1
|
Karafin MS, Glisch C, Souers RJ, Hudgins J, Park YA, Ramsey GE, Lockhart E, Pagano MB. Use of Fetal Hemoglobin Quantitation for Rh-Positive Pregnant Females: A National Survey and Review of the Literature. Arch Pathol Lab Med 2019; 143:1539-1544. [PMID: 31173529 DOI: 10.5858/arpa.2018-0523-cp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The Kleihauer-Betke (KB) test is validated for estimating the dose of Rh immune globulin needed for Rh-negative pregnant females. However, some clinicians are also ordering the test for Rh-positive women. The degree to which this practice occurs is unknown. OBJECTIVE.— To evaluate the number of laboratories that perform the KB test on Rh-positive pregnant women, and to establish current ordering practices for this indication. DESIGN.— We added 9 supplemental questions regarding KB test use for fetomaternal hemorrhage to the 2016 College of American Pathologists proficiency test survey. We also reviewed the available literature regarding the diagnostic utility of the KB test for Rh-positive women. RESULTS.— A total of 1578 surveys were evaluated and revealed that 52% (824) of respondents perform these tests for Rh-positive women, and more than 50% (440 of 819; 53.7%) of these laboratories report that the results for Rh-positive women are treated as important or very important. CONCLUSIONS.— The KB test is commonly used for Rh-positive women, and the information obtained from the test is considered as urgent and important. However, the available literature in support of this practice is still nonconclusive.
Collapse
Affiliation(s)
- Matthew S Karafin
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Chad Glisch
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Rhona J Souers
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Jay Hudgins
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Yara A Park
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Glenn E Ramsey
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Evelyn Lockhart
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | - Monica B Pagano
- From the Medical Sciences Institute, BloodCenter of Wisconsin, part of Versiti, Milwaukee (Dr Karafin); the Department of Pathology, Medical College of Wisconsin, Milwaukee (Dr Karafin); the Department of Internal Medicine, University of Iowa, Iowa City (Dr Glisch); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, University of Southern California, Los Angeles (Dr Hudgins); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Park); the Department of Pathology, Northwestern University, Chicago, Illinois (Dr Ramsey); the Department of Pathology, University of New Mexico Health Science Center, Albuquerque (Dr Lockhart); and the Department of Laboratory Medicine, University of Washington, Seattle (Dr Pagano)
| | | |
Collapse
|
3
|
Perslev A, Jørgensen FS, Nielsen LK, Berkowicz A, Dziegiel MH. Fetomaternal hemorrhage in women undergoing elective cesarean section. Acta Obstet Gynecol Scand 2010; 90:253-7. [PMID: 21306311 DOI: 10.1111/j.1600-0412.2010.01045.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the degree of fetomaternal hemorrhage (FMH) caused by elective cesarean section. DESIGN Descriptive study. SETTINGS University Hospitals in Copenhagen, Denmark. POPULATION Women scheduled for elective cesarean section, in the period September 2007 to January 2009, at the Department of Gynecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Denmark. METHODS Two maternal blood samples were taken, the first before cesarean section and the second immediately after. Both samples were analyzed at the Blood Bank, Rigshospitalet, Copenhagen, for the presence of fetal red blood cells (fRBCs) using flow cytometry. FMH associated with cesarean section was defined as the difference between the volumes of fRBCs in the two samples. MAIN OUTCOME MEASURES The frequency and volume of FMH caused by elective cesarean section. RESULTS 207 women were included in the study. FMH was detected in 38 cases (18.4%). Of these, 22 women (10.6%) had FMH of less than 1 ml fRBCs, 13 women (6.3%) had FMH between 1 and 4 ml fRBCs, and three women (1.4%) had FMH above 4 ml fRBCs. CONCLUSIONS We found no evidence for recommending general screening for FMH in connection with elective cesarean section, provided guidelines such as the current Danish guidelines for Rhesus prophylaxis are followed.
Collapse
Affiliation(s)
- Anette Perslev
- Department of Gynecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
5
|
Weisberg L, Kingdom J, Keating S, Ryan G, Seaward G, Kelly E, Okun N, Windrim R. Treatment Options in Fetomaternal Hemorrhage: Four Case Studies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004; 26:893-8. [PMID: 15507200 DOI: 10.1016/s1701-2163(16)30140-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Significant fetomaternal hemorrhage (FMH) is an uncommon event that places the fetus at risk of severe morbidity and mortality. Symptoms and signs at presentation are subtle and, if promptly recognized, appropriate management may permit the fetus to escape serious injury. CASES Four cases of significant FMH were diagnosed in the high-risk obstetrical unit at Mount Sinai Hospital, Toronto, during 2003. Three of the women complained of reduced fetal movements and were investigated initially with a non-stress test, a Kleihauer-Betke test, and ultrasound, including Doppler of the middle cerebral artery. These women all required emergency Caesarean section for non-reassuring fetal status. One fetus was treated by intravascular transfusion. Another identified case was transfused postnatally. One asymptomatic case was identified after spontaneous vaginal birth and also treated by neonatal transfusion. Neurological outcomes were good in all four cases. CONCLUSIONS Reduced fetal movements may be the only complaint of FMH. Increased awareness is required to ensure a diagnosis is made. When a non-stress test for reduced fetal movement is non-reactive, a Kleihauer-Betke test should be ordered, as well as detailed ultrasonography, including fetal Doppler studies. The perinatal prognosis for FMH may improve by facilitating the appropriate use of fetal blood transfusion or delivery by Caesarean section.
Collapse
Affiliation(s)
- Lori Weisberg
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto,Toronto, ON
| | | | | | | | | | | | | | | |
Collapse
|
6
|
David M, Smidt J, Chen FCK, Stein U, Dudenhausen JW. Risk factors for fetal-to-maternal transfusion in Rh D-negative women--results of a prospective study on 942 pregnant women. J Perinat Med 2004; 32:254-7. [PMID: 15188800 DOI: 10.1515/jpm.2004.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the incidence of severe fetal-to-maternal transfusion after delivery and to identify risk factors. MATERIAL AND METHODS In a prospective study at the Department of Obstetrics, Charité, Campus Virchow-Klinikum, Berlin, Germany, we analyzed the incidence of severe fetal-to-maternal transfusion (>10 ml) and fetal-to-maternal hemorrhage (>25 ml) in Rh D-negative pregnant women after delivery of Rh D-positive infants. 942 women were included in the study and Kleihauer-Betke tests were performed. The results were compared to perinatal data. RESULTS Fetal-to-maternal hemorrhage occurred in 13 cases out of 942 (incidence of 1.3%) and severe fetal-to-maternal transfusion in 61 cases (6.5%). In all of the cases with fetal-to-maternal hemorrhage, mothers were compatible with their infants in ABO-system. The incidence of fetal-to-maternal transfusion and its severe form was significantly higher in twin pregnancies (7/21 cases and 5/21 cases respectively, 33.3% and 23.8%) than in singleton pregnancies (22.5%, and 5.9%, P<0.001). All other factors, such as maternal age, parity, ethnicity, mode of delivery, presentation, duration of first and second stage of labor, CTG, or Apgar score were not associated with an increased risk of severe fetal-to-maternal transfusion. CONCLUSIONS Twin pregnancy is the only independent risk factor for severe fetal-to-maternal transfusion. ABO-incompatibility between mother and infant seems to be protective against Rh D-alloimmunization.
Collapse
Affiliation(s)
- Matthias David
- Universitätsklinikum Charité, Klinik für Frauenheilkunde und Geburtshilfe, Campus Virchow-Klinikum, Berlin, Germany.
| | | | | | | | | |
Collapse
|
8
|
Abstract
The etiology, clinical presentation, obstetrical antecedents, and outcome of pregnancies complicated by large fetomaternal hemorrhage (FMH) were reviewed by doing a MEDLINE search from 1966 to the present and manual search before 1966. One hundred thirty-four infants with FMH > 50 dl were reported in the literature. The primary variables: birth weight, gestational age, presence of sinusoidal fetal heart rate pattern, decrease or absent fetal body movements (FBM) estimated the amount of fetomaternal bleeding and the pretransfusion hemoglobin. Other variables included the condition of the infants at birth, erythroblasts, and reticulocyte blood counts at birth, as well as the year of publication. Thirty-five of the 134 cases were preterm. Twenty infants born to mothers reporting decreased or absent FBM survived. FBM was absent in 17 cases for a period ranging between 24 hours and 7 days. In this group, six infants survived, five were stillborn, and five died in the neonatal period. A sinusoidal heart rate (SHR) pattern was reported in 21 cases. A SHR pattern was associated with decreased FBM in 13 cases (39.3 percent). Fifteen cases with sinusoidal fetal heart rate pattern survived (71.4 percent). Both decreased or absent FBM and SHR patterns were reported more often in 1990 or later than before 1990 (P < .0017 and P < .008, respectively). The cause of FMH was not known in 82 percent of the cases. The most common presenting symptoms of FMH were anemia at birth (35.2 percent), decreased or absent FBM (26.8 percent), and unexpected stillbirths (12.5 percent). Seventeen intrauterine transfusions were performed in nine cases (eight survived). A negative correlation was found between pretransfusion hemoglobin and FMH (r = -0.35; P = .0019). No significant difference was found between the cases with FMH of > 200 ml or < 200 ml. Thus, decreased or absent FBM, SHR pattern, or hydrops fetalis are late signs of FMH. Other means of early detection are needed. The role of intrauterine transfusion (IUT) needs to be better defined. The inadequate outcome data indicate the need to follow infants born with large FMH into childhood to document the effect on the central nervous system.
Collapse
Affiliation(s)
- G P Giacoia
- Department of Pediatrics, University of Oklahoma College of Medicine, Tulsa, USA
| |
Collapse
|