FLOW-CYTOMETRY IN DIAGNOSIS AND MANAGEMENT OF LARGE FETOMATERNAL HEMORRHAGE

Aims-To evaluate an indirect immunofluorescence flow cytometry techniq ue in a series of patients with large fetomaternal haemorrhage (FMH). Methods-Patient samples identified by Kleihauer testing in local labor atories as having FMH > 4 ml were sent for flow cytometric analysis. I n a proportion of cases the mothers received anti-D immunoglobulin pro phylaxis according to the flow cytometer estimate of FMH volume. Resul ts-Forty three cases of FMH were studied prospectively. The correlatio n between Kleihauer and flow cytometry results was poor. In 38 (88%) c ases the size of FMH quantitated by flow cytometry was lower than that estimated using the Kleihauer technique. In 13 (30%) cases no Rh D im munoglobulin positive cells were detected by flow cytometry. Centralis ed review of the original Kleihauer films using a calibrated microscop e resulted in improved, but still suboptimal correlation with flow cyt ometry results. In 15 cases anti-D immunoglobulin was given according to the how cytometer estimation of FMH size, resulting in a 58% reduct ion in the amount of anti-D immunoglobulin given. None of the patients were immunised when tested six months later. Conclusions-Flow cytomet ry is helpful for the accurate quantitation and management of patients with large FMH and in cases where the presence of maternal haemoglobi n F containing cells renders the Kleihauer technique inaccurate. Worth while reductions in the use of anti-D immunoglobulin can be achieved.