{"title":"Management of pregnancies with anti-K alloantibodies and the predictive value of anti-K titration testing.","authors":"Evangelia Vlachodimitropoulou, Nadine Shehata, Greg Ryan, Gwen Clarke, Lani Lieberman","doi":"10.1016/S2352-3026(24)00239-4","DOIUrl":null,"url":null,"abstract":"<p><p>Anti-KEL1 antigen (also referred to as anti-Kell, or anti-K) alloimmunisation is the second most common cause of severe haemolytic disease of the fetus and newborn, after anti-rhesus D antigen, and can cause substantial fetal morbidity and mortality. Both fetal erythropoietic suppression and haemolysis contribute to anaemia. Typically, once a clinically significant alloantibody is identified during pregnancy, antibody titration is performed as a screening test to predict the risk of anaemia and the need for maternal-fetal medicine referral. The titre is a semiquantitative laboratory method based on the underlying principle that increased maternal antibody concentrations are associated with an increased risk of fetal anaemia. Because some studies report that anti-K alloantibodies can lead to severe anaemia even at a low antibody titration, guidelines are inconsistent with respect to the role of titration testing. Some experts recommend maternal-fetal medicine referral and middle cerebral artery Doppler ultrasound without titration testing or with the use of a very low cutoff titre. This Viewpoint evaluates management for pregnancies affected by anti-K alloantibodies and highlights literature regarding the predictive value of anti-K titration testing.</p>","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":null,"pages":null},"PeriodicalIF":15.4000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Haematology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/S2352-3026(24)00239-4","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Anti-KEL1 antigen (also referred to as anti-Kell, or anti-K) alloimmunisation is the second most common cause of severe haemolytic disease of the fetus and newborn, after anti-rhesus D antigen, and can cause substantial fetal morbidity and mortality. Both fetal erythropoietic suppression and haemolysis contribute to anaemia. Typically, once a clinically significant alloantibody is identified during pregnancy, antibody titration is performed as a screening test to predict the risk of anaemia and the need for maternal-fetal medicine referral. The titre is a semiquantitative laboratory method based on the underlying principle that increased maternal antibody concentrations are associated with an increased risk of fetal anaemia. Because some studies report that anti-K alloantibodies can lead to severe anaemia even at a low antibody titration, guidelines are inconsistent with respect to the role of titration testing. Some experts recommend maternal-fetal medicine referral and middle cerebral artery Doppler ultrasound without titration testing or with the use of a very low cutoff titre. This Viewpoint evaluates management for pregnancies affected by anti-K alloantibodies and highlights literature regarding the predictive value of anti-K titration testing.
抗 KEL1 抗原(也称为抗 Kell 或抗 K)同种免疫是继抗恒河猴 D 抗原之后导致胎儿和新生儿严重溶血病的第二大常见原因,可导致胎儿大量发病和死亡。胎儿红细胞生成抑制和溶血都会导致贫血。通常情况下,一旦在妊娠期间发现有临床意义的同种异体抗体,就会进行抗体滴定作为筛查试验,以预测贫血的风险和母胎医学转诊的需要。抗体滴定是一种半定量实验室方法,其基本原理是母体抗体浓度的增加与胎儿贫血风险的增加有关。由于一些研究报告称,即使抗体滴度较低,抗 K 同种抗体也会导致严重贫血,因此关于滴度检测作用的指南并不一致。一些专家建议进行母胎医学转诊和大脑中动脉多普勒超声检查,而不进行滴定检测或使用非常低的滴定线。本视点评估了受抗K抗体影响的妊娠管理,并重点介绍了有关抗K滴定检测预测价值的文献。
期刊介绍:
Launched in autumn 2014, The Lancet Haematology is part of the Lancet specialty journals, exclusively available online. This monthly journal is committed to publishing original research that not only sheds light on haematological clinical practice but also advocates for change within the field. Aligned with the Lancet journals' tradition of high-impact research, The Lancet Haematology aspires to achieve a similar standing and reputation within its discipline. It upholds the rigorous reporting standards characteristic of all Lancet titles, ensuring a consistent commitment to quality in its contributions to the field of haematology.