Fetal ascites detected by ultrasound as a presenting sign to anti-kell isoimmune disease

A woman who developed anti-kell antibodies following blood transfusion during the course of labor of her first pregnancy, is presented. Delay in diagnosis of maternal sensitization caused intrauterine fetal death in her next two consecutive pregnancies. A routine ultrasonographic examination revealed fetal ascites in her present (third) pregnancy, and it was the starting point for maternal antibodies screening. A high anti-kell titer confirmed the diagnosis of hydrops fetalis due to anti-kell isoimmune disease. It is recommended that a routine blood typing of minor blood groups antigens (C, E, Kell) should be performed in woman with Rh positive who have a blood transfusion during their child-bearing years. Those transfused women should have close follow-up in their first pregnancy - including early serum screening for irregular antibodies and ultrasonographic examination. When isoimmunization occurs it should be managed with the same attention one would give to patients with Rh (O) sensitization.