A standard dose of 300 micrograms of anti-D, enough to equalize a 30 ml fetal-maternal hemorrhage, is given after vaginal and operative deliveries unless Rosette/Kleihauer-Betke testing indicates an increased fetal-maternal hemorrhage. Our objective was to determine the incidence during the previous year in which routine Rosette/Kleihauer-Betke testing indicated a fetal-maternal hemorrhage greater than 30 ml of fetal blood.METHODS:
We reviewed the 2016 blood bank results for women delivering at a major Academic Perinatal Center. In routine fashion, cord blood from Rh negative women was collected at delivery. If the newborn was Rh positive, a Rosette test was performed, and if positive, this was followed by a Kleihauer-Betke to determine the quantity of anti-D required.RESULTS:
There were 180 Rh negative women with Rh positive newborns. 106 women had spontaneous vaginal delivery, 65 cesarean delivery, 7 VBAC, and 2 instrumental vaginal delivery. Rosette tests performed on all 180. Of these, 166 (92.2%) were negative, 7 (3.9%) were positive, and 7 (3.9%) were invalid. Kleihauer-Betke test was performed on the 14 positive and invalid samples, all of which were negative. We were unable to demonstrate any case in which more than the standard 300 mcg dose of anti-D was required.CONCLUSION:
In this study, the Rosette/Kleihauer-Betke model was found to be unnecessary, as there were no cases in which the fetal-maternal hemorrhage exceeded 30 ml. We anticipate extending this review for several years and if confirmed, could alter the way blood banks manage this common clinical situation, saving thousands of dollars in unneeded testing. We suggest that Rosette/Kleihauer-Betke testing be reserved for those clinical situations in which an increased fetal-maternal hemorrhage is suspected.