Persistent fetal hemoglobin in maternal circulation complicating the diagnosis of fetomaternal hemorrhage.
BACKGROUND
Transplacental hemorrhage can be life threatening to a fetus and has important maternal treatment implications. In contrast, hereditary persistence of fetal hemoglobin is a condition that has little consequence. The Kleihauer-Betke test, which is routinely used to document transplacental hemorrhage, will be positive in either case.


METHODS
We report two cases in which maternal persistence of fetal hemoglobin was unknown and led to the erroneous diagnosis of fetomaternal hemorrhage. These cases highlight both the limitations of the Kleihauer-Betke test and the role of flow cytometry in diagnosing fetomaternal hemorrhage.


CONCLUSIONS
The use of flow cytometry can clarify Kleihauer-Betke test results when there is known maternal persistence of fetal hemoglobin and can more precisely quantify a fetomaternal hemorrhage for accurate Rh immune globulin dosing.
Kush
Michelle L
ML
Center for Advanced Fetal Care, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland, Baltimore 21201, USA. michellekush@yahoo.com
Muench
Michael V
MV
Harman
Christopher R
CR
Baschat
Ahmet A
AA
D015746:Abdominal Pain / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D005331:Fetomaternal Transfusion / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006454:Hemoglobins; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology
D006454:Hemoglobins