Quantification of feto-maternal hemorrhage: selection of techniques for a resource-poor setting.

Abstract

BACKGROUND:

Though RhD sensitization in RhD-negative mothers is now almost eradicated in the developed world, it continues to be a major health problem in developing nations like India. Inadequate immunoprophylaxis is the main reason. Adequate dose calculation of anti-D Ig is possible through estimation of correct feto-maternal hemorrhage (FMH) volume. In this regard, different methods have been used.

METHODS:

We evaluated three quantitative techniques of estimating FMH: the Kleihauer-Betke test (KBT) and two flow cytometry (FC) techniques, i.e., the indirect immunofluorescence technique (IIFT) and direct immunofluorescence technique (DIFT). Stock solutions of both RhD-positive and D-negative cells were made, and 7 serial dilutions of RhD-positive cord cells in D-negative adult cells were prepared.

RESULT:

Both KBT and FC approximated the expected concentration of fetal RhD-positive cells in all mixtures tested. In both methods, an underestimation of fetal RhD-positive cells was observed when their expected concentration was ≥0.75%.

CONCLUSION:

Though FC is the most sensitive of all techniques, very few laboratories in developing nations can afford such a costly device, so it will be prudent for them to use KBT as the gold standard due to its rapidity, simplicity and affordability.

• Authors: Prashant Agarwal, Sudipta Sekhar Das, Ritu Gupta, Dheeraj Khetan, Rajendra Chaudhary
• Journal: Gynecologic and obstetric investigation (Gynecol Obstet Invest) Vol. 71 Issue 1 Pg. 47-52 ( 2011) ISSN: 1423-002X [Electronic] Switzerland
• PMID: 21160194 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2010 S. Karger AG, Basel.

Chemical References

• Rh-Hr Blood-Group System

Topics

• Erythroblastosis, Fetal (diagnosis)
• Female
• Fetomaternal Transfusion (diagnosis)
• Flow Cytometry (methods, standards)
• Fluorescent Antibody Technique, Direct (methods, standards)
• Humans
• India
• Linear Models
• Medically Underserved Area
• Pregnancy
• Prenatal Diagnosis (methods, standards)
• Reproducibility of Results
• Rh-Hr Blood-Group System
• Sensitivity and Specificity