title: False positive Kleihauer tests and unnecessary administration of anti-D immunoglobulin.
abstract: This obstetric case shows two false negative Kleihauer tests and two persistently positive Kleihauer tests leading to unnecessary administration of anti-D immunoglobulin. A diagnosis of hereditary persistence foetal haemoglobin (HPFH) was only confirmed by access to flow cytometry making use of both anti-HbF and anti-D labels. The case highlights the importance of a high index of clinical suspicion for HPFH and the importance of access to flow cytometry estimation of minor RhD red cell populations postnatally in RhD-negative mothers.
authors.affiliation: Obstetrics and Gynaecology, Altnagelvin Area Hospital, Londonderry, Northern Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Iyer
authors.forename: B
authors.initials: B
authors.lastname: McElhinney
authors.forename: N
authors.initials: N
authors.lastname: Heasley
authors.forename: M
authors.initials: M
authors.lastname: Williams
authors.forename: K
authors.initials: K
authors.lastname: Morris
mesh_terms: D000328:Adult; D001787:Blood Group Incompatibility / Q000175:diagnosis*; D003951:Diagnostic Errors; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis* / Q000276:immunology; D005331:Fetomaternal Transfusion / Q000097:blood / Q000175:diagnosis*; D005434:Flow Cytometry; D016650:Fluorescein-5-isothiocyanate; D006403:Hematologic Tests; D006453:Hemoglobinopathies / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D008297:Male; D010298:Parity; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis*; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use*; D019564:Unnecessary Procedures
chemical_list: D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; D005319:Fetal Hemoglobin; D016650:Fluorescein-5-isothiocyanate