| Massive fetomaternal hemorrhage: clearance of fetal red blood cells after intravenous anti-D prophylaxis monitored by flow cytometry. | |
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MedLine Citation:
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PMID: 18482192 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The clearance of D+ red blood cells (RBCs) from the circulation in D- individuals mediated by passively administered anti-D occurs by opsonization with the antibody and subsequent removal in the spleen. Few data exist on the kinetics of clearance of large volumes of D+ RBCs from the maternal circulation by anti-D in clinical cases of massive fetomaternal hemorrhage (FMH). CASE REPORT: A 33-year-old D- woman delivered a D+ female infant by emergency cesarean section for suspected fetal anemia. A massive FMH, initially estimated to be approximately 142 mL of RBCs, was found. In addition to the standard dose of intramuscular (IM) anti-D (300 microg) given immediately after delivery, 2700 microg of anti-D was administered intravenously (IV). The clearance of D+ fetal cells from the maternal circulation was monitored by flow cytometry in samples obtained on a daily basis using anti-D. The mother had no detectable anti-D 6 months after delivery. RESULTS: No clearance of fetal cells was apparent after the insufficient dose of IM anti-D. The IV administration of anti-D caused accelerated clearance of D+ fetal RBCs with a t1/2 of 24.5 hours. D+ reticulocytes comprised 4.2 percent of all D+ cells in the maternal circulation at delivery suggesting acute fetal blood loss. CONCLUSIONS: The approach used in this report allowed a detailed analysis of the kinetics related to the clearance of fetal D+ RBCs. Simultaneous measurements of fetal reticulocytes and fetal RBCs in maternal blood may establish the timing of an FMH. |
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Authors:
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Rune Larsen; Adela Berkowicz; Thea Lousen; Morten Hedegaard; Frederik B Clausen; Grethe R Krog; Morten H Dziegiel |
Publication Detail:
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Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't Date: 2008-05-14 |
Journal Detail:
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Title: Transfusion Volume: 48 ISSN: 0041-1132 ISO Abbreviation: Transfusion Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-08-20 Completed Date: 2008-09-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417360 Medline TA: Transfusion Country: United States |
Other Details:
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Languages: eng Pagination: 1707-12 Citation Subset: IM |
Affiliation:
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Department of Clinical Immunology, University Hospital of Copenhagen (Rigshospitalet), Copenhagen, Denmark. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cesarean Section Erythroblastosis, Fetal / blood, immunology Female Fetal Blood / cytology* Fetomaternal Transfusion / blood*, immunology* Flow Cytometry / methods* Humans Infant, Newborn Injections, Intravenous Isoantibodies / administration & dosage*, blood, immunology Pregnancy Pregnancy Outcome Reticulocytes / cytology Spleen / cytology |
| Chemical | |
Reg. No./Substance:
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0/Isoantibodies; 0/RHO(D) antibody |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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