Assessment of fetal-maternal haemorrhage in mothers with hereditary persistence of fetal haemoglobin.
Kleihauer examination of peripheral blood cannot be used reliably to detect transplacental fetal-maternal haemorrhage in mothers with hereditary persistence of fetal haemoglobin (HPFH). In Rh(D) negative pregnancies diagnostic confusion with a large fetal-maternal haemorrhage could result in the administration of inappropriately excessive amounts of anti-D immunoglobulin, and the inability to diagnose and quantify transplacental haemorrhage in maternal HPFH by current methods could result in insufficient anti-D administration and subsequent Rh(D) sensitisation. Accordingly, a method to detect and quantify fetal-Rh(D) positive maternal haemorrhage using erythrocyte fluorescent immunocytometry was developed. An indirect immunofluorescence method with IgG anti-D immunoglobulin as the primary antibody was used, combined with quantitative analysis on a fluorescence activated cell sorter. The method was accurate, specific, and sensitive and could detect a contaminating population of 0.1% Rh(D) positive cells in Rh(D) negative blood--a level of fetal-maternal haemorrhage well covered by a single dose of 500 IU of anti-D immunoglobulin.
Department of Haematology, Queen Elizabeth Hospital, Edgbaston.
W N
WN
Patton
G S
GS
Nicholson
A H
AH
Sawers
I M
IM
Franklin
F A
FA
Ala
A W
AW
Simpson
D000328:Adult; D002469:Cell Separation; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis*; D005331:Fetomaternal Transfusion / Q000175:diagnosis*; D005434:Flow Cytometry; D006453:Hemoglobinopathies / Q000235:genetics*; D006801:Humans; D007074:Immunoglobulin G; D007136:Immunoglobulins; D007518:Isoantibodies; D010455:Peptides / Q000097:blood; D011247:Pregnancy; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin
D007074:Immunoglobulin G; D007136:Immunoglobulins; D007518:Isoantibodies; D010455:Peptides; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen; D005319:Fetal Hemoglobin