Fetal–Maternal Hemorrhage Detected by Sudden Disappearance of Rh Immune Globulin–Related Anti-D

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Fetal–maternal hemorrhage is usually spontaneous and goes undetected but can be associated with adverse perinatal outcomes.


We describe the detection of a fetal–maternal hemorrhage by abrupt disappearance of prophylactic anti-D on antibody screen in an Rh-negative mother with dichorionic twins admitted for atrial flutter of one twin. Both rosette and Kleihauer-Betke tests were positive. The diagnosis was confirmed by anemia in one twin at birth.


Fetal–maternal hemorrhage requires a high index of suspicion for diagnosis. An unexpected sudden decline in Rh immune globulin–related anti-D may be an indication of fetal–maternal hemorrhage.

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