progenitor (erytroid and megakariocyte) cell lines.
  
  
  METHODS
  We present the case of G1P1 woman in whom a distinct fetal hydrops was sonographically detected in the 28th week of pregnancy. The results of immunological tests undoubtedly pointed to Kell immunization (anti-Kell antibody titer was more than 1:32), and antenatal tests for evaluation of fetal condition (Doppler ultrasound and CTG) clearly showed the severe form of hemolytic disease. We concluded that the fetus was in a hopeless, terminal stage of the disease, and then decided to terminate the pregnancy.
  
  
  CONCLUSIONS
  The only clinical approach to a problem of Kell alloimunization is active one. Early cordocentesis is recommended as the optimal method for evaluation of fetal condition. The clinical outcome of the fetus will strictly depend on a timely intrauterine transfusion (IUT) procedure. Prophylaxis emerges as a crucial factor in prevention of Kell-alloimmunization. It is to be considered that all females in childhood and throughout the reproductive period should take only K1-negative blood transfusion in order to decrease the incidence of Kell-alloimmunization.
authors.affiliation: Klinicki centar Nis, Ginekolosko-akuserska klinika. drmarija@ptt.yu
authors.forename: Marija
authors.initials: M
authors.lastname: Tasić
authors.forename: Jelena
authors.initials: J
authors.lastname: Milosević
authors.forename: Milan
authors.initials: M
authors.lastname: Stefanović
authors.forename: Dragana
authors.initials: D
authors.lastname: Radović-Janosević
authors.forename: Miljan
authors.initials: M
authors.lastname: Krstić
authors.forename: Vladimir
authors.initials: V
authors.lastname: Antić
mesh_terms: D000328:Adult; D001787:Blood Group Incompatibility; D004899:Erythroblastosis, Fetal / Q000097:blood*; D005260:Female; D006801:Humans; D007626:Kell Blood-Group System / Q000276:immunology*; D011247:Pregnancy
chemical_list: D007626:Kell Blood-Group System