FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 338:798-803 March 19, 1998 Number 12 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In alloimmune anemia of the newborn, the level of hemolysis caused by the presence of antibodies to antigens of the Kell blood-group system is less than that caused by antibodies to the D antigen of the Rh blood-group system, and the numbers of reticulocytes and normoblasts in the baby's circulation are inappropriately low for the degree of anemia. These findings suggest that sensitization to Kell antigens results in suppression of fetal erythropoiesis as well as hemolysis.

Methods We compared the growth in vitro of Kell-positive and Kell-negative hematopoietic progenitor cells from cord blood in the presence of human monoclonal anti-Kell antibodies and anti-D antibodies and serum from women with anti-Kell antibodies.

Results The growth of Kell-positive erythroid progenitor cells (erythroid burst-forming units and colony-forming units) from cord blood was markedly inhibited by monoclonal IgG and IgM anti-Kell antibodies in a dose-dependent fashion (range of concentrations, 0.2 to 20 percent), but monoclonal anti-D antibodies had no effect. The growth of these types of cells from Kell-negative cord blood was not affected by either type of antibody. Neither monoclonal anti-Kell antibodies nor monoclonal anti-D antibodies inhibited the growth of granulocyte or megakaryocyte progenitor cells from cord blood. Serum from 22 women with anti-Kell antibodies inhibited the growth of Kell-positive erythroid burst-forming units and colony-forming units but not of Kell-negative erythroid burst-forming units and colony-forming units (P<0.001 for the difference between groups). The maternal anti-Kell antibodies had no inhibitory effects on granulocyte–macrophage or megakaryocyte progenitor cells from cord blood.

Conclusions Anti-Kell antibodies specifically inhibit the growth of Kell-positive erythroid burst-forming units and colony-forming units, a finding that supports the hypothesis that these antibodies cause fetal anemia by suppressing erythropoiesis at the progenitor-cell level.

Source Information

From the Departments of Obstetrics and Haematology, Institute of Obstetrics and Gynaecology, Queen Charlotte's Hospital (J.I.V., R.M.W., E.A.L.), and the Department of Haematology, Imperial College School of Medicine at the Royal Postgraduate Medical School (M.M., N.A.M., I.A.G.R.) — both in London.

Address reprint requests to Dr. Roberts at the Department of Haematology, Imperial College School of Medicine at the Royal Postgraduate Medical School, Du Cane Rd., London W12 0NN, United Kingdom.

Full Text of this Article

This article has been cited by other articles:

• Anstee, D. J. (2009). Red cell genotyping and the future of pretransfusion testing. Blood 114: 248-256 [Abstract] [Full Text]  
• Gajjar, K., Spencer, C. (2009). Diagnosis and management of non-anti-D red cell antibodies in pregnancy. The Obstetrician and Gynaecologist 11: 89-95 [Abstract] [Full Text]  
• Murray, N. A, Roberts, I. A G (2007). Haemolytic disease of the newborn. Arch. Dis. Child. Fetal Neonatal Ed. 92: F83-F88 [Full Text]  
• Klumpp, T. R., Siegel, D. L. (2007). Transfusion medicine. ASH-SAP 2007: 408-443 [Full Text]  
• Hinchliffe, R F, Nolan, B, Vora, A J, Stamps, R (2006). Neonatal pure red cell aplasia due to anti-M.. Arch. Dis. Child. Fetal Neonatal Ed. 91: F467-F468 [Full Text]  
• Javier, M. C., Krauss, A., Nesin, M. (2003). Corrected End-Tidal Carbon Monoxide Closely Correlates With the Corrected Reticulocyte Count in Coombs' Test-Positive Term Neonates. Pediatrics 112: 1333-1337 [Abstract] [Full Text]  
• Wagner, T., Bernaschek, G., Geissler, K. (2000). Inhibition of Megakaryopoiesis by Kell-Related Antibodies. NEJM 343: 72-72 [Full Text]  
• Yazdanbakhsh, K., Lee, S., Yu, Q., Reid, M. E. (1999). Identification of a Defect in the Intracellular Trafficking of a Kell Blood Group Variant. Blood 94: 310-318 [Abstract] [Full Text]  
• Luban, N. L.C. (1998). Hemolytic Disease of the Newborn: Progenitor Cells and Late Effects. NEJM 338: 829-831 [Full Text]