Assessment of Fetomaternal Hemorrhage by Flow Cytometry and Kleihauer-Betke Test in Rh-Negative Pregnancies

Abstract

Objectives: To assess the efficacy of flow cytometry (FC) in the detection and quantification of fetomaternal hemorrhage (FMH) in comparison to the Kleihauer-Betke test (KBT). Methods: 25 unsensitized Rh-negative mothers who had delivered Rh-positive infants were included. Presence of FMH was determined by KBT and FC using FITC-labeled BRAD-3 antibodies. Results: FMH was detected in 19 (76%) patients by FC and 23 (92%) patients by KBT prior to delivery, and in 21 (84%) patients by FC and 23 (92%) patients by KBT after delivery. The mean volume of FMH in the post-delivery samples by KBT and FC were 0.34 ± 0.26 ml (range 0.05–1.2 ml) and 0.37 ± 0.57 ml (range 0.02–2.6 ml) respectively. The volume of post-delivery FMH estimated by KBT and FC correlated well (r = 0.75; ICC α = 0.73). A higher agreement between KBT and FC was seen in the 0.1–0.5 ml range (ĸ = 0.65; p < 0.01). Conclusions: Both manual KBT and FC using FITC-BRAD-3 antibodies show good sensitivity in detecting and quantifying fetal red cells. There is a good correlation between the methods in the 0.1- to 0.5-ml range of FMH.

Assessment of feto-maternal hemorrhage among rhesus D negative pregnant mothers using the kleihauer-betke test (KBT) and flow cytometry (FCM) in Addis Ababa, Ethiopia

“…The agreement between the two methods was moderate with the kappa value (κ = 0.53; 95% CI, 000 to 0.039 p = 0.000) that show the two methods have agreement for calculating RhD + ve FMH. Our result was consistent with a study conducted by Savithrisowmya et al that verified the volume of post-delivery FMH estimated by KBT and FCM correlated well (r = 0.75; ICC α = 0.73) [ 18 ]. However, less consistent with the study conducted by Pelikan et al which showed that the agreement between the manual KBT and FCM was fair with a weighted k, 0.40; 95% CI, 0.15-0.66 and correlation (r) of 0.69 [ 19 ].…”

Fetomaternal Bleeding and Neonatal Hematocrit following Cesarean Delivery: Routine versus Transplacental Transection

“…A few studies have reported on comparisons between the KB test and flow cytometry with most showing flow cytometry to be more accurate; however, the results have not been universal. 14 15 16 17 However, the primary concern with fetomaternal hemorrhage in patients who are Rh-negative would be bleeds that exceed the threshold of one vial of Rh-hyperimmune globulin. Both tests appear to be accurate in identifying large fetomaternal bleeds.…”

Lignes directrices pour la prise en charge d'une patiente enceinte ayant subi un traumatisme

“…Les contractions utérines occasionnelles constituent la constatation la plus courante à la suite d'un traumatisme pendant la grossesse; elles se manifestent dans 40 % des cas 69 Le recours à une approche novatrice pour la détection de l'HFM (faisant appel à la cytométrie en flux à titre de solution de rechange plus simple, plus objective et plus précise au test de KB) a été préconisé 87,88 . Une autre étude a indiqué que le test manuel de KB et la cytométrie en flux comptent tous deux une bonne sensibilité pour la détection et la quantification des érythrocytes foetaux 89 . En prenant en considération que la cytométrie en flux n'est pas disponible dans la plupart des établissements médicaux et que les avantages qu'elle procure font toujours l'objet d'études, nous ne pouvons en recommander l'utilisation systématique pour l'instant.…”