Fetomaternal Hemorrhage: Can We Use Hemoglobin Electrophoresis as a
                    Diagnostic Tool?

Zana Stanic; Lada Stanisic; Rajko Fureš; Zoran Persec; Kresimir Dapic; Zlatko Hrgovic

doi:10.1055/a-1041-3443

Zeitschrift für Geburtshilfe und Neonatologie, Table of Contents

Z Geburtshilfe Neonatol 2020; 224(03): 150-152
DOI: 10.1055/a-1041-3443

Case Report

Fetomaternal Hemorrhage: Can We Use Hemoglobin Electrophoresis as a Diagnostic Tool?

Zana Stanic

¹Obstetric and gynecology clinic, University Hospital Center Split Križine, Split, Croatia

,

Lada Stanisic

²Department of Medical Laboratory Diagnosis, University Hospital Center Split Križine, Split, Croatia

,

Rajko Fureš

³Department of Gynecology and Obstetrics, Zabok General Hospital, Zabok, Croatia

,

Zoran Persec

⁴Urology department, University Hospital Dubrava, Zagreb, Croatia

,

Kresimir Dapic

⁴Urology department, University Hospital Dubrava, Zagreb, Croatia

,

Zlatko Hrgovic

⁵Gynekology, J.W.Goethe University, Frankfurt

› Author Affiliations

Abstract

Fetomaternal hemorrhage (FMH) is usually detected by either the Kleihauer-Betke (KB) test or by 2 cytometry, the latter of which represents the gold standard of FMH diagnosis today. But what do we do when neither method is available? We present two cases of suspected FMH due to their characteristic signs and symptoms that were ultimately confirmed by hemoglobin electrophoresis (HE).

Keywords

Fetomaternal hemorrhage - Hemoglobin capillary electrophoresis - Fetomaternal transfusion

Full Text

References

References
1 Stefanovic V. Fetomaternal hemorrhage complicated pregnancy: risks, identification, and management. Curr Opin Obstet Gynecol 2016; 28: 86-94
2 Fernandes BJ, von Dadelszen P, Fazal I. et al. Flow cytometric assessment of feto-maternal hemorrhage; a comparison with Betke-Kleihauer. Prenat Diagn 2007; 27: 641-643
3 Fliegner JR, Fortune DW, Barrie JU. Occult fetomaternal haemorrhage as a cause of fetal mortality and morbidity. Aust N Z J Obstet Gynaecol 1987; 27: 158-161
4 Fay RA. Feto-maternal haemorrhage as a cause of fetal morbidity and mortality. Br J Obstet Gynaecol 1983; 90: 443-446
5 Kim YA, Makar RS. Detection of fetomaternal hemorrhage. Am J Hematol 2012; 87: 417-423
6 Pelikan DM, Scherjon SA, Mesker WE. et al. Quantification of fetomaternal hemorrhage: a comparative study of the manual and automated microscopic Kleihauer-Betke tests and flow cytometry in clinical samples. Am J Obstet Gynecol 2004; 191: 551-557
7 Kennedy GA, Shaw R, Just S. et al. Quantification of feto-maternal haemorrhage (FMH) by flow cytometry: anti-fetal haemoglobin labelling potentially underestimates massive FMH in comparison to labelling with anti-D. Transfus Med 2003; 13: 25-33
8 Katiyar R, Kriplani A, Agarwal N. et al. Detection of fetomaternal hemorrhage following chorionic villus sampling by Kleihauer Betke test and rise in maternal serum alpha feto protein. Prenat Diagn 2007; 27: 139-142
9 Greene DN, Pyle AL, Chang JS. et al. Comparison of Sebia Capillarys Flex capillary electrophoresis with the BioRad Variant II high pressure liquid chromatography in the evaluation of hemoglobinopathies. Clin Chim Acta 2012; 413: 1232-1238
10 Ramautar R. Capillary electrophoresis-mass spectrometry for clinical metabolomics. Adv Clin Chem 2016; 74: 1-34
11 Othman J, Orellana D, Chen LS. et al. The presence of F cells with a fetal phenotype in adults with hemoglobinopathies limits the utility of flow cytometry for quantitation of fetomaternal hemorrhage. Cytometry B Clin Cytom 2018; 94: 695-698