The Importance of Postpartum Kleihauer-Betke Test in Low Risk Rh-Incompatible Pregnant Population

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Bilgili, Ümmühan Zeynep
Gül, Ayşe Zehra
Kütük, Mehmet Serdar
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Introduction: Prevalence of Rh disease is estimated to be 276 per 100,000 live births, which is significant considering its relationship with conditions like fetal anemia, hydrops fetalis, fetal death and recurrent fetal demises in future pregnancies. In order to prevent these, anti-D immunoglobulin should be given after inciting events, in a dose sufficient. In Turkey and some other countries, anti-D dose is given on -one shot fits for all- principle. Here, we challenge the conventional wisdom and evaluate the amount of fetomaternal hemorrhage (FMH) and adjusted the dose of anti-D accordingly. Method: In our study, Rh incompatible women who gave birth between October 2020 and March 2021 were included. FMH was determined by the Kleihauer-Betke test in the blood sample taken from the mothers after delivery. Blood smears were fixed with ethyl alcohol and incubated in citric acid buffer solution. In acid medium, HbF becomes resistant to elution, while other types are removed from erythrocytes. The smears are then taken under a microscope to examine the percentage of cells containing fetal hemoglobin. We used Oski-Naiman method to count fetal cells present, then estimated FMH using Mollison-s formula. Clinical data were available at hospital-s digital system. Results: Seventy patients got tested during study period. Twenty-five (39.6%) of cases had more than 4 mL of FMH. Among them, one (1.6%) case was found to have more than 30 mL of FMH, and was given an additional dose. This case had no obstetrical risk factor such as antepartum bleeding, preeclampsia, or manual removal of placenta. The rate of smoking was significantly higher in cases with more than 4 mL of FMH (p=0.001). There were no other variables differed significantly in women having more than 4 mL of FMH. Conclusion: FMH requiring more than 300 mcg of anti-D is significantly high in low-risk pregnant women in Turkey. Implementation of quantitative FMH testing with Kleihauer-Betke or flow cytometry test is necessary. Key words: Fetomaternal hemorrhage, Rh incompatibility
Bilgili Ü. Z. , Gül A. Z. , Kütük M. S. , -The Importance of Postpartum Kleihauer-Betke Test in Low Risk Rh-Incompatible Pregnant Population-, Bezmialem Science, cilt.9, ss.1-2, 2021
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