Flow cytometry in diagnosis and management of large fetomaternal haemorrhage.
OBJECTIVE
To evaluate an indirect immunofluorescence flow cytometry technique in a series of patients with large fetomaternal haemorrhage (FMH).


METHODS
Patient samples identified by Kleihauer testing in local laboratories as having FMH > 4 ml were sent for flow cytometric analysis. In a proportion of cases the mothers received anti-D immunoglobulin prophylaxis according to the flow cytometer estimate of FMH volume.


RESULTS
Forty three cases of FMH were studied prospectively. The correlation between Kleihauer and flow cytometry results was poor. In 38 (88%) cases the size of FMH quantitated by flow cytometry was lower than that estimated using the Kleihauer technique. In 13 (30%) cases no Rh D immunoglobulin positive cells were detected by flow cytometry. Centralised review of the original Kleihauer films using a calibrated microscope resulted in improved, but still suboptimal correlation with flow cytometry results. In 15 cases anti-D immunoglobulin was given according to the flow cytometer estimation of FMH size, resulting in a 58% reduction in the amount of anti-D immunoglobulin given. None of the patients were immunised when tested six months later.


CONCLUSIONS
Flow cytometry is helpful for the accurate quantitation and management of patients with large FMH and in cases where the presence of maternal haemoglobin F containing cells renders the Kleihauer technique inaccurate. Worthwhile reductions in the use of anti-D immunoglobulin can be achieved.
Manchester Blood Centre, Plymouth Grove.
P R
PR
Johnson
R C
RC
Tait
E B
EB
Austin
K H
KH
Shwe
D
D
Lee
D002469:Cell Separation / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis; D005331:Fetomaternal Transfusion / Q000175:diagnosis* / Q000628:therapy; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage / Q000032:analysis
D018029:Rho(D) Immune Globulin; D005319:Fetal Hemoglobin