title: Fetal-Maternal Hemorrhage Detected by Sudden Disappearance of Rh Immune Globulin-Related Anti-D.
abstract: BACKGROUND
  Fetal-maternal hemorrhage is usually spontaneous and goes undetected but can be associated with adverse perinatal outcomes.
  
  
  METHODS
  We describe the detection of a fetal-maternal hemorrhage by abrupt disappearance of prophylactic anti-D on antibody screen in an Rh-negative mother with dichorionic twins admitted for atrial flutter of one twin. Both rosette and Kleihauer-Betke tests were positive. The diagnosis was confirmed by anemia in one twin at birth.
  
  
  CONCLUSIONS
  Fetal-maternal hemorrhage requires a high index of suspicion for diagnosis. An unexpected sudden decline in Rh immune globulin-related anti-D may be an indication of fetal-maternal hemorrhage.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, and the Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: King
authors.forename: Gary D
authors.initials: GD
authors.lastname: Zeger
authors.forename: Natalie
authors.initials: N
authors.lastname: Plaza
authors.forename: Richard H
authors.initials: RH
authors.lastname: Lee
authors.forename: Ira A
authors.initials: IA
authors.lastname: Shulman
mesh_terms: D000328:Adult; D005260:Female; D005331:Fetomaternal Transfusion / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000097:blood* / Q000627:therapeutic use; D011247:Pregnancy; D059285:Pregnancy, Twin; D012203:Rh Isoimmunization / Q000097:blood / Q000517:prevention & control*; D018029:Rho(D) Immune Globulin / Q000097:blood* / Q000627:therapeutic use
chemical_list: D007155:Immunologic Factors; D018029:Rho(D) Immune Globulin