OB-GYN-L Messages for September, 2003: Re: OB: Kidd JK(A) sensitization

Re: OB: Kidd JK(A) sensitization
From: Terrence.Jones@kp.org
Tue Sep 16 13:19:43 2003

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Robert, wonderful work to provide improved safety to patients with hemolytic dis. Do You have ROCC's ( or C statistic) on Timed average mean (TAM) velocity (St Michael's) Vs peak systolic? Are You moving to diastolic (deceleration angle)? or mutigated spectral? Have You looked at fetal splenic perimeter (sequestration + hematopoiesis) to reduce false positive? Any (human) experience with early onset severe disease in prior preg, and paternal leukocyte injxn to buy time 'till IUT is technically feasible? Is viscosity ever sufficiently low to see turbulent flow at aortic root or branch points? Has Dr. Copel evaluated rt atrial diameter? tj
zygote@icsi.net Sent by: ob-gyn-l@obgyn.net 09/12/2003 12:12 PM Please respond to ob-gyn-l
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> cc: Subject: Re: OB: Kidd JK(A) sensitization
Sir, it is unlike that your fetus will require a transfusion. Most Kidds have low level hemolysis at best. If fetal blood sampling is performed and the fetus has it, you need to find a center who will do middle cerebral artery Doppler PSV, and NOT!!!!!! amnio every two weeks. If they say they are going to do the latter, find another doctor. If interested go to the article we published in the 1/2/2000 New England Journal for details of MCA- PSV determination and its reliability. Hope this helps!
No address for mr. waxman, if someone knows how to contact him, please forward this to him. Thanks. RJC
On 12 Sep 2003 at 12:57, m.r. waxman wrote:
> At Wed, 8 Nov 2000, ainsron@msn.com wrote:
> >
> >Obstetrics & Gynecology, February 1997, Volume 89, Number 2
> >Pages 272 - 275
> >
> >Female Alloimmunization With Antibodies Known to Cause Hemolytic
Disease > >Ossie Geifman-Holtzman, MD,a Martha Wojtowycz, PhD,a Eleni Kosmas,a and
> >Raul Artal, MDa
> >
> >Objective: To determine the current frequency of red blood cell antigen
> >alloimmunizations that are capable of causing hemolytic disease and
> >would be suitable for prenatal DNA studies.
> >
> >Methods: We reviewed blood-bank records at a single large tertiary
> >center to identify patients with a positive antibody screen between
> >January 1993 and June 1995. Data were analyzed based on age, gender,
> >and specific blood-group alloimmunizations. The incidence of
antibodies > >as published in the literature was reviewed and compared with our data.
> >
> >Results: We identified 452 women who had a positive antibody screen.
The > >frequencies of specific alloimmunization relevant to the development of
> >fetal hemolytic disease were: anti-D, 18.4%; anti-E, 14%; anti-c, 5.8%;
> >anti-C, 4.7%; Kell group, 22%; anti-MNS, 4.7%; anti-Fya (Duffy), 5.4%;
> >and anti-Jka, 1.5%. Compared with other populations, in our group the
> >frequency of antibodies to RhD decreased and Kell alloimmunization
> >increased between 1967 and 1996.
> >
> >Conclusions: Despite the use of rhesus immune globulin, anti-D is still
> >a common antibody identified in women presenting to a tertiary care
> >center. The frequency of the Kell-group alloimmunization is higher
> >among the central New York female population than in other populations.
> >Rhesus and Kell antigen status can be determined by DNA studies.
> >Research in prenatal determination of fetal antigen status should
> >continue, as alloimmunization to these antigens is common.
> >
> >This article also had a table listing the frequency of the different
> >antibodies from five other studies.
> >
> >>I'm looking online, but does anyone have any thoughts/reference on the
> >>frequency of Kidd antigen positivity/negativity in the population
(this > >>is US, caucasian)?
> >>
> >>Garry
> >>
> >>(BTW, the couple is young, together since age 16, very rural, and
while > >>nice/polite/churchgoer types, isn't among the leaders in RAM or hard
> >>drive space up top. That said, as I explained this, drew pictures,
used > >>analogies such an bee stings (antibodies and antigens), she seemed to
> >>get it, but kind of looked up and asked me, "Now why did you ask me if
I > >>was the father of the other pregnancies?" It was all I could do to
keep > >>a smirk off of my face.)
> >>
> >>--
> >>Garry E. Siegel, M.D., F.A.C.O.G.
> >>Roswell, GA
> >>Private Practice
> >>
> >--
> >Ronald E. Ainsworth, MD
> >
>
> --
> Hello, My wife and I are experiencing some difficulty with JKa (Kidd a)
. In her previous marriage she developed this titer-antibody, the baby was prematur, with her last titer of 1:16. > The child eventually died of SIDS at 5 1/2 months. It has been 5 yrs.
and now we have decided to have a baby. But foolishly did not get blood test done to see if we were compatable. > She is 13 wks. and the doctors have given us a blood test which
indicates I also carry this JKa. The odds of this seem low. Now we are left with no clear information on what can happen. > We understand the protocal for this is a blood test at 20 wks, amnio's,
possible invetro blood transfusion, and post-birth blood transfussion. The pregnancy she carried to term, he > developed a high billiruiban level, was put on a "Wallaby" lite. Could
you please help us find more information on this. We live in a rural area in Colorado,(south west corner) the Doctors do not > feel they will be able to care for this pregnancy if the titer rises.
Please help us find more information than its rare. >

Robert J. Carpenter, Jr., M.D. St. Luke's Medical Tower # 2720 6624 Fannin, Houston, TX 77030 zygote@icsi.net 713-795-4600 FAX:713-795-4422
--=_alternative 0061E11D88256DA3_ Content-Type: text/html; charset="us-ascii"
 Robert, wonderful work to provide improved safety to patients with hemolytic dis. Do You have ROCC's ( or C statistic) on Timed average mean (TAM) velocity (St Michael's) Vs peak systolic? Are You moving to diastolic (deceleration angle)? or mutigated spectral? Have You looked at fetal splenic perimeter (sequestration + hematopoiesis) to reduce false positive? Any (human) experience with early onset severe disease in prior preg, and paternal leukocyte injxn to buy time 'till IUT is technically feasible? Is viscosity ever sufficiently low to see turbulent flow at aortic root or branch points? Has Dr. Copel evaluated rt atrial diameter? tj <table width0%> <tr valign=top> <td> <td>zygote@icsi.net Sent by: ob-gyn-l@obgyn.net 09/12/2003 12:12 PM Please respond to ob-gyn-l <td>                To:        Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>         cc:                 Subject:        Re: OB:  Kidd JK(A) sensitization</table> Sir, it is unlike that your fetus will require a transfusion. Most Kidds have low level hemolysis at best. If fetal blood sampling is performed and the fetus has it, you need to find a center who will do middle cerebral artery Doppler PSV, and NOT!!!!!! amnio every two weeks. If they say they are going to do the latter, find another doctor. If interested go to the article we published in the 1/2/2000 New England Journal for details of MCA- PSV determination and its reliability. Hope this helps! No address for mr. waxman, if someone knows how to contact him, please forward this to him. Thanks. RJC On 12 Sep 2003 at 12:57, m.r. waxman wrote: > At Wed,  8 Nov 2000, ainsron@msn.com wrote: > > > >Obstetrics & Gynecology, February 1997, Volume 89, Number 2 > >Pages 272 - 275 > > > >Female Alloimmunization With Antibodies Known to Cause Hemolytic Disease > >Ossie Geifman-Holtzman, MD,a Martha Wojtowycz, PhD,a Eleni Kosmas,a and > >Raul Artal, MDa > > > >Objective: To determine the current frequency of red blood cell antigen > >alloimmunizations that are capable of causing hemolytic disease and > >would be suitable for prenatal DNA studies. > > > >Methods: We reviewed blood-bank records at a single large tertiary > >center to identify patients with a positive antibody screen between > >January 1993 and June 1995.  Data were analyzed based on age, gender, > >and specific blood-group alloimmunizations.  The incidence of antibodies > >as published in the literature was reviewed and compared with our data. > > > >Results: We identified 452 women who had a positive antibody screen.  The > >frequencies of specific alloimmunization relevant to the development of > >fetal hemolytic disease were: anti-D, 18.4%; anti-E, 14%; anti-c, 5.8%; > >anti-C, 4.7%; Kell group, 22%; anti-MNS, 4.7%; anti-Fya (Duffy), 5.4%; > >and anti-Jka, 1.5%.  Compared with other populations, in our group the > >frequency of antibodies to RhD decreased and Kell alloimmunization > >increased between 1967 and 1996. > > > >Conclusions: Despite the use of rhesus immune globulin, anti-D is still > >a common antibody identified in women presenting to a tertiary care > >center.  The frequency of the Kell-group alloimmunization is higher > >among the central New York female population than in other populations. > >Rhesus and Kell antigen status can be determined by DNA studies. > >Research in prenatal determination of fetal antigen status should > >continue, as alloimmunization to these antigens is common. > > > >This article also had a table listing the frequency of the different > >antibodies from five other studies. > > > >>I'm looking online, but does anyone have any thoughts/reference on the > >>frequency of Kidd antigen positivity/negativity in the population (this > >>is US, caucasian)? > >> > >>Garry > >> > >>(BTW, the couple is young, together since age 16, very rural, and while > >>nice/polite/churchgoer types, isn't among the leaders in RAM or hard > >>drive space up top.  That said, as I explained this, drew pictures, used > >>analogies such an bee stings (antibodies and antigens), she seemed to > >>get it, but kind of looked up and asked me, "Now why did you ask me if I > >>was the father of the other pregnancies?" It was all I could do to keep > >>a smirk off of my face.) > >> > >>-- > >>Garry E. Siegel, M.D., F.A.C.O.G. > >>Roswell, GA > >>Private Practice > >> > >-- > >Ronald E. Ainsworth, MD > > > > -- > Hello, My wife and I are experiencing some difficulty with JKa (Kidd a) . In her previous marriage she developed this titer-antibody, the baby was prematur, with her last titer of 1:16. > The child eventually died of SIDS at 5 1/2 months.  It has been 5 yrs. and now we have decided to have a baby. But foolishly  did not  get blood test done to see if we were compatable. > She is 13 wks. and the doctors have given us a blood test which indicates I also carry this JKa.  The odds of this seem low.  Now we are left with no clear information on what can happen. > We understand the protocal for this is a blood test at 20 wks, amnio's, possible invetro blood transfusion, and post-birth blood transfussion.  The pregnancy she carried to term, he > developed a high billiruiban level, was put on a "Wallaby" lite.  Could you please help us find more information on this.  We live in a rural area in Colorado,(south west corner)  the Doctors do not > feel they will be able to care for this pregnancy if the titer rises. Please help us find more information than its rare. > Robert J. Carpenter, Jr., M.D. St. Luke's Medical Tower # 2720 6624 Fannin, Houston, TX 77030 zygote@icsi.net 713-795-4600 FAX:713-795-4422 

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