Kleihauer testing Need not be abandoned

Love, E M; Shwe, K. H.

doi:10.1136/bmj.309.6957.805

Cited by 5 publications

(4 citation statements)

References 2 publications

(2 reference statements)

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“…Recently arguments have been advanced for (Balfour et al, 1994;Love & Shwe, 1994) and against (Duguid & Bromilow, 1994) retaining the Kleihauer test. In brief, the argument against the Kleihauer test has centred around its poor reproducibility and the case for its retention on the potential for alloimmunization in women exposed to TPH not covered by a single large dose of 1250 IU anti-D. Poor reproducibility in performing the Kleihauer is not an argument for abandoning the test, but underlines the need for standardization and QA schemes to improve performance.…”

Section: Discussionmentioning

confidence: 99%

“…At present Scottish QA experience seems to support the latter view. For larger TPH, it is suggested that flow cytometry is more accurate in estimating TPHs greater than 4 mL (Love & Shwe, 1994) which occurs in about 1% of women, but relatively few district hospital blood banks will have routine access to flow cytometry. Compared with early work from the USA which showed a very poor coefficient of variation in estimation of a 'proficiency' specimen (Polesky & Serbing, 1981), our results have shown an improved CV and it is likely that the Scottish QA programme which has been in place for the last 8 years has played a role in achieving this level of reproducibility.…”

Section: Discussionmentioning

confidence: 99%

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A quality assurance scheme for the Kleihauer test: the Scottish experience 1988–1996

Raafat¹,

Fraser²,

Main³

et al. 1997

Transfusion Medicine

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This report describes the experience gained in the last 8 years of implementing and administering a Quality Assurance Scheme dedicated to improving the reliability of Kleihauer test results in Scotland. Initially the five transfusion centres in Scotland were the only participants, but since 1992 all 15 hospital laboratories in Scotland performing the Kleihauer test to ensure an adequate dose of anti-D is administered to Rh-negative women, at risk of developing allo anti-D, have joined this voluntary scheme. As a result of the standardization of technical methods, improvement in reporting of QA results has been observed since 1994.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A quality assurance scheme for the Kleihauer test: the Scottish experience 1988–1996

Raafat¹,

Fraser²,

Main³

et al. 1997

Transfusion Medicine

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“…Recently there has been much debate regarding the measures that need to be addressed to prevent RhD iso‐immunisation 7–13 . The aim of this study was to determine the likely factors that contribute to RhD sensitisation in our region.…”

Section: Discussionmentioning

confidence: 99%

An audit of anti‐D sensitisation in Yorkshire

McSweeney

Kirkham

Vinall

et al. 1998

BJOG

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Objective To determine the likely factors that contribute to RhD sensitisation. Design Retrospective study of all new cases of RhD sensitisation occurring between 1988 and 1991.Setting Leeds Blood Centre, National Blood Service, Yorkshire. Population One hundred and forty-seven cases of RhD sensitisation from 15 obstetric units within the Yorkshire region, of which 129 (312 pregnancies) could be assessed. after delivery, RhD immunisation occurred in approximately 1% of RhD negative women. There are a number of explanations for the continued development of RhD sensitisation, including failure of administration of anti-D immunoglobulin, failure of protection despite administration of anti-D immunoglobulin, and unrecognised sensitising events, such as occult fetomaternal haemorrhage during the third trimester of pregnancy. We conducted a retrospective study to determine the likely factors that contributed to RhD sensitisation in a consecutive series of 147 cases that occurred during the period 1988 to 1991. Ethics committee approval was obtained before undertaking this study. METHODSAt the outset the criteria to be measured were identified, including: 1. the identification of potential immunising events outlined in local and National 0

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“…(1994) recommended that a more reliable test was needed to replace the 35‐year‐old Kleihauer test. However, Love & Shwe (1994) emphasized that rigorous quality assurance and standardization were the key to improving the clinical utility of this deceptively simple test.…”

Section: Discussionmentioning

confidence: 99%

A modified Kleihauer technique for the quantification of foetomaternal haemorrhage

Howarth

Robinson

Williams

et al. 2002

Transfusion Medicine

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The Kleihauer technique, based on acid elution of maternal red cells, is the mostly widely used technique in the UK to screen for, and estimate the volume of, foetomaternal haemorrhage (FMH) and for determining the need for additional doses of anti-D immunoglobulin to prevent maternal alloimmunization. However, technicians often report difficulties in identifying and accurately counting maternal red cells in the blood film, leading to imprecision in the calculated FMH. In this report, we describe a simple modification of the standard Kleihauer technique, based on performing acid elution of only half of the film. Compared to the standard method, the modified technique showed improved accuracy and reduced interobserver variability across a range of simulated FMH volumes. There was a high degree of correlation between the new technique and FMH estimated by flow cytometry (r2 = 0.916, P < 0.001). Technicians found the new technique easy to incorporate into routine practice in a busy teaching hospital laboratory and were impressed by the relative ease of counting maternal ghost cells. The modified technique has been used routinely in our laboratory for 3 years, during which time our performance in the UK National External Quality Assurance Scheme for FMH has been uniformly satisfactory.

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Kleihauer testing Need not be abandoned

Cited by 5 publications

References 2 publications

A quality assurance scheme for the Kleihauer test: the Scottish experience 1988–1996

A quality assurance scheme for the Kleihauer test: the Scottish experience 1988–1996

An audit of anti‐D sensitisation in Yorkshire

A modified Kleihauer technique for the quantification of foetomaternal haemorrhage

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