title: Fetal-maternal hemorrhage detection in Ontario.
abstract: The results from fetal-maternal hemorrhage (FMH) detection and quantitation external quality assessment surveys conducted in Ontario indicate that the rosette test had a sensitivity and specificity for an FMH of more than 10 mL of 1.0 and 0.75, respectively, compared with 0.96 and 0.92, respectively, for acid elution. With FMH quantitation, the percentage error of the mean from the target FMH was 20% or more in 7 of 8 surveys, and coefficients of variation ranged from 39.5% to 71.8%. Inadequate Rho(D) immune globulin prophylaxis could have occurred in 19.4% of the challenges with an FMH of more than 10 mL. The rosette and acid elution techniques are both effective for the detection or exclusion of FMH, but acid elution lacks adequate accuracy and precision for reliable FMH quantitation. Furthermore, a strategy of prescribing an extra 1,500-IU Rho(D) immune globulin dose, in addition to the dose required to treat the volume of fetal blood detected, is an effective strategy to overcome the limitations of FMH quantitation by acid elution.
authors.affiliation: Hamilton Regional Laboratory Medicine Program, Hamilton.
authors.forename: John D
authors.initials: JD
authors.lastname: Lafferty
authors.forename: Anne
authors.initials: A
authors.lastname: Raby
authors.forename: Linda
authors.initials: L
authors.lastname: Crawford
authors.forename: Lori Anne
authors.initials: LA
authors.lastname: Linkins
authors.forename: Harold
authors.initials: H
authors.lastname: Richardson
authors.forename: Mark
authors.initials: M
authors.lastname: Crowther
mesh_terms: D000328:Adult; D019411:Clinical Laboratory Techniques / Q000592:standards*; D004899:Erythroblastosis, Fetal / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005331:Fetomaternal Transfusion / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control; D006306:Health Surveys; D006801:Humans; D009864:Ontario; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D011786:Quality Control; D015203:Reproducibility of Results; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use; D012397:Rosette Formation / Q000379:methods; D012680:Sensitivity and Specificity
chemical_list: D018029:Rho(D) Immune Globulin