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Massive antenatal fetomaternal hemorrhage: evidence for long‐term survival of fetal red blood cells
Author(s) -
Dziegiel Morten H.,
Koldkjær Ole,
Berkowicz Adela
Publication year - 2005
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.0041-1132.2005.04262.x
Subject(s) - fetus , medicine , fetal hemoglobin , pregnancy , abo blood group system , anemia , obstetrics , preeclampsia , fetal circulation , rh isoimmunization , hemoglobin , andrology , placenta , immunology , biology , genetics
BACKGROUND: Massive fetomaternal hemorrhage (FMH) can lead to life‐threatening anemia. Quantification based on flow cytometry with anti‐hemoglobin F (HbF) is applicable in all cases but underestimation of large fetal bleeds has been reported. A large FMH from an ABO‐compatible fetus allows an estimation of the life span of fetal red blood cells (RBCs) in the maternal circulation. CASE REPORT: The mother went to the obstetrician twice antepartum owing to symptoms assumed to be preeclampsia; that, however, was not found. She later delivered by cesarean section owing to diminished fetal movements. No fetal weight gain was observed during the last 2 weeks of pregnancy. STUDY DESIGN AND METHODS: Fetal RBCs were quantified by flow cytometry with anti‐HbF, anti‐Fy a , anti‐s, and anti‐Jk b on a regular basis. RESULTS: The infant had anemia at delivery and an FMH was determined to be 314 ± 17 mL (± SD) of whole blood. It is assumed that the two antenatal visits were associated with the FMH. Postpartum follow‐up showed that fetal RBCs in the maternal circulation were detectable with anti‐HbF up to 119 days. Quantification by flow cytometry based on anti‐HbF was in agreement with quantification based on anti‐Fy a , anti‐s, and anti‐Jk b , although they were less sensitive. CONCLUSION: ABO‐compatible fetal RBCs from an FMH had a life span in the maternal circulation close to that of adult RBCs.