Re: OB: Kidd JK(A) sensitization
From: zygote@icsi.net
Wed Sep 17 10:26:13 2003
All of the raw data is in others hands. I have the graphic data of the ROC since I
presented it at IFMSS meeting and Fetoscopy study group. I will atempt to find it and
send. The simple use of Maximal PSV is the reliable method. I have no experience with
spectral analysis. The simplicity of the MCA-PSV is its most redeeming and accurate
point. It really prevents >90% of invasive procedures with attendant PROM, amnionitis,
discomfort etc. Hope this helps.
On 16 Sep 2003 at 13:22, Terrence.Jones@kp.org wrote:
>
> 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
>
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
|
|
