Two cases of asymptomatic massive fetomaternal hemorrhage.
Evaluation of fetomaternal hemorrhage (FMH) in the immediate postpartum period is critical for the timely administration of Rh immunoglobulin (RhIG) prophylaxis to minimize the risk of alloimmunization in D-negative mothers of D-positive newborns. We report a series of two clinically-unsuspected cases of massive FMHs identified at our university medical center. Retrospective records of two cases of massive FMH were investigated using the electronic medical record. After positive fetal bleed screens, flow cytometric analysis for hemoglobin F was performed to quantify the volume of the hemorrhages in both cases. Flow cytometric enumeration with anti-D was also performed in one case. The two patients had 209.5 and 75 mL of fetal blood in circulation, resulting in 8 and 4 doses of RhIG administered, respectively. For the former patient, flow cytometric analysis with anti-D ruled out hereditary persistence of fetal hemoglobin and supported the fetal origin of the red cells. Due to the clinically-silent nature of both hemorrhages, further evaluation of the newborns' blood was not performed. These cases highlight the importance of rapidly obtaining accurate measurements of fetal blood loss via flow cytometric analysis in cases of FMH, particularly in clinically-unsuspected cases, to ensure timely administration of adequate immunoprophylaxis to D-negative mothers.
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
Alexis R
AR
Peedin
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
Marshall A
MA
Mazepa
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
Yara A
YA
Park
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
Eric T
ET
Weimer
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
John L
JL
Schmitz
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA. Electronic address: jay_raval@med.unc.edu.
Jay S
JS
Raval
D000328:Adult; D005260:Female; D005312:Fetal Blood; D005319:Fetal Hemoglobin / Q000276:immunology; D005331:Fetomaternal Transfusion / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*; D005434:Flow Cytometry; D006801:Humans; D007231:Infant, Newborn; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D012203:Rh Isoimmunization; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D018029:Rho(D) Immune Globulin / Q000276:immunology / Q000627:therapeutic use*; D016896:Treatment Outcome
C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; D005319:Fetal Hemoglobin
Alloimmunization; Fetomaternal; Hemorrhage; Massive