A colleague wonders why hospital transfusion services in the US do not routinely match RBC units that are intended for transfusion of women of reproductive age for the Kell antigen. She believes that such a practice would potentially decrease some cases of Kell hemolytic disease in pregnancy which has been associated with severe fetal anemia.

The following comments have been received.

1. The Editor thinks that e-Network Forum colleagues might find the following articles to be germane to the present discussion:

• van Aken WG, Christiaens GC. Prevention, diagnosis and treatment of blood group immunization during pregnancy. Ned Tijdschr Geneeskd. 1999;143:2507-10.
• van Dijk BA, Hirasing RA, Overbeeke MA. Hemolytic disease of the newborn and irregular blood group antibodies in the Netherlands: prevalence and morbidity. Ned Tijdschr Geneeskd. 1999;143:1465-9
  

ADDENDA Nov. 10, 2003

2. Neil Blumberg MD, Director of Transfusion Medicine/Blood Bank at the University of Rochester Medical Center (attribution used with permission), reports that he agrees that giving red cells lacking the K antigen to K negative women of childbearing age makes sense for preventing future hemolytic disease of the newborn. It also makes sense to avoid CcEe sensitization for the same reason. At his institution, they made the observation a few decades ago that Rh and K blood groups accounted for 87% of the clinically significant antibodies seen in transfused patients (Reference: "Should chronic transfusions be matched for antigens other than ABO and Rh (D)? Vox Sanguinis 47:205-208,1984). Dr. Blumberg later suggested that giving antigen-restricted units only to patients with sickle cell anemia and ignoring women of childbearing age made no social or clinical sense (Reference: "Beyond ABO and D antigen matching: how far and for whom? Transfusion 30:482-484,1990 - no abstract). He points out that in his experience the problem is that bleeding among women of childbearing age is usually due to obstetric disaster or trauma, and antigen-matched units are difficult to provide on short notice. On the other hand transfusions to patients with sickle cell anemia or thalassemia are usually elective or semi-elective. He concludes saying that it would be nice to provide antigen-matched blood to all women under the age of 45 or 50, but the practical considerations are that this isn't likely to happen. Making an effort to do so for girls and young women would be desirable but requires more resources than his institution currently has.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator