Massive antenatal fetomaternal hemorrhage: evidence for long-term survival of fetal red blood cells.
BACKGROUND
Massive fetomaternal hemorrhage (FMH) can lead to life-threatening anemia. Quantification based on flow cytometry with anti-hemoglobin F (HbF) is applicable in all cases but underestimation of large fetal bleeds has been reported. A large FMH from an ABO-compatible fetus allows an estimation of the life span of fetal red blood cells (RBCs) in the maternal circulation.


METHODS
The mother went to the obstetrician twice antepartum owing to symptoms assumed to be preeclampsia; that, however, was not found. She later delivered by cesarean section owing to diminished fetal movements. No fetal weight gain was observed during the last 2 weeks of pregnancy.


METHODS
Fetal RBCs were quantified by flow cytometry with anti-HbF, anti-Fy(a), anti-s, and anti-Jk(b) on a regular basis.


RESULTS
The infant had anemia at delivery and an FMH was determined to be 314 +/- 17 mL (+/- SD) of whole blood. It is assumed that the two antenatal visits were associated with the FMH. Postpartum follow-up showed that fetal RBCs in the maternal circulation were detectable with anti-HbF up to 119 days. Quantification by flow cytometry based on anti-HbF was in agreement with quantification based on anti-Fy(a), anti-s, and anti-Jk(b), although they were less sensitive.


CONCLUSIONS
ABO-compatible fetal RBCs from an FMH had a life span in the maternal circulation close to that of adult RBCs.
Dziegiel
Morten H
MH
H:S Blood Bank KI2034, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. dzielgiel@rh.dk
Koldkjaer
Ole
O
Berkowicz
Adela
A
D000328:Adult; D002470:Cell Survival; D004912:Erythrocytes / Q000166:cytology / Q000276:immunology; D005260:Female; D005312:Fetal Blood / Q000276:immunology*; D005319:Fetal Hemoglobin / Q000276:immunology*; D005331:Fetomaternal Transfusion / Q000097:blood* / Q000276:immunology*; D005434:Flow Cytometry; D006801:Humans; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D013997:Time Factors
D005319:Fetal Hemoglobin