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BB305

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    blood banker

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  1. It is my understanding that KB test alone can only tell you if there are fetal cells circulating in the mom and the percentage. It does not tell these circulating fetal cells are Rh- or Rh+. If fetal is Rh-, no matter how many fetal cells circulating, the mom is not indicated for RhoIg. Therefore, KB test itself almost has no role to play in administration of RhoIg, assuming fetal Rh status is unknown. Some may argue that, considering almost 85% population is Rh pos, even though fetal Rh unknown, it may be statistically safe to assume the fetal is Rh+ and just give the RhoIg based on the KB result. Well, it is really a hard sell, especially when there is alternative way to proceed. I will say, in the case of fetal Rh unknown, especially for prenatal mom at ER, first we do fetal screen. If neg, at least you are sure that, regardless the fetal Rh+or -, one shot is enough. if fetal screen is pos, you will automatically give one shot first, then rely on the KB result to determine how many extra shots to give with confidence, because you know the fetal is Rh+ based on post fetal screen result. The positive fetal screen tells you the fetal is Rh+, for sure, assuming mom DAT is negative (otherwise may cause false pos fetal screen). Therefore I recommend the combination of fetal screen and KB test. Whether to do KB test depends on the fetal screen result first. I still do not understand what is the reason to let Ortho limit fetal screen kit in the postpartum with known Rh of newborn (Rh+, based on Cord or heelstick grouping test)and the mom (Rh-) in its product insert.
  2. I agreed. But I did not understand why Ortho in its insert only limits its use for the postpartum.
  3. Ortho Fetal Screen kit can be used to detect the status of fetal cells (Rh +) circulating in mom’s body to decide if one dose RhoIg is sufficient or not for post-delivery mom(Rh-, no known allo anti-D). Some hospitals use this kit exclusively for the post-delivery mom, but some hospitals also use it for the pregnant patients with spotty bleeding or trauma/fall/car accident at the emergency department. In the latter case, the fetus Rh is unknown. If you read Orth insert, it only mentions that this screen kid valid for the postpartum sample with known Rh status of newborn (Rh +) and mom (Rh-). So that means the hospitals cannot use it to screen antepartum hemorrhage samples on RH- patient? If not, how can we know, with confident, that one shot RhoIg sufficient for these antepartum patients with bleeding or trauma? Even though we may think about Kleihauer–Betke test, but it did not tell you the circulating fetal cells, if K-B test positive, are Rh + or -.
  4. Welcome to the forums BB305 :)

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