title: Quantification of feto-maternal hemorrhage: selection of techniques for a resource-poor setting.
abstract: BACKGROUND
  Though RhD sensitization in RhD-negative mothers is now almost eradicated in the developed world, it continues to be a major health problem in developing nations like India. Inadequate immunoprophylaxis is the main reason. Adequate dose calculation of anti-D Ig is possible through estimation of correct feto-maternal hemorrhage (FMH) volume. In this regard, different methods have been used.
  
  
  METHODS
  We evaluated three quantitative techniques of estimating FMH: the Kleihauer-Betke test (KBT) and two flow cytometry (FC) techniques, i.e., the indirect immunofluorescence technique (IIFT) and direct immunofluorescence technique (DIFT). Stock solutions of both RhD-positive and D-negative cells were made, and 7 serial dilutions of RhD-positive cord cells in D-negative adult cells were prepared.
  
  
  RESULTS
  Both KBT and FC approximated the expected concentration of fetal RhD-positive cells in all mixtures tested. In both methods, an underestimation of fetal RhD-positive cells was observed when their expected concentration was ≥0.75%.
  
  
  CONCLUSIONS
  Though FC is the most sensitive of all techniques, very few laboratories in developing nations can afford such a costly device, so it will be prudent for them to use KBT as the gold standard due to its rapidity, simplicity and affordability.
authors.affiliation: Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. prashant@sgpgi.ac.in
authors.forename: Prashant
authors.initials: P
authors.lastname: Agarwal
authors.forename: Sudipta
authors.initials: S
authors.lastname: Sekhar Das
authors.forename: Ritu
authors.initials: R
authors.lastname: Gupta
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Khetan
authors.forename: Rajendra
authors.initials: R
authors.lastname: Chaudhary
mesh_terms: D004899:Erythroblastosis, Fetal / Q000175:diagnosis*; D005260:Female; D005331:Fetomaternal Transfusion / Q000175:diagnosis*; D005434:Flow Cytometry / Q000379:methods* / Q000592:standards; D019085:Fluorescent Antibody Technique, Direct / Q000379:methods* / Q000592:standards; D006801:Humans; D007194:India; D016014:Linear Models; D008507:Medically Underserved Area; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012204:Rh-Hr Blood-Group System; D012680:Sensitivity and Specificity
chemical_list: D012204:Rh-Hr Blood-Group System